No-Fault Case Law

The defendant insurance company had refused to pay first-party no-fault benefits to the plaintiffs, which were providers in this case. Their claims had been marked off the trial calendar but were later moved to restore the action to trial. However, the defendant argued that prosecution of the claims of the plaintiff Painless Medical, P.C. could not be pursued due to the death of the sole shareholder, officer, and director of the company. The defense claimed that the appointed administrator, Anna Val, did not have the authority to pursue pending litigation or collect settlements and judgments involving this provider. The court ruled that Ms. Val had the authority and power to recover property belonging to the estate, prosecute an action to recover assets belonging to the estate, and settle claims for money owed to the estate, and she did not have to be a member of the profession in which the professional corporation was authorized to practice. The main issue decided was whether Anna Val had the authority to pursue pending litigation or collect settlements and judgments involving the provider after being appointed as administrator of the estate, and the court ruled that she did have the authority. The holding of the court was that the motion to restore the action was made within a year after it had been marked off the trial calendar, and counsel's affirmation satisfactory justified the reason, showing a readiness to proceed to trial, and the order was affirmed.

The relevant facts the court considered for this case involved a dispute over first-party no-fault benefits for psychological services provided to an individual involved in a motor vehicle accident. The plaintiff sought reimbursement for several psychological services, but the defendant denied them as medically unnecessary. The main issue decided in the case was whether the defendant had proven the lack of medical necessity for the services for which reimbursement was sought. The court held that the defendant met its burden of proof in establishing the lack of medical necessity through a peer review report and medical records, and the plaintiff failed to rebut the evidence with its own. As a result, the court denied the plaintiff's motion for a directed verdict and granted judgment to the defendant, dismissing the complaint with prejudice.

The relevant facts the court considered were that the plaintiff sought to recover first-party no-fault benefits for psychological services provided to the subject assignor. The plaintiff was paid for the initial interview, but the rest of the services were denied by the defendant as medically unnecessary and for fees not in accordance with fee schedules. The main issues decided were lack of medical necessity and fees not in accordance with fee schedules. The holding of the court was that the defendant successfully proved lack of medical necessity for four of the six psychological services allegedly provided, as well as the review of records, and the explanation and interpretation of results. The court granted a partial judgment to the plaintiff in the amount of $266.61, plus interest, costs, and attorney's fees, and dismissed the balance of the claim with prejudice.

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint in an action to recover first-party no-fault benefits. The court considered the evidence provided by the defendant, including the timely mailing of denial of claim forms and competent medical evidence that the diagnostic testing giving rise to the plaintiff's claims lacked medical necessity. The main holding of the case was that the defendant was entitled to summary judgment, as they had made a prima facie showing of entitlement by establishing the proper and timely mailing of denial of claim forms and submitting competent medical evidence. The court found that the plaintiff's opposition, consisting of an attorney's affirmation unaccompanied by any medical evidence, was insufficient to raise a triable issue. Therefore, the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment, dismissing the complaint.

The relevant facts considered in this case were that Elmont Open MRI & Diagnostic Radiology, as the assignee of Joanne Cunningham, sought to recover first-party no-fault benefits from Tri-State Insurance Company. Tri-State had denied the claims on the ground of lack of medical necessity and submitted a peer review report setting forth a factual basis and medical rationale for the conclusion that there was a lack of medical necessity for the services at issue. The main issue decided was whether defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the court was that defendant had established its prima facie entitlement to summary judgment by demonstrating a lack of medical necessity for the services at issue, and as the plaintiff failed to rebut this showing, the defendant's motion for summary judgment dismissing the complaint was granted.

The relevant facts considered in this case were that providers had moved for summary judgment to recover assigned no-fault benefits, but the insurance company opposed the motion, stating that the claims were denied based on the assignor's eligibility for workers' compensation benefits. The main issue was whether the accident occurred during the course of the assignor's employment. The court found that there was a question of fact regarding this issue and held the action in abeyance pending a determination by the Workers' Compensation Board. The holding of the court was that the insurance company's proof was sufficient to raise a question of fact as to whether the assignor was acting as an employee at the time of the accident, and that this issue must be resolved by the Workers' Compensation Board before determining the provider's motion for summary judgment.

The relevant facts considered by the court were that defendant had timely denied plaintiff's claim, and an independent medical examination (IME) report submitted by defendant established a lack of medical necessity for the supplies provided. The main issue decided was whether defendant's motion for summary judgment dismissing the complaint should be granted. The court held that defendant's showing of a lack of medical necessity was not rebutted by plaintiff, and therefore, the motion for summary judgment was granted, reversing the lower court's decision. The defendant's motion to dismiss the complaint was therefore granted.

The court considered the standing of the provider to recover assigned first-party no-fault benefits, as the owner's license to practice medicine had been suspended. The main issue decided was whether the provider had standing to bring the action and seek to recover no-fault benefits for the services it rendered before the revocation of its owner's license. The holding of the case was that the provider was entitled to wind up its affairs and seek to recover the benefits, and therefore, plaintiff's motion for summary judgment should not have been denied, and defendant's cross motion for summary judgment dismissing the complaint should not have been granted on that ground. The order was reversed, and the case was remitted to the Civil Court for a new determination of plaintiff's motion for summary judgment and defendant's cross motion for summary judgment dismissing the complaint.

The court considered the facts that Q-B Jewish Med. Rehabilitation, P.C. was suing Allstate Insurance Company to recover first-party no-fault benefits and Allstate had requested financial and tax records from the plaintiff during the discovery process to determine if the plaintiff was eligible to recover these benefits. The main issue was whether Q-B Jewish Med. Rehabilitation, P.C. could recover the benefits and whether the defendant was entitled to its requested discovery. The court held that the defendant's motion to vacate the notice of trial and compel plaintiff to provide responses to its discovery demands was granted, on the condition that the plaintiff provide the requested financial and tax records, including W-2 and 1099 forms for individuals who provided the services, in order for the case to proceed to trial.

The relevant facts of the case involve a provider seeking to recover assigned first-party no-fault benefits, to which the insurance company denied the claims on the ground of lack of medical necessity. The main issue decided by the court was whether the insurance company's motion for summary judgment dismissing the complaint should be granted. The holding of the case was that the insurance company failed to make a prima facie showing of its entitlement to judgment as a matter of law, as the documents submitted by the chiropractor did not meet the requirements of CPLR 2309(b), and the affidavit of the plaintiff's osteopath was sufficient to rebut the peer review reports and raise a triable issue of fact. Therefore, the order denying the insurance company's motion for summary judgment dismissing the complaint was affirmed.