No-Fault Case Law

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.

The court considered whether interest on no-fault actions accrues at the time of filing or service of the summons and complaint and the impact of the tolling of interest provisions on this determination. The main issue decided in this case was whether section 412 of the New York City Civil Court Act applies to no-fault actions brought in Civil Court, and whether the interest on actions is governed by statutory and regulatory enforcement of the New York No-Fault Law. The court held that the statutory and regulatory language of Insurance Law supercede the CPLR, mandating that first-party no-fault benefits are overdue if not paid within thirty days after the claimant supplies proof of loss. The court further ruled that the commencement of the action is the point at which interest starts accruing. Additionally, the court clarified that the Superintendent of Insurance has interpreted the tolling of interest provision to apply regardless of whether the particular denial at issue was untimely, aiming to encourage applicants to swiftly seek to resolve any dispute.

The court considered an appeal from an order of the Civil Court which denied the defendant's motion to vacate a prior order granting the plaintiff's unopposed motion for summary judgment. The main issue decided was whether the Civil Court had improvidently exercised its discretion in denying the defendant's motion to vacate the prior order. The holding of the court was that the Civil Court did not improvidently exercise its discretion, as the defendant failed to demonstrate a reasonable excuse for its failure to submit written opposition to the plaintiff's motion. Therefore, the order denying the defendant's motion to vacate was affirmed.

The court considered the issue of whether the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, was entitled to recover upon claims for services rendered on April 2, 2008, despite the failure of the plaintiff's assignor to appear for independent medical examinations (IMEs) as requested by the defendant insurance company. The plaintiff argued that the assignor was not required to respond to the IME requests because they came from a third party, but the court disagreed, stating that the scheduling letters clearly apprised the assignor that they were being sent on defendant's behalf. The court ultimately affirmed the judgment dismissing that portion of the complaint, as it found the plaintiff's arguments to be without merit. Therefore, the holding of the case was in favor of the defendant insurance company, as the plaintiff was not entitled to recover upon the claims for services rendered.

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.