No-Fault Case Law

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.

The court considered the denial of a motion for summary judgment and the granting of a cross motion for summary judgment by the Civil Court. The main issue in the case was whether the defendant had timely denied the claims for first-party no-fault benefits on the ground that the supplies at issue were not medically necessary, and whether the plaintiff had failed to rebut the defendant's evidence. The holding of the case was that the judgment to dismiss the complaint was affirmed, as defendant had established that it had timely denied the claims and plaintiff had failed to rebut the evidence. The court also decided that the defendant was not required to annex copies of the medical records reviewed by defendant's peer reviewer, and that the peer review report was admissible despite containing an electronic stamped facsimile of the peer reviewer's signature.

The relevant facts considered by the court in this case were related to the denial of first-party no-fault benefits sought by Midwood Total Rehabilitation Medical, P.C. as Assignee of Jenny Carmen Hernandez, based on the failure of Hernandez to appear for scheduled independent medical examinations (IMEs). The main issue decided in this case was whether the denial of the claims by State Farm Mutual Automobile Ins. Co. was justified due to the failure of Hernandez to attend the scheduled IMEs. The holding of the court was that State Farm Mutual Automobile Ins. Co. had timely mailed the IME scheduling letters and the denial of claim forms, and had provided affidavits from its examining physician, chiropractor, and acupuncturist, all of whom stated that Hernandez had failed to appear for the scheduled IMEs. As a result, the court determined that State Farm had established its entitlement to judgment as a matter of law and granted their motion for summary judgment dismissing the complaint.

The court considered the fact that the plaintiff, Med-Tech Product, Inc., was seeking to recover assigned first-party no-fault benefits from the defendant, Progressive Northeastern Insurance Co. The main issue in the case was whether the defendant had timely mailed requests and follow-up requests for verification to the plaintiff, and whether the plaintiff had failed to provide the requested verification. The court held that the affidavit of the defendant's claims examiner established that the defendant had timely mailed its requests and follow-up requests for verification to the plaintiff, and that the plaintiff had failed to provide the requested verification. As a result, the 30-day period within which the defendant was required to pay or deny the claims did not begin to run, and the plaintiff's causes of action upon these claims were premature. Therefore, the court affirmed the lower court's decision to grant the branches of the defendant's motion seeking summary judgment dismissing the third and sixth causes of action.

The main issue in this case was whether a provider was entitled to recover assigned first-party no-fault benefits from an insurance company. The court considered the fact that the insurance company had denied the claims on the grounds that the services provided were not medically necessary, and that the provider had failed to rebut the insurance company's evidence. The court found that the insurance company had established timely denial of the claims and that the provider had not provided sufficient evidence to counter this. As a result, the court affirmed the judgment in favor of the insurance company, dismissing the complaint brought by the provider. The holding of the case was that the insurance company was not required to provide copies of the medical records reviewed by its peer reviewer, as argued by the provider, and that the provider's contentions on appeal were without merit. As a result, the judgment in favor of the insurance company was affirmed.

The relevant facts the court considered in this case include that defendant denied the claim based on a sworn peer review report which set forth a factual basis and medical rationale for the peer reviewer's determination that there was a lack of medical necessity for the services provided. In support of its cross motion, defendant submitted affidavits from its claims division employees which showed that the claim denial forms had been timely mailed. The affidavits further established that defendant had properly used the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount plaintiff was entitled to receive for the services. The main issue decided was whether the denial of the bill underlying plaintiff's first cause of action was valid based on the sworn peer review report. The holding of the court was that 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 main issue of the case was whether the defendant's motion for summary judgment dismissing the complaint should have been granted as to the services rendered from August 2, 2007 to August 9, 2007. The court considered the fact that the defendant had demonstrated, prima facie, that it had timely denied the claims at issue, but the plaintiff's employee's affidavit created a triable issue of fact as to whether the claim had been timely denied. As a result, the court held that the defendant's motion for summary judgment dismissing the complaint should not have been granted as to that claim. The judgment was reversed, and the branch of defendant's cross motion seeking summary judgment dismissing the complaint as to the services was vacated and denied. Therefore, the plaintiff's appeal was successful in this aspect.