No-Fault Case Law

The main issue in this case was whether the supplies in question were medically necessary, as the provider was seeking to recover assigned first-party no-fault benefits. The court considered the affirmed peer review reports, which provided the factual basis and medical rationale for the peer reviewer's determination that there was a lack of medical necessity for the supplies. The court found that the defendant's showing that the supplies were not medically necessary was not rebutted by the plaintiff. Therefore, the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint. The holding of the case was that the supplies were not medically necessary and as a result, the plaintiff's motion for summary judgment was properly denied and the defendant's cross motion for summary judgment dismissing the complaint was properly granted.

The main issue in this case was whether the defendant, Praetorian Insurance Company, was entitled to summary judgment dismissing the complaint brought by MSSA Corp as assignee of Angel Curet to recover first-party no-fault benefits. The court considered whether the defendant's denial of claim form was issued within 30 days of receipt of plaintiff's claim form and if the defendant had tolled its time to pay or deny the claim by timely mailing its request for verification to the plaintiff. The court held that the defendant failed to demonstrate that the claim had been timely denied and that its defense of lack of medical necessity was not precluded. As a result, the court affirmed the order denying the defendant's motion for summary judgment dismissing the complaint.

The case involved a provider's attempt to recover first-party no-fault benefits from an insurance company. The trial court had granted the insurance company's motion to vacate a notice of trial and dismiss the complaint, compelling the provider to respond to the insurance company's discovery demands. After the trial court's order, the complaint was dismissed. The appellate court decided that the dismissal of the complaint rendered the appeal academic, and therefore dismissed the appeal. The main issue decided in this case was the dismissal of the provider's complaint for first-party no-fault benefits and whether this rendered the appeal academic. The court held that the dismissal of the complaint did indeed render the appeal academic, and therefore dismissed the appeal. Holding: The appellate court held that the dismissal of the complaint rendered the appeal academic and therefore dismissed the appeal.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County which had denied the defendant's cross motion for summary judgment dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the defendant had timely denied the claims at issue on the ground of lack of medical necessity and whether the defendant had submitted a peer review report as part of their motion papers which set forth a factual basis and medical rationale for the peer reviewer's determination. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint should have been granted because the plaintiff did not raise a triable issue of fact and failed to submit an affirmation from a doctor rebutting the conclusions set forth in the peer review report. Therefore, the court reversed the order and granted the defendant's cross motion for summary judgment dismissing the complaint.

The main issue in this case was whether the insurance company was justified in denying payment for certain acupuncture services on the grounds that the amounts charged exceeded the workers' compensation fee schedule. The court considered the affidavit submitted by the insurance company's claims examiner, which showed that the company had timely denied certain portions of the provider's claims. The court held that while the affidavit was sufficient to warrant the dismissal of some of the plaintiff's claims, it was not enough to warrant the dismissal of the claim for the initial acupuncture visit, nor to establish that the amounts charged exceeded the relevant rates set forth in the fee schedule. As a result, the court affirmed the decision to deny the insurance company's cross motion for summary judgment dismissing the complaint.

The court considered the plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The court found that the plaintiff failed to establish its prima facie entitlement to that relief by not proving the submission of a claim form and the fact and amount of the loss sustained. The main issue was whether the claim form submitted by the plaintiff constituted prima facie proof of the fact and amount of the loss sustained. The court held that in order for a claim form to constitute prima facie proof, the affidavit submitted by the plaintiff must establish that the claim form is admissible under the business records exception to the hearsay rule. As the plaintiff failed to demonstrate this, the court affirmed the denial of plaintiff's motion for summary judgment.

The Court considered the fact that the plaintiff had moved for summary judgment for recovery of first-party no-fault benefits, and the defendant had cross-moved for summary judgment to dismiss the complaint. The main issue was whether the services rendered to the plaintiff's assignor were medically necessary. The Court held that the defendant was entitled to summary judgment dismissing the complaint, as the plaintiff had not meaningfully rebutted the conclusions set forth in the peer review report submitted by the defendant. The Court also found that the facsimile signature on the report was admissible, as it was placed by the doctor who performed the peer review or at his direction. Therefore, the defendant's cross motion for summary judgment was granted, and the order was reversed.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County that granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had timely denied the portion of the plaintiff's claims at issue based upon the workers' compensation fee schedule and whether the defendant had fully paid the plaintiff for the acupuncture services billed for, in accordance with the workers' compensation fee schedule. The holding of the case 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 court found that the defendant had timely denied the claims and had fully paid the plaintiff for the acupuncture services according to the fee schedule.

The main issue in this case was whether the denial of a claim for first-party no-fault benefits by Interboro Ins. Co. on the grounds of lack of medical necessity was justified. The court considered evidence from both the defendant and the plaintiff, with the defendant submitting an affirmed peer review report stating that the treatment provided by the plaintiff was not medically necessary. The plaintiff submitted an unsworn medical report in opposition to the defendant's motion. Ultimately, the court held that the purpose of the peer review report was not to prove the injury or treatment of the plaintiff's assignor but to establish that the treatment provided was not medically necessary. The court found that the defendant was not required to demonstrate that the records fell within an exception to the rule against hearsay and granted the defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that the defendant insurer properly mailed notices for an examination under oath to the plaintiff's assignor, but the assignor failed to appear. The main issue was whether the defendant was entitled to summary judgment dismissing the action for first-party no-fault benefits. The court held that the defendant made a prima facie showing of entitlement to summary judgment by establishing that it properly mailed the notices for the examination and that the assignor failed to appear. The court also held that the plaintiff failed to raise a triable issue as to the reasonableness of the requests or the assignor's failure to attend the examination, and that the defendant was not required to demonstrate that the assignor's failure to appear was willful. Therefore, the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment dismissing the complaint.