No-Fault Case Law

The main issues in this case were whether the denial of a claim form had been timely mailed, and whether there was lack of medical necessity for certain services billed by the plaintiff as a provider of first-party no-fault benefits. The court considered the submission of an affidavit by the defendant insurer, which established the timely mailing of the denial of claim form. Regarding the claim for a diagnostic interview, the court found that there was an issue of fact and that the branch of the defendant's cross motion to dismiss this claim should have been denied. However, for the remaining services at issue, the defendant had submitted a sworn peer review report which provided factual basis and a medical rationale for the psychologist's determination that there was a lack of medical necessity. The court concluded that the defendant was entitled to summary judgment dismissing the claims for these services, as the plaintiff's contentions on appeal lacked merit. The holding of the court was that the judgment was reversed, and so much of the order granting the defendant's cross motion seeking summary judgment dismissing the complaint insofar as it sought to recover upon the claim for a diagnostic interview was vacated. The branch of the defendant's cross motion seeking summary judgment dismissing the plaintiff's claim for the diagnostic interview was denied. The remaining order granting summary judgment dismissing the complaint insofar as it sought to recover for the remaining services was left undisturbed, and the judgment was reversed accordingly.

The court considered a denial of a claim form submitted by the defendant on the grounds of lack of medical necessity, as well as a sworn peer review report by a psychologist outlining the reasons for the determination of lack of medical necessity for the services in question. The main issue decided was whether the defendant's submission of the denial of claim form and peer review report constituted a prima facie showing for summary judgment. The holding of the case was that the defendant's prima facie showing was not rebutted by the plaintiff, and therefore the defendant was entitled to summary judgment dismissing the complaint. The judgment of the lower court was affirmed.

The court considered an appeal from an order from the Civil Court of the City of New York in a case involving a provider seeking to recover assigned first-party no-fault benefits. The main issue in the case was whether the denial of the claim form was timely mailed and whether there was a lack of medical necessity for the services at issue. The court held that the affidavit submitted by the defendant established the timely mailing of the denial of claim form and that the sworn peer review report provided a factual basis and medical rationale for the psychologist's determination that there was a lack of medical necessity for the services. Since the defendant's showing was not rebutted by the plaintiff, the court affirmed the judgment dismissing the complaint.

The court considered an appeal from a provider seeking to recover assigned first-party no-fault benefits, where the provider appealed an order denying its motion for summary judgment and granting the defendant's cross motion for summary judgment. The main issue decided was whether the defendant's affidavit established the timely mailing of the denial of claim forms and whether the defendant's submission of a sworn independent medical examination report that set forth a medical rationale for the denial of claims was sufficient to entitle the defendant to summary judgment. The holding of the court was that the affidavit submitted by the defendant established the timely mailing of the denial of claim forms and that the defendant's submission of a sworn independent medical examination report, which was not rebutted by the plaintiff, was sufficient to entitle the defendant to summary judgment dismissing the complaint. Therefore, the judgment of the lower court was affirmed.

The main issue in this case was whether the defendant-insurance company had the right to compel the plaintiff to produce its principal for deposition in regards to provider fraud based on fraudulent billing practices. The court considered the fact that the defendant-insurer's notice of deposition was deemed improper, as the defendant was precluded from raising this defense due to its failure to deny the plaintiff's no-fault first-party claim within the statutory 30-day period. The court held that the defendant's motion to compel plaintiff to produce its principal for deposition was denied, and the plaintiff's cross motion for a protective order was granted. The holding of the case was that the defendant-insurance company did not have the right to compel the plaintiff to produce its principal for deposition in relation to the fraudulent billing practices.

The court considered a provider's appeal to recover first-party no-fault benefits. The main issue decided was whether the defendant had timely denied the claims and whether there was a lack of medical necessity for the services at issue. The court held that the affidavit submitted by the defendant's litigation examiner was sufficient to establish that the claims were timely denied, and that the defendant had submitted an affirmed independent medical examination report which provided a factual basis and medical rationale for the lack of medical necessity. The court also held that as the plaintiff had not rebutted the defendant's prima facie showing, and their remaining contentions lacked merit, the defendant was entitled to summary judgment dismissing the complaint.

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, which denied the branches of the defendant's motion seeking summary judgment dismissing the complaint insofar as it sought to recover upon claims for $1,712.58, $49.26, and $67.60. The main issue decided was whether the provider was entitled to recover assigned first-party no-fault benefits for the specific claims listed. The holding of the case was that the order was reversed, and the branches of the defendant's motion seeking summary judgment dismissing the claims for $1,712.58, $49.26, and $67.60 were granted, as the plaintiff failed to meaningfully rebut the conclusions set forth in the IME report and the peer review report submitted by the defendant.

The court considered whether the essential facts of the case had been construed correctly by the lower court and if the plaintiff's counter claims were acceptable. It was decided that the lower court's implication that the defendant in the case is entitled to the full amount claimed without proper proof of no-fault coverage was incorrect. The holding of the case was that defendant's cross-motion for summary judgment was only granted to the extent of awarding summary judgment dismissing so much of the complaint as sought to recover upon plaintiff's claims in the sums of $793.24 and $274.20 and the unpaid portions of plaintiff's claims in the sums of $3,227.26 and $878.80. The cross-motion was only granted for some of the complaint, while the remaining part of the application was not accepted.

The case involved a dispute over the payment of first-party no-fault benefits to Acupuncture Works, P.C. as the assignee of Luis Quizhpi. The trial court granted the defendant's motion for summary judgment and dismissed the complaint. The main issues considered were whether the denial of claim forms had been timely mailed, if the defendant had fully paid the plaintiff in accordance with the workers' compensation fee schedule, and if there was a lack of medical necessity for the services based on an independent medical examination. The appellate court affirmed the judgment, stating that the defendant's motion for summary judgment was properly granted and the plaintiff's cross motion for summary judgment was properly denied based on the evidence presented. The holding of the case was that the appellate court affirmed the judgment of the trial court, dismissing the complaint by Acupuncture Works, P.C. The court found that the defendant had established that the denial of claim forms had been timely mailed, had fully paid the plaintiff in accordance with the workers' compensation fee schedule, and that there was a lack of medical necessity for the services based on the independent medical examination. Therefore, the defendant's motion for summary judgment was deemed proper and the plaintiff's cross motion for summary judgment was properly denied.

The main facts the court considered were the timely mailing of the independent medical examination (IME) scheduling letters by the defendant, and the failure of plaintiff's assignor to appear for the scheduled IMEs. The main issue decided was whether the defendant had timely denied the claims at issue based on the failure of the plaintiff's assignor to appear for the IMEs, thus establishing its prima facie entitlement to judgment as a matter of law. 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's submission of an affirmation of counsel failed to raise a triable issue of fact. Therefore, the order was reversed, plaintiff's motion for summary judgment was denied, and defendant's cross motion for summary judgment dismissing the complaint was granted.