No-Fault Case Law

The relevant facts considered by the court included that the plaintiff sought payment for $492.84 of health services rendered to an assignor pursuant to New York's No-Fault Law. The defendant, State Farm Mutual Automobile Insurance Company, moved to dismiss the action, contending that the plaintiff violated a policy condition for verification of the claim and failed to provide additional verification as requested. The main issues decided were whether the plaintiff's failure to respond to the defendant's Examination Under Oath (EUO) and verification requests justified dismissal of the action, and whether the EUO request for documents and information was outside the scope of permissible information. The court held that defendant was justified in seeking EUOs and further verification of plaintiff's claims, and that plaintiff's failure to respond to defendant's timely notifications was fatal to its causes of action. The court also held that the defendant's request for the production of documents and information before the EUO was troubling, but it was the plaintiff's reaction to the request that vitiates its causes of action. Ultimately, the court granted the defendant's motion to dismiss the plaintiff's complaint.

The relevant facts considered by the court included a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company had scheduled independent medical examinations (IMEs) for the provider's assignor, but the assignor failed to appear. The insurance company submitted evidence that the IME scheduling letters had been timely mailed, as well as affirmations from its examining physicians stating that the assignor had failed to appear for the scheduled IMEs. The main issue decided was whether the insurance company had established its prima facie entitlement to judgment as a matter of law. The holding of the court was that the insurance company had indeed established its prima facie entitlement to judgment as a matter of law, and therefore the court reversed the denial of the insurance company's motion for summary judgment and granted the motion, dismissing the complaint.

The relevant facts considered by the court in this case were that Midtown Medical Associates, P.C. was seeking to recover first-party no-fault benefits that had been assigned to them by Simeon Johnson. Clarendon National Insurance Co. appealed from the denial of their motion for summary judgment dismissing the complaint on the grounds of lack of medical necessity for the services provided. The main issue decided by the court was whether the affirmed peer review report submitted by Clarendon National Insurance Co. had clearly established a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the services at issue. The court held that as the peer review report failed to clearly establish a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the services at issue, the denial of Clarendon National Insurance Co.'s motion for summary judgment was proper. Therefore, the order denying the motion for summary judgment was affirmed.

The main issue in this case was whether the plaintiff's assignor had failed to appear at scheduled independent medical examinations (IMEs). The defendant moved for summary judgment dismissing the complaint, and the plaintiff cross-moved for summary judgment. The Civil Court found that both parties had established their prima facie cases, and that the only issue for trial was whether the assignor had failed to appear at IMEs. The defendant appealed the order denying its motion for summary judgment, and in support of its motion, submitted affidavits from its examining chiropractors stating that the assignor had failed to appear for the scheduled IMEs. In opposition, the plaintiff failed to raise a triable issue of fact. As a result, the court granted the defendant's motion for summary judgment dismissing the complaint.

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.