No-Fault Case Law

The case involved a dispute between healthcare providers and an insurance company over first-party no-fault benefits that had been assigned to the providers. The insurance company had timely denied the claims based on the assignor's eligibility for workers' compensation benefits, and argued that the matter should be submitted to the Workers' Compensation Board due to the issue of whether the assignor had been injured during the course of employment. The trial court found that there were mixed questions of law and fact regarding the availability of workers' compensation benefits, and held the action in abeyance pending a determination by the Workers' Compensation Board. The appellate court affirmed the decision of the trial court, holding that the healthcare providers did not demonstrate that a proper application for workers' compensation benefits had been made within the time provisions set forth in the court's order, and therefore affirmed the dismissal of the remaining claims asserted in the complaint. In summary, the main issues decided were whether the healthcare providers had made a proper application for workers' compensation benefits within the given time frame, and whether the claims asserted in the complaint should be dismissed. The holding was that the trial court's decision to hold the action in abeyance and subsequently dismiss the remaining claims was affirmed.

The main issues in this case were whether the New York City Civil Court had personal jurisdiction over the defendant, and whether the Michigan declaratory judgment had a collateral estoppel effect in New York. The court considered the defendant's contention that the Civil Court lacked jurisdiction over it, as the defendant is a Michigan insurance company and had not conducted any business in New York, delivered contracts of insurance to residents of New York, or provided goods or services in New York. The court also considered the plaintiff's argument that the defendant had failed to establish that the Civil Court lacked jurisdiction. The holding of the court was that the defendant demonstrated its entitlement to summary judgment dismissing the complaint for lack of jurisdiction, as it had not done any of the acts necessary to fall under the Civil Court's long-arm jurisdiction. Additionally, the court determined that the defendant's failure to submit a certificate of conformity was not a fatal error. Therefore, the order granting the defendant's motion for summary judgment was affirmed.

The case involved a dispute over first-party no-fault benefits for medical services rendered after a motor vehicle collision. The main issue before the court was whether the collision was intentionally caused, which would impact the insurance coverage. The court considered the testimony of a witness from the defendant's Special Investigation Unit and found that it was relevant to the defense that there was no coverage due to the alleged injuries not arising from an insured incident. The jury unanimously returned a verdict in favor of the defendant, finding that the collision was the result of an intentionally caused event. The court affirmed the judgment, finding that the evidence presented at trial supported the jury's finding and that the motions for judgment as a matter of law and for a new trial were properly denied.

The relevant facts considered in this case were that Elmont Open MRI & Diagnostic Radiology, P.C. was seeking to recover assigned first-party no-fault benefits from New York Central Mutual Fire Ins. Co. The main issue decided was whether the trial court properly denied the defendant's motion for summary judgment dismissing the complaint and whether the trial court properly granted summary judgment to the plaintiff. The holding of the court was that while the trial court properly denied the defendant's motion for summary judgment dismissing the complaint, it improperly granted summary judgment to the plaintiff, as there was a triable issue of fact as to whether verification is outstanding. Therefore, the order was modified by striking the provision which, upon a search of the record, granted summary judgment to the plaintiff. Overall, the order was affirmed with modifications.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, that denied the defendant's cross motion to dismiss the complaint on the grounds that it had been served late. The main issue decided was whether the defendant's cross motion was timely pursuant to a so-ordered stipulation setting forth the dates by which any cross motion had to be served. The holding of the court was that the Civil Court erred in failing to consider the defendant's cross motion, as it was timely served according to the stipulation. Therefore, the matter was remitted to the Civil Court for a determination of the merits of the defendant's cross motion to dismiss the complaint pursuant to CPLR 3211 (a) (5). The decision was concurred by Weston, J.P., Pesce and Aliotta, JJ.

