No-Fault Case Law

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.

The court considered the conflicting medical expert opinions presented by both parties regarding the medical necessity of the chiropractic services underlying the plaintiff's first-party no-fault claim. The main issue decided was whether the conflicting expert opinions raised a triable issue, and the court held that they did, thereby denying the defendant's motion for summary judgment dismissing the complaint. The holding of the case was that the conflicting medical expert opinions presented by the parties were sufficient to raise a triable issue as to the medical necessity of the chiropractic services, and therefore the defendant's motion for summary judgment was denied.

The court considered the appeal of an order by the Civil Court that granted the defendant's motion for summary judgment dismissing the complaint by a provider seeking to recover first-party no-fault benefits. The main issue decided was whether the defendant properly used the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive for acupuncture services performed by chiropractors. The court held that the defendant's affidavits sufficiently established the timely mailing of denial of claim forms, and that the defendant had properly used the workers' compensation fee schedule to determine payment for the services at issue. The judgment of the Civil Court granting the defendant's motion for summary judgment was affirmed.

The court considered the plaintiff's motion for summary judgment on the grounds that the defendant failed to comply with a discovery stipulation and the defendant's cross-motion for summary judgment dismissing the complaint based on lack of medical necessity and outstanding verifications. The court found that the defendant had a reasonable excuse for the delay in compliance with the discovery order and had demonstrated meritorious defenses to the action. The court also found that the defendant had submitted peer review reports and evidence establishing timely verification requests, while the plaintiff failed to submit any medical evidence to rebut the reports or respond to the verification requests. As a result, the court granted the defendant's cross-motion for summary judgment dismissing the complaint.

The court considered the request by the defendant to compel the plaintiff to produce its treating chiropractor for a deposition in a case where a provider was seeking first-party no-fault benefits. The main issue decided was whether the defendant was entitled to reasonable discovery of any facts bearing on the controversy to assist in the preparation for trial. The court held that under CPLR 3101 (a), parties are entitled to full disclosure of all material and necessary matters in the prosecution or defense of an action, and that the defendant, in defending the action on the ground that the services rendered lacked medical necessity, was entitled to compel the plaintiff to produce its treating chiropractor for a deposition. The holding was that the order denying the defendant's motion to compel the plaintiff to produce its treating chiropractor for a deposition was reversed, and the branch of the defendant's motion was granted.

The court considered the timely denial of claim forms issued by the defendant, as well as the payment of the subject claims at the highest rate available for acupuncture services. The main issue decided in this case was whether the defendant had paid the subject claims at the highest rate available for acupuncture services, as set forth in the chiropractic fee schedule. The holding of the case was that the defendant had established that it had paid the subject claims at the highest rate available for acupuncture services as set forth in the chiropractic fee schedule. Additionally, the court found that the denial of the claim forms had been timely mailed in accordance with the defendant's standard office practices and procedures. Therefore, the order was modified by deleting the award of summary judgment to the defendant for the initial evaluation which had been billed under code 99203.

The main issue in this case was whether a provider could recover first-party no-fault benefits when the assignor failed to appear for scheduled independent medical examinations (IMEs). The court considered the fact that the defendant had mailed the IME scheduling letters to the correct address provided by its insured, and copies of the letters were also received by the assignor's attorney. The court held that the defendant had sufficiently demonstrated that it had addressed the letters to the correct address, and therefore the assignor's failure to appear for the IMEs was a valid reason for denying the plaintiff's motion for summary judgment. The order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The court considered the facts that the plaintiff filed for a default judgment against several defendants for not appearing for an examination under oath, as required under the insurance policy. The plaintiff also sought a summary judgment against Stand-Up MRI regarding payment for expenses incurred from a collision involving defendant Curry and a motor vehicle. The main issue decided by the court was whether the plaintiff's requests for the examination under oath were reasonable and justified. The court found that the plaintiff failed to provide specific objective justification for the examination, and there was no evidence that the defendant actually failed to appear for the examination. Therefore, the court denied the plaintiff's motion for a default declaratory judgment and for a summary declaratory judgment. As a result, the plaintiff's relief was denied.