No-Fault Case Law

The relevant facts considered included a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the provider was entitled to summary judgment in their favor. The holding of the case was that the order of the Civil Court denying the provider's motion for summary judgment was reversed, and the provider's motion for summary judgment was granted. The case was remitted to the Civil Court for a calculation of statutory interest and an assessment of attorney's fees. This decision was in accordance with Insurance Law § 5106 and the regulations promulgated thereunder.

The case involves a dispute between New Century Medical Diagnostics, P.C. and Utica Mutual Insurance Company over no-fault benefits. New Century submitted its claims on time, but Utica denied the claims because New Century did not appear at two scheduled examinations under oath, which is considered a failure to comply with a condition precedent to coverage. New Century argued that the notices for the examinations were defective because they sought the production of a specific individual, but the court held that New Century's failure to appear at the scheduled examinations permitted Utica to deny the claims. The court granted Utica's motion for summary judgment, dismissing the complaint. The decision was based on the fact that while New Century was not required to produce the specific person Utica requested, its failure to produce any person at the scheduled examinations under oath allowed Utica to deny New Century's claims.

Procedural facts: The defendant has moved to strike the notice of trial and certificate of readiness for trial on the grounds that discovery is not complete. The Plaintiff has resisted, arguing that the demands for material and documents are overbroad, unduly burdensome, and irrelevant. Substantive facts: The case involves a dispute between the plaintiff and defendant over whether a medical facility, Huntington Medical Plaza, P.C., owned by Dr. Perez, is subject to a Mallela defense, which relates to fraudulent billing in connection with no-fault claims. Allstate Insurance Company, the defendant, has repeatedly requested copies of relevant documents and material, such as banking resolutions and statements, tax returns, management and office equipment leasing agreements, in connection with the Mallela defense. Legal issues: The main issue is whether Huntington Medical Plaza, P.C. is subject to a Mallela defense and, if so, whether the defendant is entitled to the production and discovery of material and documents related to this defense. Holding: The court granted the defendant's motion to the extent that the plaintiff shall produce the demanded material for an in-camera inspection. All proceedings in this action are stayed pending the production of the documents and inspection by the court.

The court considered the denial of first-party no-fault benefits, based on a lack of medical necessity, to a provider by an insurance company. The insurance company timely denied the claim and submitted an affirmed peer review report stating the lack of medical necessity for the services at issue. The main issue was whether the insurance company's showing that the services were not medically necessary was rebutted by the provider. The holding was that the insurance company's cross motion for summary judgment dismissing the complaint should have been granted, as the provider did not rebut the showing that the services were not medically necessary. Therefore, the order denying the insurance company's cross motion was reversed and the cross motion was granted.

The relevant facts considered by the court in this case included an action by a medical provider to recover assigned first-party no-fault benefits from an insurance company. The insurance company had denied the claims based on the failure of the medical provider's assignor to appear for scheduled independent medical examinations (IMEs). The main issue decided by the court was whether the insurance company had established its entitlement to summary judgment as a matter of law. The holding of the court was that the insurance company had indeed established its entitlement to judgment as a matter of law, and as a result, the order granting the medical provider's motion for summary judgment was reversed. The court held that the insurance company's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts in this case were that SS Medical Care, P.C. as the assignee of Beato Boyd was seeking to recover first-party no-fault benefits from Hartford Insurance Company. The main issue decided by the court was whether Hartford Insurance Company had timely and properly denied the plaintiff's claims based on the assignor's failure to appear for scheduled examinations under oath (EUOs). The holding of the court was that defendant had properly demonstrated that it had mailed the EUO scheduling letters and denials, and as the plaintiff raised no other argument with respect to the granting of defendant's cross motion, 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 an order from the Civil Court granting a default judgment against the defendant in a case where a provider was seeking to recover first-party no-fault benefits. The defendant then sought to vacate the order and dismiss the complaint, alleging that the plaintiff had failed to serve process upon the defendant and had mistakenly served the third-party claims administrator. The main issues decided were whether the defendant submitted to the jurisdiction of the court and whether there was a reasonable excuse for the default and a meritorious defense to the action. The court held that the defendant submitted to the jurisdiction of the court when seeking to vacate the order and permit it to defend the action, and that the defendant failed to demonstrate a meritorious defense, as there was no evidence to support the assertion that the assignor had been acting within the course of her employment when the accident occurred. Therefore, the court affirmed the order.

The court considered the circumstances under which an action to recover first-party no-fault benefits was commenced. The main issue decided was whether the action to recover assigned first-party no-fault benefits had been properly commenced within the statute of limitations period. The court held that the action was not commenced within the period of the statute of limitations because service of process had not been properly effected as required by CPLR 312-a, and, therefore, the action was time-barred. The court determined that the plaintiff did not acquire personal jurisdiction over the defendant, and thus the action was not properly commenced, the time within which the action must have been commenced to recover no-fault benefits accrued before the action was filed, and thus, it was dismissed.

The case involved a dispute over an arbitration between Jeffrey Gee et al. and State Farm Mutual Automobile Insurance Company. The Supreme Court dismissed a petition to vacate arbitration awards, and the Appellate Division affirmed the dismissal but modified it to confirm the awards. The petitioners sustained injuries in an automobile accident in 1996 and submitted their claims to State Farm for loss of earnings and medical expenses. When the claims were denied, they filed a civil action within six years of the accident and agreed to submit the matter to arbitration to resolve the dispute with State Farm. The issue in question was whether the claims were barred by the statute of limitations. The Appellate Division ultimately decided that the petitioners were not entitled to vacate the awards, affirming the determination of the arbitrator, and the arbitration awards were thus confirmed.

The court considered the fact that plaintiff Jamaica Medical Supply Inc. submitted a bill for rental of medical supply equipment beyond the 45-day time limit required by No-Fault Regulations. Defendant Geico denied the claim based on the late submission and requested a reasonable justification for the failure to give timely notice. Plaintiff argued that the rental equipment was not possible to bill within 45 days of disbursement due to uncertainty regarding the number of days the machines would be rented. The main issue decided was whether the bill submitted on its face constituted a reasonable justification for the untimely submission of the claim, or if plaintiff had an independent obligation to provide a written reasonable justification for its late bill upon receiving the denial from defendant Geico. The holding of the case was that plaintiff failed to respond to defendant's request for a reasonable excuse during the claims phase, therefore the complaint was dismissed with prejudice.