No-Fault Case Law

The court considered an appeal from an order of the Civil Court denying the defendant's cross motion for summary judgment in a case involving the recovery of first-party no-fault benefits. The main issue decided was whether the plaintiff had established the submission of bills and the fact and amount of the loss sustained, and whether a trial was necessary on the issue of medical necessity. The court held that plaintiff had indeed established the submission of bills and the fact and amount of the loss sustained, and found that a trial should be held specifically on the issue of medical necessity. The court also directed the attorneys for the defendant to show cause why sanctions and costs should not be imposed against them for engaging in frivolous conduct in their appellate brief. In conclusion, the court affirmed the order from the Civil Court and directed the attorneys to show cause regarding potential sanctions and costs.

In this case, Promed Durable Equipment, Inc. v GEICO Insurance, the appellant appealed the denial of a motion for summary judgment dismissing the complaint and sought a trial to decide the medical necessity of the supplies in question. The appellant also argued that a peer review report submitted showed a lack of medical necessity for the supplies, leading them to seek summary judgment to dismiss the complaint for supplies furnished. The court found that plaintiff established the submission of the bills and the loss sustained and affirmed the denial of the branch of the cross-motion for supplies furnished on October 23, 2008. However, the court granted the motion to dismiss the claim for supplies furnished on December 16, 2008, and directed counsel to show cause for sanctions and costs to be imposed against the respondent's counsel.

The relevant facts of this case involve a provider, South Nassau Community Hospital, seeking to recover assigned first-party no-fault benefits from Kemper Independence Insurance Company. The issue decided by the court was whether the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The holding of the case was that the defendant's motion for summary judgment dismissing the fourth and sixth causes of action was granted. The court found that the defendant had established its prima facie entitlement to summary judgment as a matter of law, and the plaintiff had failed to demonstrate the existence of a triable issue of fact. Therefore, the order denying the motion for summary judgment was reversed and the branches of defendant's motion seeking summary judgment were granted.

The relevant facts the court considered in this case were that Westchester Medical Center and other hospitals were seeking to recover first-party no-fault benefits from Allstate Insurance Company. The main issue decided was whether the plaintiffs were entitled to summary judgment, and the court held that the District Court properly denied the motion for summary judgment in favor of The New York Hospital Medical Center of Queens because it had not demonstrated its entitlement to judgment as a matter of law. The court affirmed the order in this regard, while dismissing the appeal by other plaintiffs who were not aggrieved by the order. The decision was made on August 8, 2013 by the Supreme Court, Appellate Term, Second Department.

The court considered the fact that the plaintiff had appealed from an order of the Civil Court of the City of New York, New York County, which denied its motion to dismiss the action as time-barred. The main issue decided was whether the action for assigned first-party no-fault benefits was time-barred. The court held that even though the plaintiff's allegations were accepted as true and given the benefit of every favorable inference, the action for assigned first-party no-fault benefits was time-barred and the complaint was dismissed. The court pointed out that the action, commenced on September 18, 2009, was barred by the governing six-year statute of limitations.

The main issue in this case was whether the defendant, a Massachusetts-based insurance company, was obligated to pay first-party no-fault benefits to a medical provider for services provided to a patient injured in a motor vehicle accident in New York. The court considered the conflicting interests in tort cases with multi-state contacts and ultimately decided to apply Massachusetts law as dispositive factors weighed in favor of applying Massachusetts law. The court held that the defendant did not sufficiently prove that the insured breached the duty to cooperate or that the insurer suffered actual prejudice due to lack of cooperation. Additionally, the court found that the insurer's reservation of rights letter was vague and ambiguous and that there was no evidence of the insurer's diligence and good faith in obtaining the insured's cooperation. Therefore, the plaintiff's motion and the defendant's cross motion were both denied.

The relevant facts of this case included a medical provider seeking to recover first-party no-fault benefits and the insurance company denying the claims due to the assignor's failure to attend scheduled independent medical examinations and provide requested documentary verification. The main issue decided in this case was whether the insurance company was entitled to summary judgment dismissing the claims. The holding of the case was that the insurance company failed to establish that the assignor had not appeared for scheduled IMEs, and also failed to establish that the claims for services provided by the assignor were premature. The court determined that the insurance company did not meet its burden of proof and held that the medical provider did not establish its prima facie case, therefore modifying the lower court's decision to strike the provision implicitly finding that the medical provider had established its case.

The main issue in Eagle Surgical Supply, Inc. v GEICO Gen. Ins. Co. was whether the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs). The appellate court found that the defendant failed to meet its burden at trial, as it did not submit evidence from a person with personal knowledge of the alleged nonappearances. Consequently, the judgment dismissing the complaint was reversed, and the matter was remitted to the Civil Court for the entry of a judgment in favor of the plaintiff in the principal sum of $918.75, plus statutory interest and attorney's fees. The appellate court found in favor of the plaintiff, stating that the defendant did not establish that the assignor had failed to appear for the scheduled IMEs.

This legal case involves a dispute between All Borough Group Medical Supply, Inc., the assignee of Joyce Glover, and GEICO Insurance Company. The case involves a nonjury trial where the Civil Court denied plaintiff's motions to admit into evidence some of plaintiff's documents, and ultimately, found in favor of the defendant. After presenting the relevant facts, the court held that the plaintiff had properly laid a foundation for the admissibility of its assignment of benefits form. The court also found that the plaintiff's delivery receipt and claim form should have been admitted into evidence because it was plaintiff's regular business practice to make such records. As a result, the judgment was reversed, the complaint was reinstated, and the matter was remitted to the Civil Court for a new trial.

The relevant facts considered by the court were that the plaintiff, Calvin Alford, was a pedestrian struck by a vehicle insured by Fiduciary Insurance Company of America (Fiduciary Ins.) in February 2009. Plaintiff attempted to obtain the identity of the vehicle that struck him but was unable to do so until June 1, 2009. Plaintiff filed a timely application for benefits with the Motor Vehicle Accident Indemnification Corporation (MVAIC) in April 2009 and continued his efforts to discover the identity of the vehicle. Fiduciary Ins. denied plaintiff's claim due to late notice and failure to provide written proof of the claim. Plaintiff filed a motion for summary judgment against Fiduciary Ins. declaring that they must provide no-fault benefits to him, while Fiduciary Ins. cross-moved for summary judgment dismissing the summons and complaint. The main issue decided by the court was whether Fiduciary Ins. was obligated to provide no-fault benefits to the plaintiff despite the late notice and failure to provide written proof of the claim. The court held that plaintiff was entitled to summary judgment as a matter of law. Plaintiff's notice of claim was technically late, but the court found that he was entitled to consideration due to the difficulty in ascertaining the identity of the vehicle that struck him as a pedestrian. The court also found that plaintiff had provided written notice, as requested by Fiduciary Ins., and that Fiduciary Ins.'s denial of the claim was unpersuasive. The court granted plaintiff's motion for summary judgment against Fiduciary Ins. and declared that Fiduciary Ins. must provide no-fault benefits to plaintiff with regards to the February 2009 automobile accident. The court also denied Fiduciary Ins.'s cross-motion for summary judgment.