No-Fault Case Law

The main issues considered in this case were whether an insurer's motion for summary judgment should be granted in a no-fault benefits case when the plaintiff's assignor failed to appear for scheduled examinations under oath and whether the out-of-state affidavit, which was accompanied by a proper certificate of conformity, should have been considered by the court. The court ultimately decided that the defect in the certificate of conformity was appropriately cured by the defendant submitting a certificate that rectified the defect and that the out-of-state affidavit should have been treated as if it was taken within the state. The court held that since an appearance at an examination under oath is a condition precedent to an insurer's liability on a policy and the defendant established by admissible evidence that the plaintiff's assignor did not comply with this condition, the defendant's motion for summary judgment should have been granted.

The court considered an appeal from an order of the Civil Court of New York, which granted plaintiff's motion for summary judgment and denied defendant's cross motion to dismiss the complaint. The main issue decided by the court was whether the plaintiff had established its prima facie entitlement to summary judgment and whether the defendant had raised a triable issue of fact. The holding of the court was that the plaintiff had indeed established its prima facie entitlement to summary judgment by proof of submission to the defendant of the claim forms and proof that the defendant had failed to pay or deny the claims within the requisite 30-day period. The court also held that the defendant's cross motion to dismiss the complaint was properly denied and the plaintiff's motion for summary judgment was properly granted. Therefore, the judgment was affirmed.

The relevant facts the court considered in this case were that a provider, Compas Medical, P.C., was seeking to recover assigned first-party no-fault benefits from Geico Ins. Co. However, Geico had filed a declaratory judgment action in Supreme Court, Nassau County, alleging that Compas Medical and its assignor were involved in a large-scale illegal scheme involving staged accidents and fraudulent billing practices. Both Compas Medical and its assignor were named as defendants in the declaratory judgment action. The main issue decided by the court was whether to grant defendant's motion to stay the action, pursuant to CPLR 2201, pending a final determination of the declaratory judgment action. The court held that, under the circumstances presented, it was not an improvident exercise of discretion for the Civil Court to grant defendant's motion to stay the action pending the resolution of the Supreme Court declaratory judgment action. Therefore, the order to stay the action was affirmed.

The relevant facts the court considered included a medical provider suing an insurance company to recover assigned first-party no-fault benefits. The insurance company moved for summary judgment to dismiss the complaint, arguing that the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs). They submitted an affidavit from an employee of the medical review services that scheduled the IMEs, as well as an affidavit from the chiropractor/acupuncturist who was supposed to perform the IMEs. Defendant also submitted an affidavit from their claims representative, but it was executed out of state and did not comply with the necessary certification requirements. The main issue decided was whether the insurance company's motion for summary judgment should be granted, and the court held that it should be conditionally granted pending the submission of a proper certificate of conformity for the out-of-state affidavit.

The main issue in this case was whether defendant's motion for summary judgment dismissing the complaint should be granted. The relevant facts considered by the court were that the plaintiff, a provider seeking first-party no-fault benefits, had failed to appear for duly scheduled examinations under oath (EUOs), and the defendant had timely denied the claims at issue based on this failure. The court held that the EUO scheduling letters had been timely mailed and were therefore sufficient to toll the claim determination period, contrary to the plaintiff's argument. Additionally, the court found that the letters submitted by the defendant to delay payment of the claims were also sufficient to toll the 30-day statutory time period within which a claim must be paid or denied. The court also ruled that the affidavit submitted by defendant to prove that the denial of claim forms had been timely mailed should be considered, and the argument raised by plaintiff regarding non-compliance with CPLR 2309 (c) was waived and, therefore, the order to grant defendant's motion for summary judgment dismissing the complaint was affirmed.

This case involves a dispute over assigned first-party no-fault benefits. The plaintiff, Avicenna Medical Arts, P.L.L.C, brought a claim to recover these benefits, and the defendant, GEICO Ins. Co., filed a cross motion for summary judgment dismissing the complaint. The main issue decided by the court was whether the medical services billed by the plaintiff were medically necessary. The court found that the plaintiff had established the submission of the bills and the fact and amount of the loss sustained. The court also found that the defendant was entitled to judgment dismissing so much of the complaint as sought to recover the amount of $1,916.46, as the defendant had submitted a peer review report showing a lack of medical necessity for nerve testing for this amount. However, the court did not find sufficient evidence to dismiss the claim for $590.01 for other testing, as the defendant did not demonstrate that these services were not medically necessary. The holding of the case was that defendant's cross motion for summary judgment to dismiss $1,916.46 was granted, but the rest of the complaint was allowed to proceed.

The relevant facts considered by the court included a dispute over first-party no-fault benefits between Rainbow Supply of NY, Inc. and GEICO General Insurance Company. The main issue decided was the medical necessity of the medical supply in question. The holding of this case was that the appellate court reversed the lower court's decision and granted GEICO General Insurance Company's cross motion for summary judgment dismissing the complaint. The court based its decision on the fact that defendant's prima facie showing was not rebutted by the plaintiff, and that the only issue for trial was the medical necessity of the supply. The court cited previous cases to support their decision.

The court considered the case of Horizon Radiology, P.C. as Assignee of SERGIY ANDRIYEVSKYY v Hereford Insurance Co., a dispute regarding the payment of first-party no-fault benefits. The main issue decided was whether the defendant, Hereford Insurance Co., had established that it had paid the claim at issue, and whether the plaintiff, Horizon Radiology, P.C., had failed to raise a triable issue of fact. The holding of the case was that the judgment of the Civil Court, which granted the defendant's motion for summary judgment dismissing the complaint, was affirmed. The Appellate Term found that the defendant had established prima facie evidence that it had paid the claim at issue, and that the plaintiff had failed to raise a triable issue of fact. As a result, the judgment was affirmed.

The court considered the fact that the defendant denied a claim for first-party no-fault benefits based on the alleged failure of the plaintiff's assignor to appear at scheduled examinations under oath (EUOs), but that the EUO had been rescheduled by mutual agreement prior to the original date. The main issue decided was whether a mutual rescheduling of the EUO prior to the scheduled date constitutes a failure to appear. The holding of the case was that a mutual rescheduling prior to the date of the scheduled EUO does not constitute a failure to appear, and therefore the defendant did not demonstrate that there had been a failure to appear at both an initial and a follow-up EUO, and did not prove that the plaintiff had failed to comply with a condition precedent to coverage. Therefore, the order denying the defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The court considered the cross motion for summary judgment dismissing the complaint, which was denied by the Civil Court. The main issue decided was whether there was medical necessity for the services at issue. The court held that the defendant's cross motion for summary judgment dismissing the complaint was granted based on the sworn peer review report submitted by the defendant, which provided a factual basis and medical rationale for the determination that there was no medical necessity for the services at issue. Since the plaintiff did not rebut the defendant's prima facie showing, the defendant was entitled to judgment.