No-Fault Case Law

The relevant facts the court considered in this case were that a provider was seeking to recover assigned first-party no-fault benefits, and the insurance company argued that the policy had been cancelled prior to the accident. The main issue decided was whether the insurance company had validly cancelled the policy in compliance with Vehicle and Traffic Law § 313. The holding of the case was that the burden was on the insurer to demonstrate a valid cancellation of the insurance policy, and once the insurance company made a prima facie showing that it had timely and validly cancelled the policy, the burden shifted to the party claiming coverage to establish noncompliance with statutory requirements as to form and procedure. In this case, the papers submitted in support of the insurance company's cross motion were sufficient to demonstrate prima facie that the policy had been timely and validly cancelled, and the provider did not raise a triable issue of fact as to the validity of the cancellation, so the court reversed the order and granted the insurance company's cross motion for summary judgment dismissing the complaint.

The court considered the facts surrounding a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The insurance company requested an examination under oath (EUO) for the plaintiff's assignor, but the assignor failed to appear. However, the insurance company did not mail a second request until after the 30-day claim determination period had passed, making their denial of the claim untimely. The main issue decided by the court was whether the insurance company's failure to timely send a second request for an EUO could be used as a defense against the plaintiff's motion for summary judgment. The holding of the case was that the insurance company's denial of the claim was untimely, and therefore, the judgment in favor of the plaintiff was affirmed.

The case involved an action by a provider to recover assigned first-party no-fault benefits. The defendant, an insurance company, had denied the plaintiff's claims on the ground of lack of medical necessity, and filed a cross motion for summary judgment dismissing the complaint. The main issue was whether the defendant's denial of the claims was valid, and the admissibility of the peer review reports submitted as evidence in support of the cross motion for summary judgment. The court held that the affidavit executed by the defendant's claims examiner was sufficient to establish that the denial forms had been timely mailed, but the peer review reports were not admissible as they were affirmed by a psychologist, which is not permissible, and failed to meet the requirements of CPLR 2309 (b). Therefore, the cross motion for summary judgment dismissing the complaint was denied.

The relevant facts considered by the court in this case were that Vista Surgical Supplies, Inc. was seeking to recover assigned first-party no-fault benefits based on a claim form that was allegedly mailed to Clarendon National Insurance Company. However, the proof of mailing provided by Vista Surgical lacked certain material information. The certified mail receipt did not contain amounts for postage and fees, and did not have a clerk identification and date, and the return receipt was not signed by a recipient and did not indicate a date of delivery. Clarendon National Insurance Company testified that they had not received the claim form until after the commencement of the action, three years after the purported mailing. The main issue decided in this case was whether Vista Surgical Supplies, Inc. had proven that the claim form in question had been timely and properly mailed to Clarendon National Insurance Company, in order to recover the assigned first-party no-fault benefits. The holding of the case was that the judgment of the Civil Court, which dismissed the complaint, was affirmed. The court found that Vista Surgical Supplies, Inc. had failed to satisfy its burden of proving that the claim form in question had been timely and properly mailed to Clarendon National Insurance Company. The court determined that there was no basis to disturb the Civil Court's findings regarding the failure to prove timely and proper mailing of the claim form.

The court considered the defendant's application to dismiss the case as premature due to the plaintiff's failure to respond to verification requests, as well as the plaintiff's cross-motion for summary judgment. The main issues decided included whether the defendant's verification requests were timely sent and whether they sought improper and impermissible information. The court held that the defendant's affidavits did not adequately demonstrate timely mailing of verification requests, and that the requests for information on sale of shares, transfer of ownership, and lease agreements were improper and abusive. As a result, the plaintiff's cross-motion for summary judgment was granted, and the defendant was ordered to submit judgment on twenty days' notice.

The court considered the defendant's motion to strike the notice of trial and to compel discovery, as well as the plaintiff's cross-motion for a protective order. The main issue decided was whether the defendant's motion to strike the notice of trial and to compel discovery should be granted, and whether the plaintiff's cross-motion for a protective order should be denied. The holding of the court was that the defendant's motion to strike the notice of trial and to compel discovery was granted, and the plaintiff's cross-motion for a protective order was denied. The court found that the plaintiff had not timely challenged the demands for disclosure, and therefore was obligated to produce the requested information. Additionally, the court found that the defendant was entitled to an examination before trial of the plaintiff's principle owner, as it was material and necessary to its defense.

The court considered the insurer's request for verification information about the claimant provider's corporate structure and ownership, and the claimant provider's failure/refusal to provide the information. The main issues were whether the claimant provider had the right to object to a verification request, and what the effect of the objection to the verification request would be. The court held that a provider can object to a verification request to preserve the right to challenge the request, and that the failure to provide verification, if properly requested, will result in the dismissal of the action. However, the court also held that the insurer must have a reasonable, good faith, factual basis for requesting the verification. The court ultimately denied the defendant's motion for summary judgment as well as the plaintiff's cross-motion, as the plaintiff failed to establish the documents submitted were business records.

The court considered the evidence presented by the plaintiff that the statutory billing form had been mailed to and received by the defendant insurance company but had not been paid or denied within the 30-day period as required by law. The main issue was whether the defendant insurer had raised a triable issue of fact to deny receipt and the no-fault billing within the requisite 30-day period, and whether they had provided insufficient submissions to raise triable issues of fact with respect to a lack of coverage defense. The holding of the court was that the plaintiff's motion for summary judgment on the complaint was granted, as the defendant had not raised a triable issue of fact and their submissions were insufficient to raise triable issues of fact with respect to the lack of coverage defense.

The court considered the defendant-insurer's motion for summary judgment dismissing the complaint. The main issue decided was whether the plaintiff, Comprehensive Neurological Services, PA, was entitled to no-fault first-party benefits from the defendant, Tri-State Consumer Insurance Company. The court held that the defendant's motion for summary judgment should be granted, and the complaint dismissed, as the plaintiff failed to raise a material issue requiring a trial of its claim for the benefits. The court found that the affidavit provided by the plaintiff's medical billing supervisor did not provide sufficient evidence to indicate that the verification letters sent by the defendant had been documented as received. Therefore, the defendant's proof of proper mailing of the verification letters established a presumption of receipt that the plaintiff failed to overcome.

The main issue in this case was whether the court should issue an order staying and enjoining all pending and future lawsuits and arbitrations instituted against the plaintiff, 21st Century Advantage Insurance Company, for the recovery of no-fault benefits and/or reimbursement for health care services rendered pursuant to automobile insurance policies previously issued by the plaintiff. The court considered the motion filed by the plaintiff and the cross motion filed by codefendant All Boro Psychological Services, P.C., which sought to dismiss the plaintiff's complaint, sever the claims asserted against it, and extend its time to serve an answer to the verified complaint. The court found that a separate or "cross" motion was not necessary and granted the plaintiff's motion to stay and enjoin all pending and future lawsuits and arbitrations.