The court considered the issue of whether there must be a connection between an independent medical examination (IME) that a claimant fails to attend and the treatment in question for the failure to attend the IME to serve as a basis for denying a no-fault claim and dismissing this action. Boulevard Multispec Medical, P.C. sues as assignee of Phillip Sansone to recover first-party no-fault benefits for a functional capacity evaluation performed on March 11, 2013 and chiropractic and physical therapy treatment provided to Sansone on March 1 and March 8, 2013. Defendant Tri-State timely denied all three claims on the grounds that the treatment was not medically necessary based upon the IME report. Prior to the dates of the treatment in question, Tri-State had requested Sansone appear for an IME to be performed by a psychiatrist. The main issue was centered around the connection between an IME that the claimant failed to attend and the treatment in question in order for the denial of the claim to be justified, and whether or not a lack of appearance at an IME by the injured party would provide a basis for the denial of the claim. The court held that there must be some relationship between the IME for which the injured party failed to appear and the treatment in question for the failure to attend the IME to serve as a basis for denying a no-fault claim. In this case, as there was no evidence that the treatment in question was related to the IME that Sansone failed to attend, the denial of the claim by Tri-State was denied.

The court considered the fact that Sunrise Acupuncture PC, seeking recovery of assigned first-party no-fault benefits, appealed from an order of the Civil Court of the City of New York, which granted defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant's motion for summary judgment should be granted, and the court held that the action is not ripe for summary dismissal. The court found that triable issues remain with respect to the claims denied outright by defendant on the stated basis that the CPT codes billed under were "outside the scope of the provider's specialty," and that the defendant's failure to meet its evidentiary burden mandates the denial of its motion, regardless of the sufficiency of the opposing papers. Therefore, the court reversed the order, denied defendant's motion for summary judgment, and reinstated the complaint.

The case involved a dispute between a provider seeking to recover first-party no-fault benefits and an insurance company. The insurance company moved for summary judgment to dismiss the complaint, while the provider made a cross-motion for summary judgment. The Civil Court denied the insurance company's motion as untimely, but granted the provider's cross-motion, which was made several months after the deadline. The main issue was whether the Civil Court properly considered the provider's untimely cross-motion for summary judgment without a showing of good cause for the delay. The holding of the case was that the Civil Court should not have considered the provider's untimely cross-motion, as the deadline for summary judgment motions set by CPLR 3212(a) is strictly enforced, and the absence of an objection does not constitute good cause to consider an otherwise untimely motion. Therefore, the order was reversed, and the provider's cross-motion for summary judgment was denied.

The main issue in this case was whether the defendant, Allstate Insurance Company, had failed to establish the lack of medical necessity of the diagnostic testing giving rise to the plaintiff's claim for assigned first-party no-fault benefits. The trial court found in favor of the plaintiff, Webster Ave Medical Pavilion, PC, awarding it damages in the principal sum of $3,045.08. The Appellate Term, First Department affirmed the trial court's judgment, agreeing that the defendant had not met its evidentiary burden and failed to establish the lack of medical necessity. The court also noted that the defendant's medical expert's sparse and confusing opinion testimony, which reflected a lack of knowledge as to the assignor's medical condition at the time of testing, was insufficient. As a result, the judgment in favor of the plaintiff was upheld.

The relevant facts considered by the court were that the plaintiff, Clinton Place Medical, P.C., was seeking first-party no-fault benefits from defendant New York Central Mutual Fire Insurance Company. The defendant had denied the claim based on the assignor's failure to appear for independent medical examinations (IMEs), and had timely denied the claim forms. The main issues decided by the court were whether the defendant had met the conditions for its liability on the policy by timely mailing IME scheduling letters and denying claim forms, and whether the failure to appear for IMEs by the assignor would preclude the defendant's liability if the claims had been timely denied. The holding of the court was that the defendant's motion for summary judgment dismissing the plaintiff's first through fourth causes of action was granted, as defendant had met the conditions precedent to its liability. However, the branches of defendant's motion seeking summary judgment dismissing the fifth through ninth causes of action were properly denied, as it had not been established that these claims had been timely denied.