No-Fault Case Law

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint in a no-fault benefits case. The defendant for this case, a provider to recover assigned first-party no-fault benefits, appealed from an order of the Civil Court which denied its motion for summary judgment dismissing the complaint. The appellate court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint. The court held that the defendant, in support of its motion, submitted an affidavit by its biomechanical engineer, which was in admissible form and demonstrated the lack of a causal connection between the accident and the injuries claimed by the plaintiff's assignors. The burden then shifted to the plaintiff to rebut the defendant's showing, but it failed to do so. Therefore, the defendant was entitled to judgment as a matter of law and the motion for summary judgment dismissing the complaint was granted.

The relevant facts of the case were that Medical Polis, P.C. sought to recover first-party no-fault benefits from Progressive Specialty Ins. Co. The main issue was whether Progressive's failure to assert a defense pursuant to State Farm Mut. Auto. Ins. Co. v Mallela precluded it from seeking discovery related to that defense. The court decided that based on the record before them, Progressive made sufficient allegations of fraudulent incorporation to warrant disclosure. Therefore, the court affirmed the order granting Progressive's motion to compel disclosure and produce the plaintiff's owner for an examination before trial, and denying the plaintiff's motion for a protective order. Ultimately, the holding of this case was the decision to affirm the order, allowing Progressive to seek discovery related to their defense based on fraudulent incorporation.

The case involved a medical provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company sought to amend its answer to assert an additional affirmative defense and also requested that the medical provider disclose various financial and organizational records. The court granted the insurance company leave to amend its answer, but modified the order to deny the request for disclosure of records. The court found that the medical provider was not prejudiced by the delay in the insurance company asserting its affirmative defense, and therefore, the amendment was allowed. The court also determined that the insurance company's initial discovery demands did not request the records it sought, and therefore could not compel the medical provider to provide them within 60 days. It was also stated that there is no requirement for a CPLR 321 change or withdrawal of attorney form to be notarized. The court's decision was to affirm the modified order, granting the amendment of the answer, but denying the request for disclosure of records.

The court considered the defendant insurer's motion for summary judgment dismissing the complaint, which was denied by the Civil Court of the City of New York, Bronx County. The main issue decided was whether the defendant insurer was entitled to judgment as a matter of law, based on the chiropractor's sworn peer review report stating that the diagnostic testing giving rise to the plaintiff's no-fault claim lacked medical necessity. The court held that the defendant insurer made a prima facie showing of entitlement to judgment as a matter of law, and that the plaintiff failed to raise a triable issue of fact in opposition. Therefore, the court reversed the order, granted the defendant insurer's motion, and dismissed the complaint, with costs to the defendant.

The court in this case considered an appeal from an order of the Civil Court of the City of New York that denied the defendant's cross motion for summary judgment dismissing the complaint and found that the plaintiff had established its prima facie case. The main issues before the court were whether the plaintiff had indeed established its prima facie case, and whether the defendant had provided enough evidence to support the dismissal of certain claims. The court held that the plaintiff had not established its prima facie entitlement to summary judgment, as the affidavit submitted was insufficient to prove the admissibility of the documents provided. The court also held that the defendant did not provide sufficient evidence to warrant the dismissal of certain claims, but did provide enough evidence to support the dismissal of the plaintiff's claims for certain dates of service. Therefore, the court modified the order to reflect these holdings.

The court considered a motion by the defendant to amend its answer to include affirmative defenses asserting the existence of a personal injury deductible in the insurance contract and denying that the plaintiff's assignor was an eligible injured person. The delay in filing the motion to amend was lengthy but plaintiff did not deny that discovery and trial postponements intervened to delay the action and for reasons unrelated to the motion's merits. The relevant fact was based on the claim of prejudice or surprise, and the main issue was whether the delay in filing the motion to amend was ground for denial. The holding of the case was that the delay in filing the motion to amend was not a barrier to amendment absent a showing of "significant" prejudice to the opposing party, and the court affirmed the order without costs.

The appellate court considered a case where Ava Acupuncture, P.C. was seeking to recover no-fault benefits for medical services provided to its assignors. The defendant, NY Central Mutual Fire Ins. Co., had previously obtained a declaratory judgment from the Supreme Court, stating that they had no obligation to furnish benefits to the parties involved. Ava Acupuncture, P.C. then filed a motion to compel discovery and the defendant cross-moved for summary judgment to dismiss the complaint, citing the previous declaratory judgment. The main issue decided was whether the previous order of the Supreme Court, which declared that the defendant had no present or future obligation to furnish benefits, would bar the instant action. The court held that the instant action was barred under the doctrine of res judicata, as to hold otherwise could result in a judgment that would impair rights established by the order rendered by the Supreme Court. The court further emphasized that the Supreme Court's order constituted a conclusive final determination, and therefore, the plaintiff's motion to compel discovery or strike defendant's answer was rendered moot and properly denied. The order of the Civil Court was affirmed.

The court considered a case in which Ave T MPC Corp., as assignee, sought to recover assigned first-party no-fault benefits from Travelers Property Casualty Ins. Co. The main issues decided were whether the plaintiff's action should be struck from the trial calendar and whether the plaintiff's owner should be compelled to undergo an examination before trial. The court held that because the notice of trial and certificate of readiness filed by the plaintiff contained the erroneous statement that discovery had been completed, the Civil Court properly granted the branch of defendant's motion seeking to strike the matter from the trial calendar. The court also found no basis to disturb the Civil Court's order compelling the plaintiff's owner to undergo an examination before trial, and therefore denied the plaintiff's cross motions seeking costs and sanctions.

The relevant facts considered by the court were that the Civil Court granted the plaintiffs' motion to restore the action to the trial calendar pursuant to Uniform Rules for New York City Civil Court. The owner of plaintiff Exact Medical Services, P.C. had passed away and an administrator had been appointed to preserve the estate's value. The main issue decided was whether the action should be restored to the trial calendar, and the holding was that the order granting the restoration was affirmed by the court. The decision was made based on similar reasons as another case, and the judges Weston, Pesce, and Rios all concurred with the decision.

The relevant facts the court considered were that the plaintiff, Upper E. Side Surgical, PLLC, sought reimbursement for medical services provided to an insured individual from the defendant, State Farm Insurance Company. The plaintiff claimed the defendant timely denied their claim and cited that the fees claimed were not in compliance with the New York Workers' Compensation Board Schedule of Medical Fees. The main issue was whether the plaintiff was entitled to reimbursement under the no-fault insurance law and what rate of reimbursement they were entitled to. The court held that while the plaintiff was entitled to reimbursement for the medical services provided, the facility fees set forth by the NY State Workers' Compensation Board were not applicable to the plaintiff as they were not listed as a Public Health Law Article 28 facility. The court also held that a trial of the issue was necessary to determine the amount of the charge for services. As a result, the defendant's motion for summary judgment was denied on the fee schedule issue and granted on the issue of timely denial of claim.