No-Fault Case Law

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.

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.