No-Fault Case Law

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.

The court considered the defendant's motion to renew its prior motion for summary judgment dismissing the complaint. The defendant offered a reasonable excuse for its inadvertent submission of motion papers relating to a companion case, provided the correct moving papers, and demonstrated the merit of its defenses. The main issue decided was whether the defendant should be granted renewal of its motion for summary judgment, and upon renewal, the defendant's motion for summary judgment dismissing the complaint was granted. The holding of the court was that the defendant's motion to renew should have been granted, and upon renewal, the defendant demonstrated entitlement to summary judgment dismissing the plaintiff's complaint seeking recovery of first-party no-fault benefits. In opposition, the plaintiff failed to raise an issue of fact requiring a trial of any of plaintiff's no-fault claims. Therefore, the defendant's motion for summary judgment was granted.

The court considered the facts of the case, where the plaintiff, State Farm Mutual Insurance Company, sought to dismiss the counterclaims made by the defendants in relation to a lawsuit for declaratory judgment and to recover no-fault payments made to the defendant professional corporations. The main issues decided were whether the defendants' counterclaims, which included claims for consequential damages, common law fraud, violation of General Business Law, punitive damages, and violation of Judiciary Law, had any legal standing. The holding of the case was that the motion made by the plaintiff to dismiss the counterclaims for consequential damages, common law fraud, violation of General Business Law, and punitive damages was granted with prejudice, as the defendants did not have a cause of action for these claims. The court also severed and continued the first cause of action for breach of contract.

The main issues in this case were whether the provider was entitled to recover no-fault benefits from the insurer, and whether the services provided were medically necessary. The court considered various causes of action brought by the provider, including the medical necessity of services rendered, and whether the insurer had timely denied the claim forms. The court found that the insurer had established timely and proper denial of claim forms based on lack of medical necessity, and that the provider failed to rebut this showing. As a result, the court granted the insurer's cross motion for summary judgment dismissing several causes of action, but allowed the provider to recover on two claim forms for a certain amount. The court also granted the insurer's motion for summary judgment dismissing the complaint as to a claim form in a different amount. Ultimately, the court affirmed the judgment in favor of the provider for a specified amount but modified the order to grant the insurer's cross motion for summary judgment on certain causes of action.

The relevant facts in this case were that Complete Radiology, P.C. was seeking to recover assigned first-party no-fault benefits on behalf of Jerrell Jacobs, and the defendant, GEICO Insurance Company, had denied the claim based on lack of medical necessity. The main issue decided by the court was whether there was a triable issue of fact as to medical necessity, as the defendant had established its prima facie entitlement to summary judgment on those grounds. The holding of the court was that the affirmed letter of medical necessity submitted by plaintiff's assignor's treating physician was sufficient to demonstrate that there is a triable issue of fact as to medical necessity, and therefore the judgment of the Civil Court was reversed, the order granting the defendant's cross motion for summary judgment was vacated, and the defendant's cross motion for summary judgment was denied.

The main issue in this case was whether the provider, Rally Chiropractic, P.C., as Assignee of NARABIA OAKLEY, was entitled to recover assigned first-party no-fault benefits from Nationwide Mutual Ins. Co. The court considered the fact that the assignor was not an eligible injured person under the policy because she did not "regularly reside" with the insured at the time of the accident. The court also considered that the defendant had timely denied the plaintiff's claim on this ground. Additionally, the court found that the plaintiff had submitted the claim more than 45 days after the services were rendered, and the reason proffered by the plaintiff for the late submission was deemed insufficient. The court ultimately held that the judgment of the Civil Court dismissing the complaint was affirmed. Therefore, the appeal was deemed to have been taken from a judgment that dismissed the complaint, and the judgment was affirmed.

The main issue in this case was the recovery of assigned first-party no-fault benefits by a provider. Quality Health Prods, as the assignee of Marisa Trottman, appealed from an order denying its motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint. The court considered the peer review report and determined that there was a lack of medical necessity for the supplies at issue. The court also found that the affirmation of the peer review report contained a factual basis and medical rationale for the determination of lack of medical necessity. Plaintiff's motion for summary judgment was denied and defendant's cross motion for summary judgment dismissing the complaint was granted. Thus, the judgment of the Civil Court was affirmed.