No-Fault Case Law

The court was considering an appeal from an order granting a motion to dismiss the complaint of a provider seeking to recover assigned first-party no-fault benefits. The order compelled the plaintiff to respond to the defendant's discovery demands. Subsequent to this order, the Civil Court entered another order dismissing the complaint, which made the appeal academic. The main issue of the case was whether the dismissal of the complaint made the appeal moot. The holding of the court was that the dismissal of the complaint rendered the appeal academic, and therefore, the appeal was dismissed.

The relevant fact considered by the court was that a no-fault provider was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the provider demonstrated its prima facie entitlement to summary judgment by proving the submission of a claim form, proof of the amount and fact of the loss sustained, and the failure of the defendant to pay or deny the claim within the requisite 30-day period. The holding of the case was that the provider failed to demonstrate that the defendant had failed to deny the claim or that the denial of the claim was legally insufficient, thus granting summary judgment to the defendant and dismissing the complaint.

The case involved a chiropractic office, Axis Chiropractic, attempting to recover assigned first-party no-fault benefits from Geico General Insurance Company. Axis Chiropractic appealed an order from the Civil Court which denied their motion for summary judgment and granted Geico’s cross motion for summary judgment. Geico had submitted an affidavit and independent medical examination (IME) reports that supported their denial of the claim based on lack of medical necessity. Axis Chiropractic failed to submit an affirmation or affidavit from a medical professional to rebut the IME reports, and therefore did not raise a triable issue of fact. As a result, the judgment to dismiss the complaint was affirmed by the court.

The relevant facts considered by the court were that plaintiff, as an assignee of an individual, was seeking to recover first-party no-fault benefits from defendant. Plaintiff's motion for summary judgment was denied and defendant's cross motion for summary judgment was granted, resulting in the dismissal of the complaint. The main issue decided by the court was whether defendant timely mailed denial of claim forms and whether there was a lack of medical necessity for the services rendered. The holding of the court was that defendant had timely mailed the denial of claim forms and had provided an affirmed independent medical examination report setting forth a basis and medical rationale for the determination of lack of medical necessity. In addition, the court held that plaintiff failed to raise a triable issue of fact by not submitting evidence rebutting the conclusions set forth in the independent medical examination report, and therefore the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment was proper.

The relevant facts considered by the court were that defendant had timely mailed denial of claim forms which denied the claims on the ground of lack of medical necessity, and had submitted an independent medical examination (IME) report which provided a factual basis and medical rationale for the determination by defendant's chiropractor that there was a lack of medical necessity for the services rendered. The main issue decided by the court was whether plaintiff raised a triable issue of fact in opposition to defendant's cross motion for summary judgment dismissing the complaint. The holding of the court was that in opposition to defendant's motion, plaintiff failed to raise a triable issue of fact, as it did not submit an affirmation or an affidavit from a medical professional rebutting the conclusions set forth in the IME report, so the Civil Court's grant of defendant's cross motion for summary judgment dismissing the complaint was proper.

The relevant facts of this case include an action by a medical supply company to recover assigned first-party no-fault benefits. The defendant insurance company had timely denied the claim on the ground of lack of medical necessity and supported their motion for summary judgment with an affirmed independent medical examination (IME) report. The main issue decided was whether the plaintiff had raised a triable issue of fact to rebut the conclusions set forth in the IME report, and the court held that they had not. The court affirmed the judgment of the Civil Court, granting the defendant's motion for summary judgment and dismissing the complaint. The decision was made on January 14, 2013.

The relevant facts considered by the court were that Alfa Medical Supplies was seeking to recover assigned first-party no-fault benefits from GEICO General Insurance Company. GEICO had timely mailed the denial of claim form and provided a sworn peer review report which indicated a lack of medical necessity for the supplies provided. The main issue decided was whether Alfa Medical Supplies had provided enough evidence to rebut GEICO's prima facie showing of lack of medical necessity for the supplies. The court held that Alfa Medical Supplies had provided an affidavit from its doctor which demonstrated the existence of a question of fact as to the medical necessity of the supplies, and therefore, GEICO's motion for summary judgment should have been denied. As a result, the judgment was reversed, and GEICO's cross motion for summary judgment was denied.

The relevant facts the court considered in this case were whether the defendant's NF-10 form denying the plaintiff's no-fault benefits claim based on lack of medical necessity had been timely mailed, and whether the peer review report submitted by the defendant was admissible. The main issue was whether defendant's motion for summary judgment should be granted and plaintiff's cross motion for summary judgment denied. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was denied and the plaintiff's cross motion for summary judgment was also denied. The court found that the peer review report submitted by the defendant was not in admissible form, and while the plaintiff demonstrated that the claim had not been paid, it failed to demonstrate that the defendant had issued a legally insufficient denial of claim form. Therefore, the order was modified by providing that plaintiff's cross motion for summary judgment is denied.

The court considered the appeal of a provider seeking to recover first-party no-fault benefits, which was dismissed by the Civil Court. The main issue was whether the plaintiff's release of all claims related to the instant case, including the claims in the complaint, voluntarily relinquished their right to recover upon those claims. The court held that the plaintiff's execution of a release bearing the caption of the case and its index number, which stated that the plaintiff released all claims ever had, now have, or hereafter can, shall, or may have for, upon, or by reason of, an assignment of rights from its assignor, effectively relinquished their right to recover upon the claims forming the object of the instant action. As a result, the court dismissed the appeal.

The court in this case considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted summary judgment in favor of the plaintiff, Eastern Star Acupuncture, P.C., in their action to recover assigned first-party no-fault benefits from the defendant, American Transit Insurance Company. The main issue decided was whether the defendant was entitled to summary judgment dismissing the plaintiff's complaint. The court held that the defendant was entitled to summary judgment dismissing the plaintiff's claim for $612.59 and a claim for $167.07 for services rendered on September 8, 2006 through September 19, 2006, as the defendant had established that these claims had been timely denied on the grounds that the assignor had failed to appear at independent medical examinations. However, the court did not disturb the part of the order that awarded the plaintiff summary judgment with respect to a claim for $167.07 for services rendered on August 15, 2006 and other claims totaling $668.28 and $222.76, as the defendant had failed to establish timeliness of denial for these claims.