No-Fault Case Law

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.

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.