No-Fault Case Law

The court considered a case in which Hands On Physical Therapy Care, as the assignee of Jacqueline Drouillard, appealed from an order of the Civil Court of the City of New York, Kings County that granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue decided was whether the provider was entitled to recover assigned first-party no-fault benefits. The holding of the court was that the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment is affirmed, with $25 costs. The court's decision was based on the reasons stated in a similar case, PFJ Med. Care, P.C., as Assignee of Simmond, Tylon B. v Nationwide Ins. The decision was entered on June 10, 2022.

The court considered the denial of the plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant's affirmations and transcripts of the examinations under oath were sufficient to establish that the plaintiff had failed to appear for the examinations. The holding of the case was that the affirmations submitted by the defendant's counsel and the transcripts of the examinations under oath were indeed sufficient to establish that the plaintiff had failed to appear for the examinations, and therefore, the order denying the motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed by the court.

The relevant facts the court considered in this case were that Columbus Imaging Center, LLC was seeking to recover assigned first-party no-fault benefits from Erie Insurance Company of New York. The main issue decided was whether defendant needed to demonstrate, as part of its prima facie case, that the first independent medical examination scheduling letter had been sent to plaintiff's assignor within 15 days of defendant's receipt of either the NF-2 or a claim received from another provider. The holding of the court was that defendant did not need to demonstrate this as part of its prima facie case, and therefore the order granting defendant's motion for summary judgment and denying plaintiff's cross motion for summary judgment was affirmed.

The court considered an order of the Civil Court of the City of New York, Kings County, which denied the branches of defendant's motion to dismiss the fifth and ninth causes of action seeking to recover in excess of the amounts permitted by the workers' compensation fee schedule. The main issues decided were whether the services rendered were medically necessary and whether the defendant was entitled to summary judgment dismissing all of the claims on the ground that all of the services were not medically necessary. The holding of the case was that the defendant was not entitled to summary judgment dismissing the fifth and ninth causes of action as sought to recover in excess of the amounts permitted by the workers' compensation fee schedule, and the appeal was dismissed.

The relevant facts considered by the court in Dr. Orenbakh Psychologist, P.C. v Nationwide Affinity Ins. Co. of Am. involved a dispute over the denial of first-party no-fault benefits by the insurance company. The insurer denied the claims on the basis that the plaintiff failed to appear for examinations under oath (EUOs). The main issue decided by the court was whether the insurer's denial of the claims was timely and whether the plaintiff failed to appear for the scheduled EUOs. The holding of the court was that the insurer sufficiently proved that the EUO scheduling letters were mailed and that the plaintiff failed to appear for the scheduled EUOs, leading to the granting of summary judgment in favor of the insurer for certain claims. However, the court also held that the insurer's denial of another claim was untimely because the EUO scheduling letter was mailed more than 30 days after receipt of the claim form, and therefore summary judgment was properly denied for that claim.

The relevant facts the court considered were that the plaintiff was seeking to recover assigned first-party no-fault benefits and had allegedly served the summons and complaint by mail, but had not obtained personal jurisdiction over the defendants. Defendant American Independent Ins. Co. moved to dismiss the complaint on the ground of lack of personal jurisdiction, and other defendants moved in a single motion to dismiss the complaint against them on the same ground. The main issue decided was whether the plaintiff had obtained personal jurisdiction over the defendants, and the court ultimately held that the appeal of the order denying the motion to dismiss insofar as asserted against American Independent Insurance Co. was reversed and the motion was granted, and the branches of the motion seeking to dismiss so much of the complaint as was asserted against the other defendants were granted as well.

The court considered the appeal from an order of the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue decided in this case was whether the defendant needed to demonstrate, as part of its prima facie case, that the first examination under oath scheduling letter had been sent to the plaintiff's assignor within 15 days of the defendant's receipt of either the NF-2 or a claim received from another provider. The holding of the court was that the defendant did not need to demonstrate this as part of its prima facie case and that the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment was affirmed.

The relevant facts the court considered were that the plaintiff, Charles Deng Acupuncture, P.C., was seeking to recover assigned first-party no-fault benefits from the defendant, American Independent Ins. Co. The affidavit of service alleged that the summons and complaint were served by mail, but the plaintiff's papers did not contain an acknowledgment of service. The main issue decided by the court was whether the plaintiff had obtained personal jurisdiction over the defendant. The holding of the case was that the defendant's motion to dismiss the complaint was granted, as the plaintiff had failed to obtain personal jurisdiction over the defendant. The court reversed the order of the Civil Court and granted the defendant's motion to dismiss the complaint.

The relevant facts considered by the court in this case were that JPC Medical, P.C. was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. as the assignee of the patient, Isaacs. State Farm had filed a motion for summary judgment to dismiss the complaint, which was granted by the lower court, and plaintiff's cross motion for summary judgment was denied. The main issues considered were whether State Farm had proved that it had paid the limits of the policy in accordance with the law, and whether JPC Medical, P.C. had demonstrated its entitlement to summary judgment based on the timely denial of claim form. The holding of the case was that the appellate court modified the lower court's order by denying State Farm's motion for summary judgment dismissing the complaint. It was found that State Farm failed to demonstrate, as a matter of law, that it had made any payments under the policy, and JPC Medical, P.C. had also failed to demonstrate its entitlement to summary judgment. Therefore, the appellant's motion for summary judgment was denied, and the order was affirmed as modified.

The court considered that in this action by a provider to recover assigned first-party no-fault benefits, the affidavit of service alleged that the summons and complaint were served by mail pursuant to CPLR 312-a, but plaintiff's papers did not contain an acknowledgment of service. Defendant American Independent Ins. Co. moved to dismiss the complaint insofar as asserted against it on the ground that plaintiff had failed to obtain personal jurisdiction over it, while the other defendants moved to dismiss so much of the complaint as was asserted against them on the same ground. Plaintiff opposed both motions and cross-moved for summary judgment. The main issue decided was whether the court had personal jurisdiction over the defendants due to the lack of acknowledgment of service. The holding of the case was that the court did not have personal jurisdiction over the defendants and therefore, the motions to dismiss the complaint insofar as asserted against the defendants were granted.