No-Fault Case Law

The relevant facts in this case were that the plaintiffs failed to timely provide defendant with the so-ordered discovery responses, which would preclude them from offering evidence at trial. The main issue decided was whether the plaintiffs had a reasonable excuse for their failure to comply with the so-ordered stipulation and the existence of a meritorious cause of action. The Court held that the conditional so-ordered stipulation becomes absolute upon a party's failure to sufficiently and timely comply and that the plaintiffs failed to demonstrate a reasonable excuse for their failure to timely comply with the stipulation and the existence of a meritorious cause of action. Therefore, the defendant's motion for summary judgment dismissing the complaint was granted.

The relevant facts considered in this case were that the defendant had moved to compel the plaintiff to produce two principals for depositions and the plaintiff cross-moved for summary judgment upon seven claims. The issues decided were whether the defendant was entitled to the discovery it sought and whether the defendant was precluded from raising certain defenses. The holding of the case was that the defendant was not entitled to the discovery it sought because the defenses were precluded. The court also determined that the defendant was not precluded from interposing certain defenses with respect to five remaining claims, so the branches of the plaintiff's cross motion seeking summary judgment upon those claims were denied.

The main issues in the case were whether the insurance company, Lancer, was entitled to depositions from two of the plaintiff's principals, Dr. Mayard and Dr. Berardi, and whether Lancer had timely denied the claims at issue. Lancer sought the depositions in order to obtain information regarding the treatment and billing practices of the plaintiff. The court held that Lancer was not entitled to the depositions, as they only sought them for purposes which the court found to be precluded. Additionally, the court held that Lancer failed to prove that it had timely denied the claims at issue, and therefore, was precluded from asserting certain defenses. As a result, Lancer's motion to compel plaintiff to produce the principals for depositions was denied, and plaintiff's cross-motion for summary judgment was granted.

The court considered whether the defendant was entitled to compel the plaintiff to produce two of its principals for depositions and whether the plaintiff was entitled to summary judgment in an action to recover assigned first-party no-fault benefits. The main issues decided were whether the defendant's requests for EUOs were timely mailed, and whether the denial of claims was timely and proper based on plaintiff's failure to comply with a condition precedent to coverage. The court held that the defendant's motion to compel the plaintiff to produce the principals for depositions should have been granted because the information sought was material and necessary to the defense. However, the court also held that the plaintiff's cross motion for summary judgment was denied, as the defendant demonstrated that the plaintiff failed to comply with a condition precedent to coverage. Therefore, the defendant raised a triable issue of fact, and the plaintiff's motion was denied.

The main issue in the case was whether the plaintiff, as the assignee of HAO CHENG PIAO, was entitled to recover assigned first-party no-fault benefits from the defendant, GEICO General Insurance Company. The court considered whether the bill in question was timely denied, or that the denial was conclusory, vague, or without merit as a matter of law. The court held that because the plaintiff failed to establish that the bill in question was not timely denied, or that the denial was conclusory, vague, or without merit as a matter of law, the plaintiff failed to establish its prima facie case. Therefore, the court affirmed the order that denied the plaintiff's motion for summary judgment without costs. The court also declined the defendant's request to search the record and award it summary judgment dismissing the complaint.

The relevant facts considered by the court in this case were that Biobalance Medical, P.C. was seeking to recover assigned first-party no-fault benefits from Clarendon National Insurance Company. Clarendon had timely denied Biobalance's claim on the ground of lack of medical necessity. The main issue decided by the court was whether defendant's motion for summary judgment dismissing plaintiff's third cause of action should be granted. The holding of the court was that defendant established its prima facie entitlement to summary judgment dismissing plaintiff's third cause of action, as the peer review report provided a factual basis and medical rationale for the determination of lack of medical necessity. In opposition, plaintiff failed to raise a triable issue of fact, as they did not proffer an affidavit from a healthcare practitioner that meaningfully referred to, let alone rebutted, the conclusions set forth in the peer review report. Therefore, the court reversed the Civil Court's order and granted defendant's motion for summary judgment dismissing plaintiff's third cause of action.

The court considered the issue of whether an insurer had timely denied payment for no-fault benefits for medical services. The main issue decided was whether the insurer had fully paid the provider for the services billed, and whether there was evidence to warrant the dismissal of a claim for an initial acupuncture visit. The holding of the case was that the insurer had timely denied payment on the ground that the unpaid portion exceeded the amount permitted by the workers' compensation fee schedule, and had fully paid the provider for the services billed. The court granted summary judgment in the sum of $114 for the initial acupuncture visit on October 26, 2005, and granted summary judgment to the insurer dismissing the remaining claims for acupuncture services from October 26, 2005 through January 19, 2006.

The relevant facts in this case involved a provider seeking to recover assigned first-party no-fault benefits from an insurer. The provider appealed from an order denying its motion for summary judgment, arguing that the insurer did not pay its claims within 30 days. The main issue decided was whether the provider had established its entitlement to judgment as a matter of law. The court found that although the provider had shown that the insurer did not pay its claims, it failed to demonstrate that the claims were not denied within 30 days or that the basis for the denials was conclusory, vague, or had no merit as a matter of law. The court affirmed the order denying the provider's motion for summary judgment, but on different grounds, and without costs.

The court considered the appeal of a provider seeking to recover assigned first-party no-fault benefits that had been denied by the insurance company. The insurance company had partially paid and partially denied the claim for services rendered from September 6 through September 29, 2005, on the basis that the unpaid portion exceeded the amount permitted by the workers' compensation fee schedule. The insurance company demonstrated that it had fully paid the provider for the billed-for services in accordance with the workers' compensation fee schedule. The main issue decided was whether the insurance company was entitled to summary judgment upon the claim, and the court held that the insurance company was not entitled to summary judgment upon the claim for services rendered from September 6 through September 29, 2005.

The court considered the fact that in an action by a provider to recover assigned first-party no-fault benefits, the plaintiff had moved for summary judgment and the defendant failed to submit written opposition. The Civil Court granted the plaintiff's motion, and the defendant subsequently moved to vacate the order, which was denied by the court. The issue decided was whether an order granting a motion is appealable if the opposing party fails to submit written opposition, even if the party orally argued the motion. The holding of the case was that where a party fails to submit written opposition to a motion, an order granting the motion is considered to have been entered on default and is not appealable, even if the party orally argued the motion. Therefore, the appeal from the judgment entered pursuant to the default order was dismissed. The defendant's remedy, if so advised, was to move to reargue the denied order or to file a notice of appeal therefrom.