No-Fault Case Law

The relevant facts the court considered in this case were that a healthcare provider, Physical Performance Testing of NY, was seeking to recover assigned first-party no-fault benefits from New York Central Mutual Insurance Company. However, Mutual moved for summary judgment, arguing that Physical was unlicensed and therefore ineligible for reimbursement of the benefits. The main issue decided by the court was whether a healthcare provider is eligible for reimbursement of first-party no-fault benefits if they fail to meet New York State or local licensing requirements. The holding of the court was that a provider of healthcare services is not eligible for reimbursement if they fail to meet licensing requirements, and in this case, Physical failed to raise a triable issue of fact with respect to its claims because the services were not performed by a medical professional corporation or a licensed health provider. Therefore, the court affirmed the orders and dismissed Physical's complaints.

The relevant facts of this case are that after a motor vehicle accident, Kocourek sought treatment at Sound Shore Medical Center and assigned her no-fault benefits to the center. The medical center submitted a UB-04 form to New York Central, her insurance company, indicating that $13,053.02 in services were provided to Kocourek. In response, New York Central requested further verification and treatment information from Sound Shore. Then, Sound Shore submitted an N-F 5 form requesting $4,834.95 for the treatment, as well as an assignment of benefits form, which New York Central rejected. The main issue the court decided was whether the UB-04 form was the same as the N-F 5 form, which would trigger the 30-day period in which an insurer must pay or deny a claim. The court held that the UB-04 form sent by Sound Shore is not the "functional equivalent" of an N-F 5 form, reversing the Appellate Term's decision. The court also determined that New York Central's time to respond to Sound Shore's claim was not tolled, and therefore, Sound Shore's claim was not premature. Consequently, Sound Shore established its entitlement to judgment, and New York Central failed to raise a triable issue of fact and was required to pay the claim to Sound Shore. Ultimately, the court reversed the Appellate Term's decision and reinstated the District Court's order.

The case involved a dispute between W.H.O. Acupuncture, P.C., an assignee of individuals who were injured, and American Transit Insurance Company, regarding the payment of first-party no-fault benefits. American Transit Insurance Company argued that the injured individuals may be eligible for workers' compensation benefits, and therefore they moved for summary judgment dismissing the complaint. The Civil Court denied the defendant's motion and granted the plaintiff's cross motion for summary judgment. However, the Appellate Court reversed the decision, stating that the issue of the injured individuals' eligibility for workers' compensation benefits must be resolved by the Workers' Compensation Board. Therefore, both the defendant's motion and the plaintiff's cross motion were remitted to the Civil Court for a new determination after the final resolution of the application to the Workers' Compensation Board to determine the parties' rights under the Workers' Compensation Law. If the plaintiff fails to file proof with the Civil Court within 90 days of the date of this decision, the court is instructed to grant the defendant's motion for summary judgment and deny the plaintiff's cross motion unless the plaintiff shows good cause why the complaint should not be dismissed.

The court considered the motion to stay the case pending a determination of the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law. The relevant facts considered were whether the plaintiff's assignor had been acting as an employee at the time of the accident, and whether workers' compensation benefits might be available. The main issue decided was whether the defendant proffered sufficient evidence that workers' compensation benefits might be available to warrant a stay of the action. The holding of the court was that the defendant did proffer sufficient evidence in admissible form of the alleged facts, and therefore the Civil Court properly granted the motion for a stay pending the Board's determination of the parties' rights under the Workers' Compensation Law.

The court considered a motion to stay the action pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law. The main issue was whether the plaintiff's assignor had been acting as an employee at the time of the accident, which needed to be resolved by the Workers' Compensation Board. The court held that the defendant's proof, including a police accident report, was sufficient to raise a question of fact on the issue, and therefore, the action was stayed pending a determination by the Workers' Compensation Board. The order was affirmed by the court.

The main issues decided in this case were whether the defendant was entitled to a credit against a judgment and whether the plaintiff was entitled to counsel fees. The court considered the fact that the plaintiff had been awarded partial summary judgment and secured a judgment in its favor, whereas the defendant sought to recover a credit of $825.55 against the judgment. The holding of the case was that the Supreme Court properly granted the plaintiff's request for a turnover order and directed the defendant to pay the plaintiff $5,254.02 in full satisfaction of the underlying judgment. The court also found the defendant's pursuit of the appeal to be frivolous and granted the plaintiff's request for counsel fees incurred in responding to the appeal. The matter was remitted to the Supreme Court for a determination of the amount of reasonable counsel fees incurred.

The relevant facts considered by the court included a dispute over an arbitration award between Allstate Insurance Company and Natural Healing Acupuncture, P.C. The main issue decided was whether the master arbitrator's confirmation of the original arbitrator's decision, which awarded $927.99 to Natural Healing Acupuncture, was arbitrary, capricious, or contrary to well-settled law. The holding of the court was that the master arbitrator's award was vacated because it was not in accordance with well-established precedent and was contrary to the law. The court directed the arbitrator to recalculate the fees owed to Natural Healing Acupuncture in accordance with the fee schedule for licensed chiropractors who perform acupuncture.

The main issues in the case involved a provider seeking to recover assigned first-party no-fault benefits. The defendant insurance company had moved for summary judgment dismissing the complaint or, alternatively, for a finding that certain correspondence was timely and valid. They also sought an order compelling the plaintiff to appear for an examination before trial. The Civil Court granted both motions to the extent that the only remaining issues for trial were related to the medical necessity of the services provided and whether the billing was in accordance with the New York State Workers' Compensation Fee Schedule. The court found that the plaintiff had established its prima facie case, and the defendant's motion for summary judgment was properly denied. However, the defendant's motion for an order compelling the plaintiff to appear for an examination before trial was granted, with the examination to be held within 60 days. The Appellate Court affirmed this decision.

The relevant facts that the court considered were that the plaintiff, City Dental Services, P.C., sought to recover first-party no-fault benefits that were assigned to them. The defendant, Country Wide Insurance Company, attempted to file opposing papers almost two months after the stipulated due date, and the court rejected them, granting the plaintiff's motion on default. The main issue decided by the court was whether the defendant should be allowed to "renew and reargue" its opposition to the plaintiff's motion for summary judgment, and whether the previous default order should be vacated. The holding of the court was that the branch of the defendant's motion seeking leave to "renew" its opposition to plaintiff's motion for summary judgment was proper, as the defendant had defaulted in opposing the motion, and their remedy was to seek to vacate the default order. The court also noted that the branch of the plaintiff's motion seeking to vacate the previous order remained pending and undecided.

The court considered the issue of a provider's right to recover assigned first-party no-fault benefits in this case. The main issues decided were whether the denial of claim forms and verification requests had been timely mailed by the defendant, and whether the plaintiff had failed to respond to defendant's verification requests. The court held that the denial of claim forms and verification requests had been timely mailed and that the plaintiff had failed to respond to defendant's requests, entitling the defendant to summary judgment dismissing the complaint. Additionally, the court found that the plaintiff's treating doctor had failed to rebut the conclusions set forth in the peer review reports submitted by the defendant, leading to the granting of summary judgment dismissing plaintiff's first, second and fourth causes of action.