No-Fault Case Law

The court considered the fact that Advanced Neurological Care, P.C. ("Advanced") sought to recover first party no-fault benefits for MRI's performed on Daisha Sylvester on January 17, 2012 and other treatment provided on January 24, 2012, and that State Farm Mutual Automobile Ins. Co. ("State Farm") acknowledged receipt of the claim. The main issue was whether State Farm timely mailed and properly addressed verification requests and follow-up verification requests, and whether Advanced acted in accordance with the 30-day time frame for responding to verification requests. The holding of the case was that State Farm's motion for summary judgment was denied, as the court found questions of fact regarding the timely mailing and addressed verification requests, and Advanced's cross-motion for summary judgment was also denied, as its action would be dismissed as premature if the verification requests were found to be properly addressed and timely mailed.

The relevant facts considered by the court in this case involved a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company had timely mailed verification requests and follow-up verification requests, but had not received all of the verification requested. The main issue before the court was whether the insurance company had met its obligations under the law to pay or deny the claims within a 30-day period. The court ultimately held that the insurance company had not received all the verification requested and the provider had not demonstrated that such verification had been provided before the commencement of the action, making the provider's action premature. Therefore, the judgment was reversed, the provider's motion for summary judgment was denied, and the insurance company's cross motion for summary judgment dismissing the complaint was granted.

The main issue in this case was whether or not the defendant insurance company was obligated to pay or deny a claim when the plaintiff had failed to respond to the defendant's verification requests. The court held that the defendant did not have to pay or deny a claim until it had received all relevant verification, and therefore the plaintiff's action was prematurely commenced. The court found that the defendant had timely mailed its requests and follow-up requests for verification, and that the plaintiff had not provided the requested verification to the defendant prior to the commencement of the action. As a result, the court affirmed the order granting the defendant's cross motion for summary judgment dismissing the complaint.

The main issue in this case was whether the Civil Court erred in denying the plaintiff's motion to enter a default judgment and deeming the defendant's answer "served and accepted and filed." The court found that the plaintiff did not establish their entitlement to the entry of a default judgment based on the evidence provided. However, the court also found that the Civil Court erred in deeming the defendant's answer "served and accepted and filed" as the defendant had not demonstrated a reasonable excuse for its default and a meritorious defense to the action. Therefore, the court modified the order by striking the provision deeming the defendant's answer as accepted and filed, and affirmed the order as modified.

The relevant facts considered by the court were that a medical provider sought to recover no-fault benefits from an insurance company, and the insurance company denied the claims on the basis that two of the medical provider's principals had failed to appear for examinations under oath. The main issues decided by the court were whether the medical provider had established its prima facie case, whether the insurance company's initial and follow-up examination requests had been timely and properly mailed, and whether the insurance company was precluded from raising certain defenses. The holding of the court was that the denial of the insurance company's motion to compel was reversed, and the medical provider was compelled to produce the principals for examinations before trial solely with respect to the issue of the provider's billing practices, while the provider's cross motion for summary judgment was denied.

The relevant facts considered by the court were that Ukon Medical Care, P.C. was seeking to recover first-party no-fault benefits as an assignee. The insurance company, Clarendon National Insurance Co., had denied the claims on the basis that the assignor had not submitted proper notice of the accident within 30 days. The court considered the affidavit of the defendant's claims division employee that stated the denial of claim forms had been timely mailed and that the insurance company had only learned of the accident when it received a bill two months after the accident. The main issue decided was whether defendant had established its prima facie entitlement to judgment as a matter of law, shifting the burden to the plaintiff. The court held that the defendant had indeed established its entitlement to judgment, and plaintiff, in opposition, did not present any proof to demonstrate the existence of a triable issue of fact. The holding of the case was that the order granting the defendant's motion for summary judgment and dismissing the complaint was affirmed, as plaintiff had failed to demonstrate the existence of a triable issue of fact.

The court considered the evidentiary proof submitted by the defendant, which established that the action for assigned first-party no-fault benefits was premature as it was commenced less than 30 days after the plaintiff's service of the claim. The main issue decided was whether the action for assigned first-party no-fault benefits was premature. The holding of the court was that defendant's motion was granted in its entirety and the complaint was dismissed, as the plaintiff's assertion that it mailed the claim to the defendant in March 2010 was insufficient to raise a triable issue, since the record showed that the claim related to services rendered on a different date than that set forth in the claim at issue in the case. Therefore, the court found in favor of the defendant and dismissed the complaint.

The relevant facts considered by the court in this case include an action by a provider to recover assigned first-party no-fault benefits, in which the defendant's motion for summary judgment dismissing the complaint was granted and the plaintiff's cross motion for summary judgment was denied. The main issue decided by the court was whether the evidence proffered by the defendant in support of its motion, including a police report that was not certified, was admissible. The court held that the defendant had submitted NF-2 forms from the assignors of the plaintiff, both of which asserted that the accident occurred in North Carolina, and that the remaining contentions of the plaintiff lacked merit. As a result, the court affirmed the order, finding that the plaintiff failed to raise any triable issue of fact in response to the defendant's motion.

The relevant facts the court considered were that an insurance company appealed an order granting summary judgment to a provider seeking to recover assigned first-party no-fault benefits. The insurance company had submitted two sworn peer review reports, each of which set forth the factual basis and medical rationale for the psychologist's determination that there was a lack of medical necessity for the services at issue. In opposition, the provider submitted an affidavit by a psychologist which failed to meaningfully refer to, let alone rebut, the conclusions set forth in the peer review reports. The main issue decided was whether the insurance company's evidence was sufficient to establish the lack of medical necessity and justify the denial of the claim. The holding of the court was that the insurance company's cross motion for summary judgment should have been granted, and the provider's motion for summary judgment was denied.

The court considered the timely denials of first-party no-fault benefits by the defendant insurance company. The main issue was whether the denials were timely and valid in response to claims for medical services rendered. The holding of the court was that the defendant established it had timely denied the claim for services rendered on November 16, 2007, on the ground of lack of medical necessity. However, there was an issue of fact regarding the timely denial of the claim for services rendered on October 30, 2007. The court found that there was a significant discrepancy between the date the bill was sent and the date it was received. The court also found that there was an issue of fact regarding the medical necessity of the services at issue, and the plaintiff's motion for summary judgment was properly denied. The court modified the order to vacate the finding that the claim for services on October 30, 2007 was timely denied, affirming the order in all other respects.