No-Fault Case Law

The relevant facts considered by the court were that a provider, Parsons Medical Supply, Inc., had filed claims for $865 and $1,737 on January 28, 2008 and February 6, 2008, and the defendant insurance company did not pay or deny the claims within 30 days of receipt. The insurance company had sent letters to the provider indicating that they were investigating the claims and obtaining verification, including examinations under oath. The main issue decided by the court was whether the insurance company's delay letters were sufficient to toll the 30-day statutory time period within which a claim must be paid or denied. The holding of the case was that the insurance company's delay letters, which requested no verification, were insufficient to toll the 30-day statutory time period, and therefore the insurance company failed to demonstrate that the claims had been timely denied. As a result, the judgment was reversed, the order granting the insurance company's cross motion for summary judgment dismissing the complaint was vacated, and the insurance company's cross motion was denied.

The court considered a prior arbitration proceeding involving the defendant and a third health care provider who had provided services to the same assignor for injuries from the same accident. The main issue was whether the doctrine of collateral estoppel, based on the prior arbitration decision, should bar the relitigation of the issue in the Civil Court, requiring the complaints to be dismissed. The court held that the doctrine of collateral estoppel applies only against those who were either a party, or in privity with a party, to a prior proceeding, and as it had not been demonstrated that the plaintiff was either a party or in privity with a party to the prior arbitration proceeding, the doctrine of collateral estoppel was inapplicable. Therefore, the judgment was reversed, the order granting the defendant's motion to dismiss the complaints was vacated, the defendant's motion was denied, and the matter was remitted to the Civil Court for all further proceedings.

The court considered an appeal from an order denying defendant's motion for summary judgment dismissing the complaint in a case by a provider to recover assigned first-party no-fault benefits. The only issue on appeal was whether the services provided were medically necessary, as the timeliness of defendant's denials was conceded by the plaintiff. Defendant submitted two affirmed peer review reports to support their motion, which stated there was a lack of medical necessity for the services. However, the plaintiff submitted an affidavit from a doctor which demonstrated the existence of a question of fact as to medical necessity. The court affirmed the order without costs, holding that there was a question of fact as to the medical necessity of the services provided.

The relevant facts the court considered in this case were that Quality Health Products filed a notice of trial and certificate of readiness stating that all discovery had been completed, even though they had failed to provide responses to the defendant's demand for discovery and inspection. The main issue decided was whether the defendant's motion to vacate the notice of trial and to compel plaintiff to respond to defendant's outstanding discovery demands should be granted. The holding of the case was that the defendant's timely motion to vacate the notice of trial was properly granted, as Quality Health Products had failed to provide responses to the defendant's demand for discovery and inspection. The court also compelled Quality Health Products to provide responses to the defendant's outstanding discovery demands, as they did not challenge the propriety of the defendant's demand for discovery and inspection in a timely manner.

The relevant facts the court considered in this case were that the defendant had timely mailed letters scheduling independent medical examinations (IMEs) for the plaintiff's assignor. However, the plaintiff's assignor had failed to appear for the scheduled IMEs. The defendant had also timely denied the plaintiff's claim on the ground that the assignor had failed to appear at the scheduled IMEs. The main issue decided by the court was whether the defendant was entitled to summary judgment dismissing the complaint. The holding of the case was that the judgment in favor of the plaintiff was reversed, the order granting the plaintiff's motion for summary judgment was vacated, and the defendant's cross motion for summary judgment dismissing the complaint was granted. Therefore, the defendant was entitled to summary judgment dismissing the complaint.

The relevant facts considered by the court in the case of Biddle v Safeco Ins. Co. included a dispute over first-party no-fault benefits, with the plaintiff, a medical provider, seeking to recover assigned benefits from the defendant insurance company. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The court held that the motion for summary judgment was properly denied, as the defendant's motion papers failed to establish the timeliness of the denial of claim form and the defense that the plaintiff's assignor had misrepresented her residence in connection with the insurance policy. The court found that the affidavit of the defendant's claims representative did not constitute evidence in admissible form, and as a result, the motion for summary judgment was properly denied.

The court considered the fact that the defendant had timely mailed the initial and follow-up requests for verification to the plaintiff, but had not received the requested verification. As a result, the 30-day period within which the defendant was required to pay or deny the claims did not begin to run and the plaintiff's action was found to be premature. The main issue decided was whether the defendant's failure to receive the requested verification prior to the commencement of the action justified the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment dismissing the complaint. The holding was that the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The court considered the denial of the defendant's motion for summary judgment in a case where a provider was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether there was a triable issue of fact as to the medical necessity of the services at issue, based on the affidavit of the plaintiff's treating chiropractor. The court held that there was indeed a triable issue of fact, and therefore denied the defendant's motion for summary judgment. Additionally, the court found that the award of motion costs to the plaintiff was not an improper exercise of discretion. Therefore, the order denying the defendant's motion for summary judgment was affirmed by the court.

The relevant facts considered by the court in the case of Neomy Medical, P.C. v Clarendon National Insurance Company involved a provider seeking to recover assigned first-party no-fault benefits from the insurance company. The main issue decided was whether the insurance company had timely denied the claims at issue and if it was precluded from raising its defense of lack of medical necessity. The court held that the insurance company's affidavit failed to establish that it had timely denied the claims, and therefore, the provider's claims were not precluded. Therefore, the court affirmed the denial of the insurance company's cross motion for summary judgment dismissing the complaint.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which denied the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether there was a question of fact as to the medical necessity of the services in question. The court held that the plaintiff's submission of an affidavit from its doctor demonstrated the existence of a question of fact as to medical necessity, and therefore, the defendant's cross motion for summary judgment was properly denied. The decision was affirmed without costs.