No-Fault Case Law
Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52398(U))
December 21, 2012
The court considered whether the defendant was entitled to summary judgment dismissing the complaint and whether the plaintiff was entitled to summary judgment. The main issue was whether the defendant established its entitlement to summary judgment by proving the timely mailing of the NF-10 denial of claim forms at issue. The holding was that the defendant failed to establish its entitlement to summary judgment because the affidavit of the defendant's litigation examiner was insufficient to establish the timely mailing of the NF-10 denial of claim forms. As a result, the plaintiff also failed to establish its entitlement to summary judgment with respect to its claims for $1,180, $550.44, $780.98, and $489.28. Therefore, the court denied the branches of the plaintiff's cross motion seeking summary judgment with respect to those claims.
Parsons Med. Supply, Inc. v Utica Mut. Ins. Co. (2012 NY Slip Op 52397(U))
December 21, 2012
The court considered the fact that Parsons Medical Supply, Inc. was seeking to recover first-party no-fault benefits from Utica Mutual Insurance Co. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint. The court held that the defendant was not entitled to summary judgment because they failed to demonstrate that their initial and follow-up requests for examinations under oath of the plaintiff had been timely sent, as required by Insurance Department Regulations. Therefore, the defendant did not establish that it had tolled its time to pay or deny the plaintiff's claims, and was not entitled to summary judgment. The court affirmed the order denying the defendant's motion for summary judgment.
Infinity Health Prods., Ltd. v Liberty Mut. Fire Ins. Co. (2012 NY Slip Op 52396(U))
December 21, 2012
The court considered the fact that the defendant had timely mailed requests and follow-up requests for verification, as well as the affidavit of the defendant's claim specialist which established that the plaintiff had failed to respond to those requests. The main issue decided was whether the 30-day period within which the defendant was required to pay or deny the plaintiff's claims had commenced to run, and whether the plaintiff's action was premature. The holding of the court was that the plaintiff's motion for summary judgment should have been denied and the defendant's cross motion, in effect, for summary judgment should have been granted. Therefore, the judgment was reversed, the order entered on March 5, 2010 was vacated, and the defendant's cross motion for summary judgment was granted.
Lenox Hill Hosp. v Tower Ins. Co. of N.Y. (2012 NY Slip Op 52391(U))
December 20, 2012
The relevant facts considered by the court were that Lenox Hill Hospital was seeking to recover no-fault benefits on behalf of Charles Barclay. The main issue decided was whether Lenox Hill Hospital was entitled to summary judgment in their favor, and the court held that they were not entitled to summary judgment as they had not demonstrated their prima facie entitlement to judgment as a matter of law. The court affirmed the denial of Lenox Hill Hospital's motion for summary judgment, stating that they had not shown sufficient evidence to support their claim.
New York Hosp. Med. Ctr. of Queens v Utica Mut. Ins. Co. (2012 NY Slip Op 52388(U))
December 20, 2012
The court considered the facts that the plaintiff was seeking to recover assigned first-party no-fault benefits under an insurance policy after their assignor was allegedly injured in a motor vehicle incident. The defendant's insured stated that the assignor had jumped on the hood of their parked car and got off without incident, and drove away without further contact. The plaintiff disputed this, submitting a police accident report and the assignor's hospital records which indicated the assignor was injured when the defendant's insured drove their car into the assignor. The main issue decided was whether the injuries arose out of an insured incident. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint should have been granted, as the plaintiff failed to raise a triable issue of fact and demonstrated that the injuries in question did not arise out of an insured incident.
NYU-Hospital for Joint Diseases v American Tr. Ins. Co. (2012 NY Slip Op 52387(U))
December 20, 2012
The relevant facts considered in this case were the denial of plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had demonstrated its prima facie entitlement to judgment as a matter of law. The holding of the court was that the District Court properly denied the plaintiff's motion for summary judgment, as they had not shown their entitlement to judgment as a matter of law, citing a similar case as precedent. The order was affirmed without costs by the Appellate Term, Second Department.
NYU Hosp. for Joint Diseases v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 22379)
December 18, 2012
The main issue in this legal case was whether the plaintiff NYU Hospital for Joint Diseases, as assignee of Michael Samilo, had demonstrated its prima facie entitlement to judgment as a matter of law in an action to recover assigned first-party no-fault benefits. The court found that the hospital had not demonstrated such entitlement, as it did not provide proof of the fact and the amount of the loss sustained as required by the Insurance Law § 5106 (a). The court denied the hospital's motion for summary judgment on this ground, finding that the documents submitted did not constitute prima facie proof of the loss sustained, specifically as there was no certification given that the bill was correct, the items were necessary, and the amount charged was reasonable. The court also found that prior cases cited by the plaintiff were not applicable to the case at hand, affirming the lower court's decision. As a result, the order was affirmed by the court, and the motion for summary judgement was denied.
Bay Plaza Chiropractic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 52315(U))
December 13, 2012
The court considered the motion for summary judgment made by the defendant, who sought to dismiss the complaint brought by the plaintiff, a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether there was a lack of medical necessity for the chiropractic services rendered, and if there was an issue of fact as to the medical necessity of the services. The court held that both the plaintiff and the defendant had established their prima facie cases, and that the sole issue for trial was the medical necessity of the services rendered to the plaintiff's assignor. The court affirmed the order, denying the defendant's motion for summary judgment.
Advanced Neurological Care, P.C. v State Farm Mut. Auto. Ins. Co. (2012 NY Slip Op 22373)
December 12, 2012
The relevant facts of the case involved plaintiff, a medical provider, submitting a claim for no-fault benefits to the defendant, an insurance company, through their attorneys. The defendant then mailed verification requests directly to the plaintiff, but failed to send copies of the letters to the plaintiff's attorneys, as requested. The main issue decided was whether the defendant's failure to send verification requests to the plaintiff's attorneys, as explicitly requested, was legally consequential, and whether the failure to send the requests to the attorneys warranted dismissing the claim. The holding of the case was that the defendant's mistake in not sending verification requests to the plaintiff's attorneys was not legally consequential, and the court ruled in favor of the defendant's cross motion for summary judgment, dismissing the claim as premature.
Magenta Med. P.C. v Clarendon Natl. Ins. Co. (2012 NY Slip Op 52236(U))
December 11, 2012
The court considered the fact that the defendant had appealed from an order of the Civil Court of the City of New York, Bronx County, which denied its motion for summary judgment dismissing the complaint. The main issue decided was whether the plaintiff had submitted timely proof of its claim for first-party no-fault benefits. The court held that in opposition to the defendant's showing of entitlement to judgment as a matter of law, the plaintiff had failed to raise a triable issue of fact. The conclusory affidavit of the plaintiff's employee and the certified mail receipt were insufficient to raise an issue of fact, especially given that the receipt contained two different postmarks and a file number that did not correspond to the plaintiff's claim. The court also noted that the plaintiff had submitted no proof of "reasonable justification" for the failure to provide timely notice of the claim. Therefore, the court reversed the order, granted the defendant's motion, and dismissed the complaint.