No-Fault Case Law

The relevant facts of the case A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co. were that the plaintiff, a medical provider and professional service corporation, sought to recover no-fault benefits for medical services allegedly rendered to a person injured in an automobile accident. The appellant identified medical professionals on claim forms as independent contractors. The insurer failed to issue a written denial of coverage based on the independent contractor issue. The insurer moved for summary judgment, which was granted by the Civil Court and affirmed by the Appellate Term. The Appellate Division, Second Department reversed the judgment. The main issue was whether the plaintiff, as assignee of the injured person, was entitled to recover no-fault benefits from the insurer where the medical professionals were independent contractors. The court held that the insurer was precluded from raising the independent contractor defense because it failed to issue a timely denial of the claim on that ground. The court also held that the defense of lack of a valid assignment is precluded if not timely asserted. The holding of the case was that the insurer's motion for summary judgment was denied because it was precluded from raising the independent contractor defense.

The relevant facts the court considered in this case involved an insurance policy issued in Connecticut to the insured, who purportedly resided in Connecticut, for a vehicle garaged in Connecticut. The only connection to New York was that the third-party assignors were injured while riding in the insured's vehicle in New York. Plaintiff moved for summary judgment to recover first-party no-fault benefits, while defendant cross-moved for summary judgment dismissing the complaint based on the rescission of the automobile insurance policy. The main issue decided was whether Connecticut or New York law was controlling and whether the retroactive rescission of the insurance policy affected the rights of the innocent third-party assignors. The court held that Connecticut law was controlling under New York's conflict of law rules and that any retroactive rescission of the insurance policy did not affect the rights of the innocent third-party assignors, so defendant's cross motion for summary judgment dismissing the complaint was properly denied. Therefore, the court affirmed the order.

The main issue in this case was whether the defendant, New York Central Mutual Fire Insurance Company, was entitled to summary judgment dismissing the complaint brought by Infinity Health Products, Ltd as the assignee of Damian Thomas. The court considered the fact that the defendant had submitted evidence of timely mailing of independent medical examination (IME) scheduling letters and denial of claim forms, and that the plaintiff's assignor had failed to appear for the scheduled IMEs. The court held that the defendant had established its prima facie entitlement to judgment as a matter of law, as the plaintiff's evidence failed to raise a triable issue of fact. As a result, the court reversed the order of the Civil Court, and granted the defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that New Way Acupuncture, P.C. was seeking to recover first-party no-fault benefits as the assignee of Doreen L. Polanco. The main issue decided was whether the defendant was entitled to summary judgment dismissing the third, fourth, fifth, and sixth causes of action on the ground that Polanco had failed to appear for scheduled independent medical examinations (IMEs). The court held that the branches of the defendant's motion seeking summary judgment dismissing these causes of action were granted, as it was established that Polanco had failed to appear for the IMEs. Thus, the court reversed the denial of the defendant's motion and found that the defendant was entitled to judgment with respect to the causes of action.

The court considered the fact that the defendant, a medical services provider, was seeking to recover first-party no-fault benefits from the insurance company. The defendant had moved for summary judgment to dismiss the complaint, with the central issue being whether the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs), which was a condition precedent to the insurer's liability on the policy. The insurance company submitted evidence, including an affidavit of an employee of the entity that scheduled the IMEs and affirmations of its doctors, establishing that the plaintiff's assignor had indeed failed to appear for the scheduled IMEs. The court held that since the plaintiff had only submitted an affirmation from its counsel, it had failed to raise a triable issue of fact. Therefore, the court ruled in favor of the insurance company, granting its motion for summary judgment and dismissing the complaint.

The case involved an action to recover assigned first-party no-fault benefits for dental services provided to plaintiff's assignor as a result of injuries sustained in an automobile accident. Defendant Preferred Mutual Insurance Company had previously commenced a declaratory judgment action against plaintiff's assignor, in which it was declared not obligated to provide no-fault benefits or defend any claims for bodily injury or property damage on its policy issued to the assignor. The main issue in this case was whether the instant action was barred by virtue of the order in the declaratory judgment action. The court held that plaintiff was not subject to dismissal by virtue of the order in the declaratory judgment action, as it was neither named nor served in that action and had no full and fair opportunity to appear and defend its interests in that proceeding. As a result, the defendant's motion for summary judgment was properly denied, and the order of the Civil Court was affirmed.

The court considered the fact that EBM Medical Health Care, P.C. had commenced an action to recover first-party no-fault benefits for medical services provided to its assignor as a result of injuries sustained in an automobile accident. The insurance company Republic Western Insurance initiated a declaratory judgment action alleging that EBM was not properly licensed to recover no-fault benefits. A judgment was entered, on default, in the declaratory judgment action where Republic had no duty to pay no-fault benefits to EBM. After the judgment in the declaratory judgment action, Republic moved in this no-fault action for summary judgment dismissing EBM's complaint. The main issue decided was whether the no-fault action was barred by virtue of the declaratory judgment. The holding of the court was that the instant action was barred under the doctrine of res judicata and that the no-fault action falls within the ambit of the declaratory judgment as a "current" proceeding. Therefore, the order of the Civil Court was reversed and Republic's motion for summary judgment dismissing the complaint was granted.

The relevant facts the court considered in this case were that the defendant had timely mailed denial of claim forms, denying the claims on the ground of lack of medical necessity. The defendant also submitted the affirmed reports of its peer reviewer, which set forth a factual basis and medical rationale for the doctor's opinion that there was a lack of medical necessity for the services provided to the plaintiff's assignor. In response, the plaintiff failed to submit any medical evidence sufficient to raise a triable issue of fact as to medical necessity. The main issue decided by the court was whether the defendant established its prima facie entitlement to summary judgment, and whether the plaintiff submitted sufficient evidence to raise a triable issue of fact as to medical necessity. The holding of the court was that the order granting the plaintiff's motion for summary judgment was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court in Rainbow Med. Care, P.C. v Kemper Ins. Co. included the timely scheduling of independent medical examinations (IMEs) and the assignor's failure to appear for the IMEs. The main issue decided by the court was whether the defendant had established that the IME scheduling letters had been timely mailed, and whether the assignor's failure to appear for the IMEs had been sufficiently established. The holding of the court was that the defendant had sufficiently established the timely mailing of the IME scheduling letters, as well as the assignor's failure to appear for the IMEs. Therefore, the court granted the defendant's motion for summary judgment dismissing the complaint.

The relevant facts of the case were that Okslen Acupuncture, P.C. brought a lawsuit against NY Central Mutual Fire Ins. Co. for failing to timely deny the claim for first-party no-fault benefits within the prescribed 30-day period. The main issue decided was whether the defendant insurer was precluded from asserting the defense that the fees charged were excessive due to not timely denying the claim. The holding of the case was that the defendant insurer was indeed precluded from asserting the defense, and the court granted plaintiff summary judgment in the principal amount demanded in the first cause of action. The court also did not pass upon plaintiff's request for statutory interest and attorneys' fees.