No-Fault Case Law

The court considered whether a provider was entitled to recover assigned first-party no-fault benefits. The main issues were the timeliness of the provider's submission of the claim for services rendered, and whether there was medical necessity for the services provided. The court held that there was a triable issue of fact regarding the timeliness of the submission of the claim, and that neither party was entitled to summary judgment on this claim. Additionally, the court found that the provider failed to rebut the insurer's prima facie showing of a lack of medical necessity, and granted the insurer's motion seeking summary judgment on the claims for services provided from October 5, 2007 through February 21, 2008.

The court considered whether the defendant's motion for summary judgment dismissing the complaint would be granted. This was based on the fact that the defendant denied the plaintiff's claims on the ground that the plaintiff's assignors had failed to appear for scheduled examinations under oath (EUOs). The main issue was whether the certificate of conformity which accompanied the affidavit of Marcy Gonzalez, the defendant's claims representative, complied with CPLR 2309 (c). The court held that while an affidavit which is executed outside of New York State must be accompanied by a certificate of conformity, a party may be permitted to secure such certificate later and give it nunc pro tunc effect. The court affirmed the order, without costs, conditionally granting the defendant's motion for summary judgment.

The court considered the denial of plaintiffs' motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiffs had demonstrated their prima facie entitlement to judgment as a matter of law. The holding of the court was that the District Court properly denied the plaintiffs' motion for summary judgment on the grounds that they had not shown their prima facie entitlement to judgment as a matter of law. The decision of the court was to affirm the order, without costs.

The court considered the motion for summary judgment by the plaintiff, Westchester Medical Center, in a case to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had demonstrated its prima facie entitlement to judgment as a matter of law. The court held that the District Court properly denied the plaintiff's motion for summary judgment on the grounds that the plaintiff had not demonstrated its entitlement to judgment as a matter of law. The appellate court affirmed the denial of the motion for summary judgment. Therefore, the holding of the case was that the plaintiff did not demonstrate its entitlement to judgment as a matter of law, and the motion for summary judgment was properly denied.

The main issues in this case were whether the peer review reports submitted by the defendant were admissible and whether they demonstrated a lack of medical necessity for the supplies provided by the plaintiff's assignor. The court found that the peer review reports were sufficient to demonstrate a lack of medical necessity, but the plaintiff argued that the doctor's signatures on the reports were not admissible because they were electronically generated or stamped. The court held that this issue raised by the plaintiff should be resolved through a hearing to determine the validity of the doctor's signatures, in accordance with CPLR 2218. As a result, the judgment was reversed, the order was vacated, and the matter was remitted to the Civil Court for a hearing on the admissibility of the peer review reports, with a new determination to be made afterwards.

The relevant facts considered by the court were that Complete Radiology, P.C. was appealing from an order which denied its motion for summary judgment in an action to recover assigned first-party no-fault benefits from Progressive Insurance Company. The main issue decided in this case was whether the provider had established its entitlement to summary judgment by proof of submission of a claim form, proof of the fact and the amount of the loss sustained, and proof either that the defendant had failed to pay or deny the claim within the requisite 30-day period, or that the defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law. The holding of the court was that the provider's affidavit failed to state unequivocally that defendant's denial of claim forms were either untimely or without merit as a matter of law, and thus the order denying the motion for summary judgment was affirmed.

The relevant facts of the case involved an appeal from an order denying plaintiff's motion for summary judgment and granting the defendant's cross motion seeking to compel plaintiff to respond to specified discovery demands and produce a doctor for a deposition. The main issue decided was whether the plaintiff had established its entitlement to judgment as a matter of law and whether the defendant's discovery demands were legitimate. The holding of the case was that the defendant's discovery demands were considered palpably improper in relation to the plaintiff's claims, and the branch of the defendant's cross motion seeking to compel plaintiff to provide responses to specified discovery demands and to produce a doctor "with relevant knowledge of the claim for a deposition . . . with regard to [defendant's] staged accident defense" was denied.

The relevant facts considered in this case were that an insurance provider was seeking to recover no-fault benefits on behalf of a policyholder and appealed the dismissal of their complaint. The main issues decided were whether the insurance company had followed proper procedures in requesting an examination under oath (EUO) and whether the provider had failed to appear at the scheduled EUOs, which would be a condition precedent to the insurer's liability on the policy. The holding of the case was that the insurance company had established that the scheduling letters and denial of claim forms had been timely mailed and that the provider had failed to appear at the scheduled EUOs, therefore affirming the judgment in favor of the insurance company.

The relevant facts considered by the court were that VE Medical Care, P.C. was seeking to recover first-party no-fault benefits from Auto One Ins. Co. as the assignee of Felipe Dominguez. The court granted the defense's motion to vacate a notice of trial and leave to amend the answer, as well as to compel plaintiff to respond to discovery requests and provide specified documents. The main issues decided were whether the notice of trial and certificate of readiness filed by plaintiff contained an erroneous statement about the completion of discovery, and whether the defense had valid reasons to believe that the plaintiff was ineligible to recover benefits and to warrant disclosure of specific tax documents. The holding of the court was that the order to vacate the notice of trial and amend the answer, as well as the request for specific documents, were affirmed, without costs. It was found that the defense had valid reasons to believe that the plaintiff was ineligible to recover benefits and to warrant disclosure of specific tax documents. Therefore, plaintiff's remaining contentions were found to lack merit, and the order, insofar as appealed from, was affirmed.

The court considered the facts that the defendant had hired a company to schedule independent medical examinations (IMEs) for the purpose of determining coverage for first-party no-fault benefits. The plaintiff's assignor had failed to appear for the scheduled IMEs, leading to the defendant's denial of the claim for benefits. The main issue decided was whether the assignor's failure to comply with the scheduled IMEs constituted a breach of a condition precedent to the insurance policy, and thus relieving the insurer of liability. The holding of the court was that the appearance of the assignor at an IME was indeed a condition precedent to the insurer's liability on the policy, and as such, the defendant's motion for summary judgment dismissing the complaint was granted.