No-Fault Case Law

The court considered the denial of the defendant-insurer's motion for summary judgment in a case to recover assigned first-party no-fault benefits. The main issue decided was whether the peer review report and affidavit submitted by the defendant's chiropractor provided a sufficient basis to conclude that the medical supplies at issue were not medically necessary. The court held that the peer reviewer's assertion was insufficient to meet defendant's burden of eliminating all triable issues as to medical necessity. Additionally, the court found that the plaintiff's submission of an affidavit prepared by the assignor's treating chiropractor was sufficient to raise a triable issue as to medical necessity. Therefore, the order denying the defendant's motion for summary judgment was affirmed.

The court considered whether the defendant's motion for summary judgment dismissing the complaint was justified. The main issue was whether the plaintiff had failed to comply with a condition precedent to coverage by failing to appear for scheduled examinations under oath (EUOs). The court held that the defendant had established through affidavits that the EUO scheduling letters and denial of claim forms had been timely mailed. Additionally, since the plaintiff did not respond in any way to the EUO requests, their objections regarding the requests were not heard. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered the issue of whether the defendant-insurer's verification letters were timely and properly mailed to the plaintiff in a first-party no-fault action. The main issue decided was whether the plaintiff raised a triable issue sufficient to withstand summary judgment dismissal. The court held that the affidavit of an employee of a third-party biller, who had no personal knowledge of the date the purported "verification compliance" letter was mailed to the defendant, and described in only the most general terms her office's mailing practices and procedures, was insufficient to raise an issue of fact. Therefore, the defendant was entitled to summary judgment dismissing the claim as premature.

The relevant facts in this case are that the defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the action for first-party no-fault benefits by establishing that it timely and properly mailed the notices for independent medical examinations (IMEs) to the plaintiff's assignor, and that the assignor failed to appear. The main issue decided by the court was whether the defendant made a sufficient showing to be entitled to summary judgment. The court ultimately held that the defendant made a prima facie showing of entitlement to summary judgment by establishing that it timely and properly mailed the notices for IMEs to the plaintiff's assignor, and that the assignor failed to appear. The court further held that the plaintiff did not raise a triable issue with respect to the assignor's nonappearance or as to the mailing or reasonableness of the underlying notices. The defendant's motion for summary judgment dismissing the complaint was granted.

The court considered a provider's attempt to recover first-party no-fault benefits, with the defendant arguing lack of medical necessity as a defense. The main issue was whether the peer review report relied upon by the defendant was admissible, as the plaintiff argued that the signature on the report was stamped and therefore inadmissible. The court held that the plaintiff's assertion, without any indication as to why they believed the signature was stamped, was insufficient to raise an issue of fact, and therefore affirmed the judgment in favor of the defendant.

The court considered the evidence provided by the defendant, including affidavits from a manager of Crossland Medical Review Services, Inc., an affidavit from the defendant's litigation examiner, and affidavits from the doctors scheduled to perform the independent medical examinations (IMEs). The main issue was whether the defendant had established that the plaintiff's assignor failed to appear for the scheduled IMEs and whether the denial of claim forms had been timely mailed to the plaintiff's address. The holding of the case was that the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment dismissing the complaint. The court found that the evidence provided by the defendant was sufficient to establish that the plaintiff's assignor had failed to appear for the scheduled IMEs and that the denial of claim forms had been timely mailed to the plaintiff's address.

The relevant facts the court considered in this case included the denial of a claim form by the defendants, who were insurance companies, and the late submission of the plaintiff's claims. The main issue decided was whether the defendants were justified in denying the claim and whether the plaintiff had provided a reasonable justification for the late submission. The holding of the case was that the defendants' denial of the claim form was timely and adequately advised the plaintiff of the basis for the denial, as well as the potential for excusing the late submission if a reasonable justification was provided. As the plaintiff failed to offer any explanation for the delay, the court reversed the original order and granted the defendants' motion for summary judgment dismissing the complaint.

The court considered whether the defendant's denial of the claims was timely and whether the defendant had properly scheduled examinations under oath (EUOs) for the plaintiff's assignor. The main issue was to determine whether the defendant had complied with Insurance Department Regulations (NYCRR) § 65-3.6 (b), and if the defendant's denial of the claim form had been timely mailed. The holding of the case was that the defendant failed to demonstrate that its denial of the claim form had been timely mailed, as it did not comply with the regulations by identifying in writing the missing verification and the party from whom it was requested. As a result, the court reversed the order and denied the defendant's motion for summary judgment.

The relevant facts considered by the court were that the defendant, Allstate Insurance Company, filed a motion to vacate the notice of trial and compel the plaintiff, Jamaica Dedicated Medical Care, to provide complete responses to discovery demands and to produce the owner, Viviane Etienne, M.D., for an examination before trial. The main issue decided was whether the Civil Court properly granted the defendant's motion to vacate the notice of trial and compel the plaintiff to provide discovery. The holding of the case was that the Civil Court properly granted the defendant's motion, as the notice of trial and certificate of readiness filed by the plaintiff contained an erroneous statement that discovery had been completed. Additionally, the defendant's outstanding discovery demands sought to ascertain whether the plaintiff was a professional service corporation and ineligible to recover no-fault benefits, which was a valid defense. Therefore, the order to vacate the notice of trial and compel discovery was affirmed.

The court considered a motion by the defendant to strike the notice of trial, compel the plaintiff to provide full and complete responses to discovery demands, and produce Dr. Wilkins Williams for an examination before trial, among other things. The main issue in the case was whether the defendant was entitled to the discovery ordered by the court, including the production of the plaintiff's tax returns and the deposition of Dr. Wilkins Williams. The court held that while the defendant was not entitled to the plaintiff's tax returns, they were entitled to depose Dr. Wilkins Williams. The court also ordered that certain branches of the plaintiff's cross motion, which sought to compel the defendant to produce its special investigator and claims examiner for examinations before trial, were not properly before the court and remained pending and undecided.