No-Fault Case Law

The relevant facts the court considered were that the plaintiff's insured's vehicle was struck and damaged by a bicycle allegedly operated by the defendant, which was legally parked on the street in front of her residence. The main issue decided was whether the evidence established defendant's liability for the collision. The holding of the court was that the plaintiff had established its prima facie entitlement to summary judgment on the issue of liability by submitting evidence demonstrating that defendant's bicycle struck plaintiff's subrogor's legally parked vehicle, and the defendant failed to submit competent evidence to rebut the inference of negligence. Therefore, the order granting plaintiff summary judgment on the issue of liability was affirmed.

The main issue in this case was whether the provider was entitled to recover assigned first-party no-fault benefits, specifically focusing on the medical necessity of the services provided. The court denied the plaintiff's motion for summary judgment and made findings in plaintiff's favor, limiting the issues for trial to medical necessity. The defendant failed to provide a sufficient basis to dispute the findings made in plaintiff's favor. Additionally, the court's order did not intend to find that the defendant had issued denials that were untimely or without merit as a matter of law. Ultimately, the court affirmed the order, and the case was directed to go to trial to determine the medical necessity of the services provided by the provider.

The court considered the timing of the denial of the claim form and the submission of the claim by the plaintiff. The main issue decided was whether the defendant's denial of claim form had been timely mailed and whether the plaintiff submitted the claim more than 45 days after the date the services had been rendered. The holding of the court was that the defendant's denial of claim form was timely mailed and the plaintiff had submitted its claim more than 45 days after the services had been rendered. As a result, the court affirmed the order granting the defendant's cross motion for summary judgment dismissing the complaint.

The relevant facts the court considered in this case were that New Way Medical Supply Corp., as the assignee of JESULA ST. VICTOR, was seeking to recover assigned first-party no-fault benefits from Geico Ins. Co. Plaintiff moved for summary judgment, and defendant cross-moved for summary judgment on the basis that the claim was denied due to a lack of medical necessity. The Civil Court denied plaintiff's motion and made findings in plaintiff's favor, denying defendant's cross motion and holding that the only remaining issue for trial was medical necessity. The main issue decided in the case was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The holding of the case was that the order, insofar as appealed from, was affirmed, with the court finding that there was a triable issue of fact regarding the medical necessity of the services at issue.

The relevant facts considered in this case were that the plaintiff, High Quality Medical Supplies, Inc., was seeking to recover first-party no-fault benefits from the defendant, Praetorian Ins. Co. The plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment on the grounds that it had properly denied the claims based on lack of medical necessity. The Civil Court denied the plaintiff's motion and made findings in the plaintiff's favor, as well as denying the defendant's cross motion. On appeal, the defendant failed to provide a sufficient basis to strike the Civil Court's findings in the plaintiff's favor and there was a triable issue of fact regarding the medical necessity of the supplies at issue. As a result, the defendant was not entitled to summary judgment dismissing the complaint. Therefore, the Appellate Term affirmed the order in favor of the plaintiff.

The court considered a motion for summary judgment by the plaintiff in a case involving a provider seeking to recover assigned first-party no-fault benefits. The defendant had cross-moved for summary judgment to dismiss the complaint based on a lack of medical necessity for the claims at issue. The Civil Court denied the plaintiff's motion for summary judgment, made findings in the plaintiff's favor, and denied the defendant's cross motion, holding that the only remaining issue for trial was whether the verification requested by the defendant was outstanding. The Appellate Court affirmed the lower court's decision, finding that the defendant failed to articulate a sufficient basis to strike the court's findings in the plaintiff's favor, and that there is a triable issue of fact as to whether the verification requested by defendant was outstanding. Therefore, the court's decision was affirmed.

Promed Durable Equipment, Inc. sued Geico Insurance to recover assigned first-party no-fault benefits, and the main issue the court decided was whether the supplies provided were medically necessary. Plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint based on a lack of medical necessity. The Civil Court denied plaintiff's motion, made findings in favor of the plaintiff, and held that the only remaining issue for trial was medical necessity. On appeal, the defendant failed to provide a sufficient basis to strike the Civil Court's findings in plaintiff's favor. The court ultimately held that summary judgment dismissing some of the claims for recovery of supplies was granted, as the supplies were found to be superfluous due to the assignor receiving physical therapy and treatment by a chiropractor and acupuncturist. The remaining claims for recovery of supplies were allowed, as the plaintiff had raised a triable issue of fact as to their medical necessity.

The court considered a case involving an action by a medical equipment provider to recover assigned first-party no-fault benefits. The main issue decided was whether the supplies furnished by the plaintiff were medically necessary. The court held that, based on a review of the record, a triable issue of fact existed regarding the medical necessity of the supplies furnished on December 12, 2008, therefore the defendant's cross motion to dismiss was denied. However, the court found that there was a lack of medical necessity for supplies furnished on January 9, 2009, and therefore granted the defendant's cross motion seeking summary judgment dismissing that portion of the complaint. The appellate court modified the lower court's order to reflect the granting of the defendant's cross motion and affirmed the order in all other respects.

The court considered an action by a provider to recover assigned first-party no-fault benefits, where the plaintiff moved for summary judgment and the defendant cross-moved for summary judgment dismissing the complaint based on a lack of medical necessity. The Civil Court made findings in the plaintiff's favor and held that the only remaining issue for trial was medical necessity. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The holding was that there was a triable issue of fact regarding the medical necessity of the services, and the order was affirmed. The defendant failed to articulate a sufficient basis to strike the Civil Court's findings in the plaintiff's favor, and the court found that there is a triable issue of fact regarding the medical necessity of the services at issue.

The relevant facts considered by the court were that Imperium Insurance Company sued Innovative Chiropractic Services and Park Slope Advanced Medical seeking declaratory relief and review of five master arbitrator's awards issued in favor of the defendants on their claims for first-party no-fault benefits. The main issue decided was whether the court had jurisdiction to entertain the lawsuit and whether the dismissal of the consolidated actions was warranted on the merits. The holding of the court was that while the Civil Court had jurisdiction to entertain the lawsuit, the dismissal of the consolidated actions on the merits was sustained because de novo review of the master arbitrator's awards was limited to the grounds set forth in CPLR article 75, and since none of the awards met or exceeded the statutory threshold sum of $5,000, de novo review was unavailable. Therefore, the individual complaints served by plaintiff seeking such relief did not state a viable cause of action, and the court was warranted in dismissing the consolidated actions upon plaintiff's motion for entry of a default judgment.