No-Fault Case Law

The case involves an appeal from a provider seeking to recover assigned first-party no-fault benefits. The court considered whether the services rendered were medically necessary and if the provider had established its prima facie case. The court found that the provider had raised a triable issue of fact as to the medical necessity of the services through the submission of an affirmation by a medical doctor. However, the court also found that the provider's cross motion failed to establish its prima facie case as the affidavit submitted did not prove that the claims had not been timely denied or that the denials were conclusory, vague, or without merit. As a result, the court modified the order by denying the defendant's motion for summary judgment to dismiss the complaint. The holding of the court was that the defendant's motion for summary judgment was denied.

The main issue in this case was whether the defendant insurer had timely denied the plaintiff's claims on the grounds of lack of medical necessity, and whether the defendant had provided sufficient proof to establish this defense. The appellant, Jamaica Medical Supply, Inc., argued that the defendant failed to provide proof in admissible form to establish its defense of lack of medical necessity due to the use of electronic stamped facsimiles of the peer reviewers' signatures on affirmations executed by the peer review physicians. However, the court held that the affidavit submitted by the defendant established the timely mailing of the denial of claim forms, and that the defendant had submitted peer review reports as well as affirmations executed by the physicians who had performed the peer reviews, which set forth a factual basis and medical rationale for the conclusion that there was no medical necessity for the medical supplies at issue. Therefore, the judgment of the Civil Court, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment, was affirmed.

The main issue in this case was whether the defendant insurance company was liable for no-fault benefits for medical equipment provided by the plaintiff. The court considered the evidence presented, including claim denial forms and peer review reports by doctors, to determine the medical necessity of the equipment in question. The defendant had denied the claims on the ground that the medical equipment provided was not medically necessary, and the court found that the evidence presented by the defendant was lacking sufficient support for their determination. In response to the defendant's cross motion, the plaintiff submitted an affirmation from a doctor that raised a triable issue of fact as to the medical necessity of the equipment. The court ultimately reversed the judgment, vacated the order granting the plaintiff's motion for summary judgment, and denied the plaintiff's motion for summary judgment.

The relevant facts of this case involved an action by a medical care provider to recover assigned first-party no-fault benefits from an insurance company. The main issues decided in this case were whether the provider's motion for summary judgment was properly denied, and whether the insurance company's cross motion for summary judgment dismissing the complaint was properly granted. The holding of the case was that the judgment was reversed, and the branches of the insurance company's cross motion seeking summary judgment dismissing the complaint were denied. The matter was remitted to the Civil Court for all further proceedings. The court found that the insurance company had not conclusively established its defense for claims beyond a certain date, and therefore the complaint seeking to recover on those claims was not dismissed. The court also found that the insurance company had failed to timely deny one of the claims, and therefore that claim was not dismissed.

The main issue in this case was whether the defendant, GEICO General Insurance Company, was entitled to summary judgment dismissing the complaint by the plaintiff, Viviane Etienne Medical Care, P.C., seeking to recover claims for no-fault benefits on various dates. The court considered the defendant's timely mailing of denial of claim forms, peer review reports, and independent medical examination reports which provided evidence that the medical services at issue were not medically necessary. The court found that the defendant had established its prima facie entitlement to summary judgment, and that the plaintiff had not rebutted this showing. As a result, the court affirmed the order in favor of the defendant, dismissing the complaint seeking to recover benefits on the specified dates.

The relevant facts of this case involved an appeal by a medical provider seeking to recover first-party no-fault benefits from an insurance company. The insurance company had filed a cross-motion for summary judgment to dismiss the complaint, which was granted in part by the lower court. The provider appealed this decision, arguing that there were certain claims for which the judgment should have been reversed and denied. The main issue decided by the court was whether the insurance company had established as a matter of law that the claims in question had been improperly billed or were in excess of the amount permitted by the fee schedule. The holding of the court was that while the insurance company had established its entitlement to summary judgment for certain claims, it had failed to do so for others, and thus the judgment was reversed in part and vacated for those specific claims.

The main issues in the case involved a no-fault provider's entitlement to recover assigned first-party benefits, and whether the defendant had timely denied the claims based on a lack of medical necessity. The court considered whether the plaintiff had submitted proof of the submission to the defendant of a claim form, proof of the fact and the amount of the loss sustained, and proof that the defendant had failed to pay or deny the claim within the requisite 30-day period. The court also addressed whether the defendant had timely denied the plaintiff's claim for a specific amount, and if the plaintiff had established its prima facie entitlement to summary judgment. The holding was that the order denying the branch of plaintiff's motion seeking summary judgment on the complaint insofar as it sought to recover upon plaintiff's claim for $879.73 was reversed, and plaintiff was granted summary judgment on that claim. The matter was remitted to the Civil Court for a calculation of statutory interest and an assessment of attorney's fees as to that claim.

The main issue in this case was an appeal from an order of the Civil Court that denied the plaintiff's motion for summary judgment and granted the defendant's cross motion to compel the plaintiff to provide responses to its discovery demands and to produce an individual for an examination before trial. The court found that subsequent to the entry of the order, the Civil Court dismissed the complaint, rendering the appeal academic. As a result, the appeal was dismissed. The relevant facts considered by the court were the actions of the lower court and the subsequent dismissal of the complaint, which led to the decision to dismiss the appeal as academic.

The case involved an action by a provider to recover assigned first-party no-fault benefits. Plaintiff had appealed an order of the Civil Court which denied plaintiff's motion for summary judgment and granted defendant's cross motion to compel plaintiff to provide full and complete responses to defendant's discovery demands and to produce Vladimir Grinberg for an examination before trial (EBT). Plaintiff had failed to challenge the propriety of defendant's discovery demands in a timely manner. Defendant had set forth detailed reasons for believing that plaintiff was ineligible to recover no-fault benefits and sought discovery of certain documents as well as an EBT of Vladimir Grinberg. As a result, the court affirmed the order, finding that the defendant's discovery demands were not palpably improper, and defendant was entitled to the information and EBT they were seeking.

The relevant facts of the case involved a New York corporation, Advanced Medical Diagnostics of Queens, P.C., which provided medical services to its assignor in New York after she was injured in a motor vehicle accident. The vehicle was owned by a New Jersey resident and was insured by a New Jersey automobile insurance policy. The main issue in the case was whether New York or New Jersey law should control the payment of no-fault benefits and the jurisdiction of the Civil Court. The holding of the case was that under a "center of gravity" or "grouping of contacts" analysis, the dispositive factors weighed in favor of New Jersey and its law should control. Therefore, the provider's motion for summary judgment was denied, as under New Jersey law, the provider had to establish the medical necessity of the services provided, and failed to do so. Additionally, the Civil Court did not lack jurisdiction as disputed resolution was not mandatory under the New Jersey insurance policy, and therefore the defendant's cross motion for summary judgment dismissing the complaint was also denied.