No-Fault Case Law

The court considered the plaintiff's motion for summary judgment and the defendant's cross motion for summary judgment in a case to recover assigned first-party no-fault benefits. The court found that the plaintiff had established its prima facie case, but that the sole issue for trial was the medical necessity of the services rendered to the plaintiff's assignor. The main issue decided was whether there was a lack of medical necessity for the services rendered, and the court found in favor of the defendant, as the defendant's showing of a lack of medical necessity was not rebutted by the plaintiff. Therefore, the court reversed the order and granted the defendant's cross motion for summary judgment dismissing the complaint.

In the case of Park Slope Medical and Surgical Supply, Inc. as Assignee of IRA FRANKLIN v Progressive Insurance Company, the issue at hand was the preclusion of testimony of defendant's expert witness and the granting of plaintiff's motion for a directed verdict in a nonjury trial. The court found that defendant's expert witness should have been allowed to testify as to the medical necessity of the supplies at issue, limited to the basis for the denial as set forth in the original peer review report. The court also found that a new trial was required, as the denial did not make an explicit or implicit finding that there were any facts established for all purposes in the action. As a result, the judgment was reversed, and the matter was remitted to the Civil Court for a new trial.

The main issue decided in this case was whether the plaintiff, Quality Health Products, was entitled to recover assigned first-party no-fault benefits from the defendant, Geico General Insurance Company. The court considered the fact that Geico had timely denied the claim on the ground of lack of medical necessity, in accordance with their standard office practices and procedures. In support of its cross motion for summary judgment, Geico submitted an affirmed peer review report which provided a factual basis and medical rationale for the determination that there was a lack of medical necessity for the supplies provided. The court held that Geico had established its entitlement to summary judgment dismissing the complaint, as the plaintiff failed to raise a triable issue of fact in opposition to Geico's cross motion. Therefore, the judgment of the Civil Court was reversed and Geico's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts of the case include W.H.O. Acupuncture, P.C. appealing the grant of defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether defendant was entitled to summary judgment due to the untimely denial of claim form. The court held that defendant's denial of claim form was mailed more than 30 days after receiving plaintiff's claims, and as a result, the issue could be raised for the first time on appeal. As defendant's moving papers were insufficient to establish that defendant had timely mailed requests for verification, the court found that defendant failed to establish that its 30-day claim determination period was tolled and therefore, defendant's motion for summary judgment should have been denied. The judgment was reversed and the motion for summary judgment was denied.

The relevant facts the court considered in this case were that Alrof, Inc., as an assignee of Maria Eden, was seeking to recover assigned first-party no-fault benefits from Country Wide Insurance Company. The main issues in the case were whether Alrof, Inc. established a prima facie case for summary judgment by submitting a claim form, proof of loss, and proof that the defendant failed to pay or deny the claim within 30 days. Additionally, the court considered whether the defendant's denial of claim form was conclusory, vague, or without merit as a matter of law, and whether there was evidence that the assignor failed to appear at independent medical examinations (IMEs) as claimed by the defendant. The holding of the case was that Alrof, Inc. was not entitled to summary judgment, and so much of the order as granted Alrof's motion for summary judgment was vacated and Alrof's motion for summary judgment was denied. Additionally, the court reversed the judgment awarded to the plaintiff.

The main issues in this case were whether the Civil Court should have granted the defendant's motion to vacate the notice of trial and whether the court should have compelled the plaintiff to respond to the defendant's discovery demands. The court held that the notice of trial was properly vacated because the plaintiff failed to timely challenge the propriety of the defendant's discovery demands and the notice contained an erroneous statement about the completion of discovery. As for the discovery demands, the court held that the plaintiff was obligated to produce the information sought except for matters which are privileged or palpably improper, and that the defendant's interrogatories seeking information for the time period of January 1, 2002 until May 2, 2005 were granted. The court also found that the plaintiff's remaining contentions lacked merit.

The relevant facts considered by the court were that Crossbridge Diagnostic Radiology, as the assignee of Crystal Hoseine, appealed from an order of the Civil Court of the City of New York denying their motion to vacate a prior order granting defendant's unopposed motion for summary judgment. The main issue decided was whether the Civil Court improvidently exercised its discretion in denying plaintiff's motion to vacate a prior order granting defendant's unopposed motion for summary judgment. The holding of the case was that the Civil Court did not improvidently exercise its discretion in denying plaintiff's motion to vacate the prior order, as plaintiff failed to demonstrate a reasonable excuse for its failure to submit written opposition to defendant's motion. Therefore, the order was affirmed.

The relevant facts of the case involved Great Wall Acupuncture seeking to recover $3,854.30 in assigned first-party no-fault benefits from Interboro Mutual Indemnity Ins. The parties entered into a "Stipulation of Settlement" in April 2006, settling the claim for $1,387.55, with the stipulation that failure to comply would result in the entry of judgment. However, the stipulation was not considered effective until August 8, 2007. Defendant sent two checks totaling $1,387.55 in September 2007, which plaintiff deposited without reservation of rights. Plaintiff then attempted to enter judgment for the remaining amount owed, but the Civil Court denied the motion based on the binding stipulation of discontinuance filed by defendant prior to the attempt to enter judgment. The main issue decided was whether plaintiff was entitled to enter judgment for the remaining amount owed after cashing the checks from the defendant. The court held that since the action was terminated with the filing of the binding stipulation of discontinuance, the relief requested by plaintiff was no longer available by motion in this action and the plaintiff was required to commence a plenary action. Therefore, the order denying plaintiff's motion for leave to enter judgment was affirmed.

The main issue in this case was whether the defendant is entitled to summary judgment seeking the dismissal of the first through fourth causes of action in an action to recover assigned first-party no-fault benefits. The defendant submitted affirmed peer review reports which set forth the factual basis and medical rationale for the doctor's determination that there was a lack of medical necessity for the supplies at issue. The defendant's showing that the supplies were not medically necessary was not rebutted by the plaintiff. Therefore, the court ruled in favor of the defendant and granted the branches of the defendant's motion for summary judgment seeking the dismissal of the first through fourth causes of action. As a result, the order of the Civil Court of the City of New York, Queens County denying the defendant's motion for summary judgment was reversed, and the branches of the defendant's motion for summary judgment seeking the dismissal of the first through fourth causes of action were granted.

The court in this case considered a provider's attempt to recover assigned first-party no-fault benefits. The defendant had denied most of the plaintiff's claims, except for two claims totaling $290.64, due to the assignor's failure to appear at three independent medical examinations (IMEs). The Civil Court had granted the defendant's motion for summary judgment dismissing the complaint. On appeal, the plaintiff argued that the scheduling of the IMEs was unreasonable, but failed to provide sufficient evidence to raise an issue of fact on this matter. The Appellate Term modified the order by striking the part that granted summary judgment for the defendant regarding the $155.84 and $134.80 claims, then remitted the matter to the Civil Court for a new determination on these two claims, as the grounds for the summary judgment motion had not been properly considered by the lower court.