No-Fault Case Law

The court considered the fact that in an action to recover assigned first-party no-fault benefits, the case was marked off the trial calendar in August 2010, and in September 2011, the defendant moved to dismiss the complaint based on the claim that the plaintiff had abandoned the case by failing to move to restore it to the trial calendar within one year after it was stricken. The defendant also moved to dismiss the complaint because the plaintiff failed to provide requested disclosure. The main issues decided were whether the Civil Court erred in dismissing the complaint as abandoned under the Civil Court rule, and whether the matter should be remitted to the Civil Court for a determination of the branch of defendant's motion seeking dismissal of the complaint pursuant to CPLR 3126. The holding of the case was that the Civil Court erred in dismissing the complaint as abandoned, and the matter was remitted to the Civil Court for a determination of the branch of defendant's motion seeking dismissal of the complaint pursuant to CPLR 3126.

The main issues in this case were whether the defendant's motion to vacate a judgment and for leave to renew and reargue its cross motion for summary judgment should be granted, and whether the submission of a notarized affidavit constituted new evidence sufficient to support a motion for leave to renew. The court considered the facts of the case, including the denial of defendant's cross motion and the subsequent judgment in favor of the plaintiff. The holding of the court was that the defendant's motion to vacate the judgment and for leave to renew and reargue its cross motion should be denied, as the defendant failed to set forth a reasonable justification for its initial failure to submit a properly sworn affidavit. The court also found that the branch of the defendant's motion seeking leave to reargue its cross motion and its opposition to plaintiff's motion was untimely, and therefore affirmed the order of the Civil Court denying defendant's motion.

The court considered the fact that the defendant, a Georgia-based insurance company, argued that the court lacked personal jurisdiction over it in New York. The plaintiff, a healthcare provider, argued that there may be an agent of the defendant operating in New York and that discovery was needed to determine this. The main issue decided was whether the Civil Court had personal jurisdiction over the defendant. The court held that the defendant had not conducted any of the enumerated acts within New York City to bring it within the court's long-arm jurisdiction, and the plaintiff failed to establish that necessary facts were not available to it, warranting discovery. Therefore, the defendant's motion to dismiss the complaint was properly granted.

The relevant facts considered by the court were that a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company argued that the action was premature because the provider had failed to provide requested documentary verification. The insurance company demonstrated that it had timely requested verification from the provider and that the provider had not responded to these requests. The main issue decided by the court was whether the action by the provider to recover benefits was premature due to the lack of response to verification requests. The holding of the case was that the court reversed the prior determination, denying the provider's motion for summary judgment and granting the insurance company's cross motion for summary judgment dismissing the complaint. Therefore, the complaint was deemed to be premature due to the lack of response to verification requests.

The main issue in this case was whether the defendant, Praetorian Insurance Company, was entitled to summary judgment dismissing the complaint brought by the plaintiff, American Chiropractic Care, P.C., seeking to recover assigned first-party no-fault benefits. The defendant had timely mailed denial of claim forms based on lack of medical necessity and provided a sworn peer review report by their chiropractor to support their determination. The court found that the defendant had established its prima facie entitlement to summary judgment. However, the plaintiff submitted a sworn letter of medical necessity by its treating chiropractor, which created a question of fact as to medical necessity. As a result, the court affirmed the order denying the defendant's motion for summary judgment, without costs.

The court considered the fact that in this action by a provider to recover assigned first-party no-fault benefits, a nonjury trial was held, at which plaintiff's witness was the sole witness. Plaintiff attempted to move into evidence certain documents, including an NF-10 denial of claim form and a mailing log, but the court refused to admit those documents. After the trial, the complaint was dismissed on the ground that plaintiff had failed to establish a prima facie case. The main issue decided was whether plaintiff should have been allowed to use the denial of claim form as an admission by the defendant that the claim form had been received. The holding of the case was that the matter was remitted to the Civil Court for the entry of judgment in favor of plaintiff in the principal sum of $918.75, plus statutory interest and attorney's fees due pursuant to Insurance Law § 5106 (a) and the regulations promulgated thereunder, as plaintiff proved that defendant had not paid the claim and as defendant consented to the admission into evidence of plaintiff's claim form.

The main issues decided in this case were whether the plaintiff's assignor was eligible for workers' compensation benefits and if those benefits might be available. The court held both motions for summary judgment in abeyance until an application could be made to the Workers' Compensation Board to determine the parties' rights under the Workers' Compensation Law. The court determined that there was sufficient evidence to support the contention that the plaintiff's assignor may have been acting in the course of his employment at the time of the accident, and thus workers' compensation benefits might be available. The court also found that defendant's failure to submit certificates of conformity was not a fatal error. Therefore, the order of the Civil Court was affirmed.

The relevant facts considered by the court in this case were that the defendant insurance company denied payment for first-party no-fault benefits to the plaintiff, Stracar Medical Services, for the medical treatment of Inma Villa. The main issue decided by the court was whether the insurance company was entitled to summary judgment dismissing the complaint based on the assignor's failure to appear at scheduled independent medical examinations (IMEs). The holding of the court was that the insurance company demonstrated its entitlement to summary judgment by submitting evidence that the notices scheduling the IMEs were timely and properly mailed, and that the assignor failed to appear at the scheduled IMEs. The court found that the plaintiff did not raise a triable issue with respect to the assignor's nonappearance or the mailing and reasonableness of the notices, and therefore the defendant's motion for summary judgment dismissing the complaint was granted in full.

The case involved an action to recover no-fault benefits under a policy of automobile insurance. The plaintiff appealed from an order denying its motion for summary judgment on the complaint, which was based on the defendant's alleged failure to timely pay or deny the no-fault claim within 30 days. The issue was whether the defendant raised a triable issue of fact regarding its timely denial of the plaintiff's claim. In opposition to the plaintiff's showing of entitlement to judgment as a matter of law, the defendant raised a triable issue of fact as to whether it mailed a proper NF-10 denial of claim form to the plaintiff. The court held that the defendant satisfied its burden by raising a triable issue and affirmed the order denying the plaintiff's motion for summary judgment on the complaint.

The case involves Wyckoff Heights Medical Center as the assignee of Aida Ruiz and Government Employees Insurance Company in an action to recover no-fault benefits under an automobile insurance policy. The Supreme Court, Nassau County granted Wyckoff Height Medical Center's motion for summary judgment on the first cause of action, but the defendant appealed. While the plaintiff showed evidence that the prescribed billing forms were sent to and received by the defendant, the defendant raised a triable issue of fact as to whether it timely and properly denied the claim. The defendant submitted evidence showing that it had mailed a denial of claim form within the required 30-day period, and although there were minor errors on the form, they were not considered fatal. The Supreme Court reversed the original order, denying the plaintiff's motion and holding that the defendant's denial of the claim was not ineffective despite the issues raised by the plaintiff.