No-Fault Case Law

The main issues in this case were whether the supplies provided to the plaintiff's assignor were medically necessary and whether the defendant was entitled to summary judgment. Jesa Medical Supply, Inc. as the assignee of Wilfred Jones, sought to recover first-party no-fault benefits from Progressive Insurance Co. The Civil Court found that the plaintiff had established its prima facie case, but also found that the sole issue for trial was the medical necessity of the supplies. The appellate court held that the defendant's cross motion for summary judgment dismissing the complaint should be granted, as the supplies were deemed not medically necessary by the defendant's peer review report and the plaintiff did not rebut this showing. In summary, the relevant facts considered by the court were the medical necessity of the supplies provided to the plaintiff's assignor, the timely denial of claims by the defendant, and the standards required to establish a prima facie case for recovery of first-party no-fault benefits. The main issues decided by the court were whether the supplies at issue were medically necessary and whether the defendant was entitled to summary judgment. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was granted, as the defendant's showing that the supplies were not medically necessary was unrebutted by the plaintiff.

The relevant facts considered in Comfort Supply, Inc. v Progressive Northeastern Ins. Co. are that Comfort Supply, Inc. was appealing an order from the Civil Court of New York dismissing their complaint and denying their cross motion for summary judgment. The main issue decided in this case was whether defendant provided enough evidence to show a lack of medical necessity for the equipment that was the subject of the claim. The holding of the case was that the order from the Civil Court was affirmed, as the defendant had submitted an affidavit and peer review report which established a lack of medical necessity, shifting the burden to the plaintiff to rebut the defendant's showing, which they failed to do. The appellate court found that the remaining contentions from the plaintiff were either unpreserved or lacked merit, and affirmed the order.

The relevant facts in this case involved a provider seeking to recover assigned first-party no-fault benefits. The defendant, Nationwide Mutual Insurance Co., had denied the claims at issue on the grounds that the fees sought exceeded the amount permitted by the workers' compensation fee schedule. The main issue decided was whether the denial of claim forms had been timely mailed and whether they had been mailed in accordance with the defendant's standard office practices and procedures. The court ultimately held that the defendant's motion for summary judgment should have been denied because they had not established that the denial of claim forms had been timely mailed. As a result, the court reversed the order and denied the defendant's motion for summary judgment.

The relevant facts the court considered included Brownsville Advance Medical providing medical care to Alejandro Ramos after a motor vehicle accident and Country-Wide Insurance Company's repeated demands for verification of the medical treatment provided. The main issues decided were whether the repeated verification requests from Country-Wide were unduly burdensome and if Brownsville should be required to repeatedly provide the same documentation. The holding of the case was that Country-Wide's repetitive verification demands upon Brownsville were contrary to regulations and the insurer did not have a good reason for repeatedly demanding identical verification. The court denied Country-Wide's motion for summary judgment.

The relevant facts the court considered were that the insurance policy and the accident in question took place in Buffalo, New York, and all relevant parties were from Buffalo, New York. The main issues decided were whether the court had the power to dismiss or transfer the action between two New York State residents to a court in Buffalo. The court held that it did not have the power to transfer the case to Erie County, as it was prohibited by statute to order a transfer outside of its geographic jurisdiction. However, the court found that it had the authority to dismiss the case due to forum non conveniens, as the location of all parties involved was in Buffalo and there were no other compelling factors to litigate the case in another forum. As a result, the plaintiff's complaint was dismissed.

The court considered the facts that the defendant sought summary judgment to dismiss a complaint by a provider to recover assigned first-party no-fault benefits, on the grounds that the insurance policy had been fraudulently procured. The defendant presented evidence that the assignor, who was also the insured under the policy, had misrepresented his state of residence, which was material to the issuance of the policy. The court found that the defendant's evidence sufficiently established that the misrepresentation was material, rendering the assignor ineligible to receive first-party no-fault benefits under the insurance policy. The main issue decided was whether the defendant proffered admissible evidence of a fraudulently procured insurance policy, and the holding of the case was that the judgment in favor of the defendant was affirmed.

The court considered the appeal from an order of the Civil Court of the City of New York, Kings County denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint. The main issue was whether defendant had timely denied the claim at issue, on the ground of lack of medical necessity, in accordance with defendant's standard office practices and procedures. The holding of the court was that the defendant had established that it had timely denied the claim at issue, and that there was a lack of medical necessity for the supplies provided. Plaintiff failed to raise a triable issue of fact, therefore the Civil Court properly granted defendant's cross motion for summary judgment dismissing the complaint and denied plaintiff's motion for summary judgment. Therefore, the order was affirmed by the appellate court.

The main issue in this case was whether the provider was entitled to recover assigned first-party no-fault benefits from the insurance company. The court considered the fact that the insurance company failed to timely serve responses to the plaintiff's interrogatories, resulting in the plaintiff moving for an order of preclusion against the defendant. The court held that the so-ordered stipulation functioned as a conditional order of preclusion, which became absolute upon the defendant's failure to comply. As a result, the defendant was precluded from offering evidence in the action. However, the court also held that the plaintiff was not entitled to summary judgment because its moving papers failed to establish a prima facie entitlement to such relief. Therefore, the court reversed the judgment, vacated the branch of the motion seeking summary judgment, and denied the plaintiff's motion for summary judgment.

The court considered the motion for summary judgment by the plaintiff and the cross motion for summary judgment by the defendant in this case involving a provider seeking to recover assigned first-party no-fault benefits. The main issue before the court was the medical necessity of the supplies provided to the plaintiff's assignor. The court found that the defendant had demonstrated that it had timely denied the plaintiff's claim and that the sole issue for trial was the medical necessity of the supplies provided. In support of its cross motion, the defendant submitted an affirmed peer review report which showed a lack of medical necessity for the medical supplies at issue. Plaintiff did not provide any rebuttal to defendant's showing. As a result, the court granted the defendant's cross motion for summary judgment dismissing the complaint.

The court considered the issue of whether a provider was entitled to recover assigned first-party no-fault benefits. The main issue was whether the denial of the claim based on the plaintiff's assignor's failure to appear for independent medical examinations (IMEs) was timely and in accordance with defendant's standard office practices and procedures. The court held that the affidavit submitted by defendant's claims representative was insufficient to establish the timely mailing of the denial of claim form, and as a result, the defense that the assignor failed to appear for scheduled IMEs was precluded. The court reversed the denial of the plaintiff's motion for summary judgment and remitted the matter to the Civil Court for the calculation of statutory interest and an assessment of attorney's fees.