No-Fault Case Law

The court considered the denial of plaintiff's motion for summary judgment and the denial of defendant's cross motion for summary judgment. The main issue decided was the medical necessity of the services at issue in the action to recover first-party no-fault benefits. The court held that in this case, the provider had not rebutted the defendant's prima facie showing that there was no medical necessity for the services at issue, and therefore granted the defendant's cross motion for summary judgment dismissing the complaint. The appellate court reversed the lower court's order and granted the defendant's cross motion for summary judgment, with costs.

The court considered the dispute between ABA Chiropractic, P.C. and GEICO General Insurance Company regarding the medical necessity of services provided by the plaintiff to Yolanda Rivera. The main issue decided was whether the services at issue were medically necessary, as defendant argued they were not. The holding of the court was that there was a triable issue of fact regarding the medical necessity of the services, reversing the order granting defendant's cross motion for summary judgment and denying defendant's motion for summary judgment dismissing the complaint. The court also declined plaintiff's request to limit the issues for trial.

The relevant facts of this case involve a medical provider seeking to recover first-party no-fault benefits from an insurance company. The insurance company had moved for summary judgment dismissing the complaint, arguing that the medical provider's assignor had failed to appear for duly scheduled examinations under oath (EUOs). The Civil Court had denied the insurance company's motion and granted the medical provider's cross motion for summary judgment on certain claims. On appeal, the insurance company argued that it had timely and properly denied the claims at issue due to the assignor's failure to appear for the EUOs. The Appellate Term found that the insurance company had demonstrated that it had timely denied certain claims on this ground, and therefore, the branches of the insurance company's motion seeking summary judgment dismissing those claims were granted. The main issue in this case was whether the insurance company had properly denied the medical provider's claims on the ground that the assignor had failed to appear for the EUOs. The holding of the case was that the insurance company demonstrated that it had timely and properly denied certain claims on this basis, and therefore, the branches of the insurance company's motion seeking summary judgment dismissing those claims were granted. The order of the Civil Court was modified to reflect this decision.

The court considered the facts of a provider seeking payment for assigned first-party no-fault benefits and an insurance company's denial of the claim due to the plaintiff's assignor's failure to appear for scheduled independent medical examinations (IMEs). The main issue decided was whether the insurance company had established its entitlement to summary judgment dismissing the complaint. The court held that the insurance company had indeed established its entitlement to summary judgment, as it had submitted sufficient evidence to demonstrate that the IME requests had been timely mailed, and that the plaintiff's assignor had failed to appear for the scheduled IMEs. Therefore, the court reversed the lower court's decision and granted the insurance company's cross motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in this case were that Alev Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits, and Praetorian Insurance Company had denied the claims on the grounds of lack of medical necessity for the medical supplies. The main issue decided was whether the denial of claim forms at issue had been timely mailed and whether there was a medical necessity for the medical supplies. The holding of the case was that the court reversed the order of the Civil Court, granting defendant's motion for summary judgment dismissing the complaint, as defendant had timely denied the claims and submitted a sworn peer review report providing medical rationale for the determination of lack of medical necessity. The court found that plaintiff's opposition failed to meaningfully refer to or rebut the conclusions set forth in the peer review report, and therefore the defendant's motion for summary judgment dismissing the complaint was granted.

The court considered the fact that in an action by a provider to recover assigned first-party no-fault benefits, the plaintiff had moved for summary judgment and the defendant had cross-moved for summary judgment dismissing the complaint. The Civil Court denied both motions, finding that the plaintiff had established its prima facie entitlement to summary judgment, but the only issue for trial was the no-show of the assignor at the independent medical examinations (IMEs). The defendant submitted an affidavit by the healthcare professional retained to perform the IMEs which established that the plaintiff's assignor had failed to appear at the IMEs. As appearing at an IME is a condition precedent to an insurer's liability on a policy and the plaintiff did not challenge the Civil Court's finding, the defendant's cross motion for summary judgment dismissing the complaint was granted. The main issue decided was that the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's assignor's failure to appear for IMEs, and the holding of the case was that the defendant's cross-motion for summary judgment dismissing the complaint was granted.

The court considered the denial of the defendant's motion for summary judgment in a case where a provider sought to recover assigned first-party no-fault benefits. The only issue for trial was the medical necessity of the supplies at issue. The main issue before the court was whether there was a triable issue of fact regarding the medical necessity of the supplies. The court held that the defendant's motion for summary judgment dismissing the complaint should be granted, as the plaintiff failed to meaningfully rebut the conclusions set forth in the peer review report submitted by the defendant. Therefore, the defendant was entitled to judgment, and the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in this case were that Ortho Products & Equipment, Inc. was seeking to recover assigned first-party no-fault benefits from Interboro Ins. Co. upon the claims assigned to them by Daniel Robinson and Bradley Forbes. Interboro Ins. Co. had timely denied the claims, citing the failure of the assignors to appear for examinations under oath (EUOs). The main issue decided by the court was whether the failure of the assignors to appear for the scheduled EUOs was sufficient grounds for Interboro Ins. Co. to deny the claims. The holding of the court was that Interboro Ins. Co. had established the failure of the assignors to attend the EUOs, and that their appearance at an EUO was a condition precedent to the insurer's liability on a policy. Therefore, the court granted the branches of Interboro Ins. Co.'s motion seeking summary judgment dismissing the claims assigned to Ortho Products & Equipment, Inc. by Daniel Robinson and Bradley Forbes.

The main issue in this case was whether a provider could recover first-party no-fault benefits from an insurance company. The court considered the defendant's motion to compel the plaintiff to produce individuals for examinations before trial regarding the plaintiff's treatment and billing practices. The court also considered the plaintiff's cross motion for summary judgment. The court ultimately held that the defendant's motion to compel the plaintiff to produce individuals for exams before trial was granted to the extent of compelling the plaintiff to produce individuals solely with respect to the issue of the plaintiff's billing practices. Additionally, the court held that the plaintiff's cross motion for summary judgment was denied for certain claims but granted for others.

The main issues decided in this case were whether the plaintiff, a health service provider, had established its entitlement to no-fault reimbursement and whether the defendant insurance company's request for an examination under oath (EUO) was reasonable. The court found that the plaintiff failed to establish its entitlement to reimbursement and that the defendant's request for the EUO was reasonable. The court also found that the plaintiff had failed to comply with a condition precedent to coverage, voiding the policy contract ab initio. As a result, the plaintiff's application seeking summary judgment was denied and the defendant's application seeking summary judgment against the plaintiff was granted, leading to the dismissal of the case.