No-Fault Case Law

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.

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.