No-Fault Case Law

The main issue in this case was whether the defendant insurer's motion to strike the notice of trial and compel discovery should have been granted or denied. The court considered the plaintiff's appeal from the order of the Civil Court of the City of New York, Bronx County, which granted the defendant's motion. The court held that the defendant's demands for discovery pertaining to its affirmative defense that another insurance carrier was primarily liable were immaterial and improper. The court also determined that the defendant had not set forth any case-specific allegations in support of its defense that the plaintiff was fraudulently incorporated. Therefore, the defendant's motion to strike the notice of trial and compel discovery was reversed and denied.

The relevant facts considered by the court were that the defendant-insurer timely and properly mailed notices regarding independent medical examinations (IMEs) and examinations under oath (EUOs) to the plaintiff's assignor, who then failed to appear for these examinations. The main issue decided by the court was whether the defendant had made a prima facie showing of entitlement to summary judgment dismissing the action for first-party no-fault benefits. The court held that the defendant-insurer had indeed made a prima facie showing, as the plaintiff did not specifically deny the assignor's nonappearance or raise a triable issue with respect to the mailing or reasonableness of the underlying notices. Therefore, the court reversed the order of the Civil Court, granted the defendant's motion for summary judgment, and dismissed the complaint.

The relevant facts considered by the court included that the plaintiff sought payment for $492.84 of health services rendered to an assignor pursuant to New York's No-Fault Law. The defendant, State Farm Mutual Automobile Insurance Company, moved to dismiss the action, contending that the plaintiff violated a policy condition for verification of the claim and failed to provide additional verification as requested. The main issues decided were whether the plaintiff's failure to respond to the defendant's Examination Under Oath (EUO) and verification requests justified dismissal of the action, and whether the EUO request for documents and information was outside the scope of permissible information. The court held that defendant was justified in seeking EUOs and further verification of plaintiff's claims, and that plaintiff's failure to respond to defendant's timely notifications was fatal to its causes of action. The court also held that the defendant's request for the production of documents and information before the EUO was troubling, but it was the plaintiff's reaction to the request that vitiates its causes of action. Ultimately, the court granted the defendant's motion to dismiss the plaintiff's complaint.

The relevant facts considered by the court included a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company had scheduled independent medical examinations (IMEs) for the provider's assignor, but the assignor failed to appear. The insurance company submitted evidence that the IME scheduling letters had been timely mailed, as well as affirmations from its examining physicians stating that the assignor had failed to appear for the scheduled IMEs. The main issue decided was whether the insurance company had established its prima facie entitlement to judgment as a matter of law. The holding of the court was that the insurance company had indeed established its prima facie entitlement to judgment as a matter of law, and therefore the court reversed the denial of the insurance company's motion for summary judgment and granted the motion, dismissing the complaint.

The relevant facts considered by the court in this case were that Midtown Medical Associates, P.C. was seeking to recover first-party no-fault benefits that had been assigned to them by Simeon Johnson. Clarendon National Insurance Co. appealed from the denial of their motion for summary judgment dismissing the complaint on the grounds of lack of medical necessity for the services provided. The main issue decided by the court was whether the affirmed peer review report submitted by Clarendon National Insurance Co. had clearly established a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the services at issue. The court held that as the peer review report failed to clearly establish a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the services at issue, the denial of Clarendon National Insurance Co.'s motion for summary judgment was proper. Therefore, the order denying the motion for summary judgment was affirmed.

The main issue in this case was whether the plaintiff's assignor had failed to appear at scheduled independent medical examinations (IMEs). The defendant moved for summary judgment dismissing the complaint, and the plaintiff cross-moved for summary judgment. The Civil Court found that both parties had established their prima facie cases, and that the only issue for trial was whether the assignor had failed to appear at IMEs. The defendant appealed the order denying its motion for summary judgment, and in support of its motion, submitted affidavits from its examining chiropractors stating that the assignor had failed to appear for the scheduled IMEs. In opposition, the plaintiff failed to raise a triable issue of fact. As a result, the court granted the defendant's motion for summary judgment dismissing the complaint.

The main issue of this case was whether the court should vacate an order dismissing the complaint of PDG Psychological, P.C. after noncompliance with a prior conditional order to produce documents, including personal tax returns of its principal owner. PDG argued that the insurance company misrepresented their noncompliance and that the proposed order with notice of settlement was not timely submitted for court approval. However, the court held that PDG failed to establish the existence of any misrepresentation on the part of the insurance company, and that they did not produce the required documents in compliance with the prior order. Therefore, the court affirmed the order dismissing the complaint.

The court considered the facts of a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company had denied the benefits and moved for summary judgment to dismiss the complaint. The main issue decided was whether the insurance company had established its defense of the plaintiff's failure to appear at an independent medical examination (IME). The court held that the insurance company had failed to establish its defense based on the failure of the plaintiff's assignor to appear at an IME, as there was a discrepancy in the evidence presented by the insurance company. Therefore, the court affirmed the order denying the insurance company's motion for summary judgment.

The relevant facts the court considered in this case included a provider's attempt to recover assigned first-party no-fault benefits, with the provider seeking summary judgment on the first and second causes of action, and the denial of defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the court improperly granted plaintiff summary judgment on the first and second causes of action. The holding of the court was that the Civil Court had improperly granted plaintiff summary judgment on the first and second causes of action, and the judgment awarding the plaintiff the principal sum of $1,285.56 was reversed. The Civil Court correctly denied the branch of defendant's motion seeking summary judgment dismissing the third cause of action and also modified the order to provide that the only triable issue of fact remaining as to the third cause of action is whether verification is still outstanding.

The court considered the issue of the medical necessity of services provided to the plaintiff's assignor in a case where a provider sought to recover assigned first-party no-fault benefits. Defendant submitted peer review reports stating there was a lack of medical necessity for the services, and plaintiff's health care practitioner's affidavit did not meaningfully rebut the conclusions in the peer review reports. The Civil Court denied summary judgment and cross motion, finding the sole issue for trial was the medical necessity of the services provided. The Appellate Term reversed the decision, finding that as there was no challenge to the finding that defendant was otherwise entitled to judgment, defendant's cross motion for summary judgment dismissing the complaint was granted. The holding was that the order denying defendant's cross motion for summary judgment was reversed, and the cross motion for summary judgment dismissing the complaint was granted.