No-Fault Case Law

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.

The case of Matter of Allstate Insurance Company v. Daniel Wilen involved a proceeding to vacate the award of a master arbitrator, which vacated an award of an arbitrator. The appellate division upheld the Supreme Court's decision to deny the petition and confirm the master arbitrator's award. The court determined that the master arbitrator did not exceed his powers and was empowered to apply the law to the given set of facts, even if his conclusion differed from that of the arbitrator. The master arbitrator properly vacated the arbitration award which was "incorrect as a matter of law" in light of the evidence. The petitioner's remaining contentions were found to be without merit by the court.

The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits for acupuncture services provided by its licensed acupuncturist, and the complaint sought to recover the difference between the amount billed by the plaintiff and the amount paid by the defendant-insurer. The main issue decided was whether the defendant-insurer properly limited payment to "charges permissible for similar procedures under schedules already adopted or established by the superintendent" or whether the plaintiff was entitled to any additional reimbursement. The holding of the case was that since the Superintendent of Insurance had not adopted a fee schedule for the reimbursement of acupuncture services performed by a licensed acupuncturist, the defendant properly limited payment to the workers' compensation fee schedule for acupuncture services performed by chiropractors, and therefore the plaintiff was not entitled to any additional reimbursement. As a result, the defendant's motion for summary judgment dismissing the complaint was granted and the complaint was dismissed.

The main issue in this case was whether prejudgment interest should accrue from the filing or the service of the summons and complaint in an action by a provider to recover assigned first-party no-fault benefits. The relevant facts in this case were that the plaintiff filed the summons and complaint in October 2008, but service was not completed until January 2009. A nonjury trial was subsequently held, and the Civil Court found in favor of the plaintiff, awarding them the principal sum plus interest from the date of filing. The defendant argued that interest should have been awarded from the date of service, rather than from the date of filing. The court held that interest on a no-fault claim does not accrue until the date of service of the summons and complaint and not from the date of filing. Therefore, the judgment was modified, and the matter was remitted to the Civil Court for a re-calculation of statutory interest in accordance with the court's decision.

The relevant facts were that this was a case where the plaintiff, Alev Medical Supply, Inc., was appealing the dismissal of their complaint, which sought to recover assigned first-party no-fault benefits from Geico Indemnity Company. A nonjury trial was held, and the trial court dismissed the plaintiff's complaint on the grounds that they had not established their prima facie case. The main issue decided by the appellate court was whether the plaintiff had provided sufficient evidence to support their claim for no-fault benefits. The appellate court held that the plaintiff had presented a witness at the trial who provided testimony and claim forms that established the prima facie evidence of the fact and amount of the loss sustained, thus reversing the judgment, awarding costs, and remitting the matter to the Civil Court for the entry of a judgment in favor of the plaintiff in the principal sum of $1,530, plus statutory interest and attorney's fees.

The main issue in this case was whether the default judgment should be vacated pursuant to CPLR 5015 (a) (1) in an action by a provider to recover assigned first-party no-fault benefits. The court considered the fact that defendant had subsequently been granted summary judgment dismissing the complaint, making the appeal academic. The court ultimately decided to dismiss the appeal in light of the subsequent order granting summary judgment, as it rendered the appeal unnecessary. The holding of the case was that the appeal must be dismissed as academic in light of the subsequent order granting defendant's unopposed motion for summary judgment dismissing the complaint.

The main issue in this case was whether the defendant had failed to establish its prima facie case in a no-fault benefits action by a provider. The court considered the fact that at the nonjury trial, the plaintiff presented a witness whose knowledge of the business practices and procedures of the provider was deemed sufficient to lay a foundation for the claim forms to be admitted into evidence as business records. The Civil Court had erroneously directed judgment in favor of the defendant before the plaintiff's counsel had the opportunity to move the claim forms into evidence or to elicit testimony regarding the nonpayment of the claims. The holding of the court was that the judgment was reversed and the matter was remitted to the Civil Court for a new trial.

The relevant facts of the case included the plaintiff's motion for summary judgment against defendants Multiple Medical Health Services, P.C. and Infinite Chiropractic, PLLC. The main issue decided by the court was whether the plaintiff was entitled to summary judgment based on its submission of an affidavit of service demonstrating that notices scheduling independent medical examinations were properly mailed to the defendant in connection with a no-fault insurance claim. The holding of the court was that the plaintiff was entitled to summary judgment based on the evidence provided, and that the defendant had failed to rebut the presumption of a proper mailing. The court also rejected a request for modification of the order by defendant Empire Acupuncture, PC, and upheld the decision regarding Empire.