No-Fault Case Law

The main issues in this case were whether the provider was entitled to recover no-fault benefits from the insurer, and whether the services provided were medically necessary. The court considered various causes of action brought by the provider, including the medical necessity of services rendered, and whether the insurer had timely denied the claim forms. The court found that the insurer had established timely and proper denial of claim forms based on lack of medical necessity, and that the provider failed to rebut this showing. As a result, the court granted the insurer's cross motion for summary judgment dismissing several causes of action, but allowed the provider to recover on two claim forms for a certain amount. The court also granted the insurer's motion for summary judgment dismissing the complaint as to a claim form in a different amount. Ultimately, the court affirmed the judgment in favor of the provider for a specified amount but modified the order to grant the insurer's cross motion for summary judgment on certain causes of action.

The relevant facts in this case were that Complete Radiology, P.C. was seeking to recover assigned first-party no-fault benefits on behalf of Jerrell Jacobs, and the defendant, GEICO Insurance Company, had denied the claim based on lack of medical necessity. The main issue decided by the court was whether there was a triable issue of fact as to medical necessity, as the defendant had established its prima facie entitlement to summary judgment on those grounds. The holding of the court was that the affirmed letter of medical necessity submitted by plaintiff's assignor's treating physician was sufficient to demonstrate that there is a triable issue of fact as to medical necessity, and therefore the judgment of the Civil Court was reversed, the order granting the defendant's cross motion for summary judgment was vacated, and the defendant's cross motion for summary judgment was denied.

The main issue in this case was whether the provider, Rally Chiropractic, P.C., as Assignee of NARABIA OAKLEY, was entitled to recover assigned first-party no-fault benefits from Nationwide Mutual Ins. Co. The court considered the fact that the assignor was not an eligible injured person under the policy because she did not "regularly reside" with the insured at the time of the accident. The court also considered that the defendant had timely denied the plaintiff's claim on this ground. Additionally, the court found that the plaintiff had submitted the claim more than 45 days after the services were rendered, and the reason proffered by the plaintiff for the late submission was deemed insufficient. The court ultimately held that the judgment of the Civil Court dismissing the complaint was affirmed. Therefore, the appeal was deemed to have been taken from a judgment that dismissed the complaint, and the judgment was affirmed.

The main issue in this case was the recovery of assigned first-party no-fault benefits by a provider. Quality Health Prods, as the assignee of Marisa Trottman, appealed from an order denying its motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint. The court considered the peer review report and determined that there was a lack of medical necessity for the supplies at issue. The court also found that the affirmation of the peer review report contained a factual basis and medical rationale for the determination of lack of medical necessity. Plaintiff's motion for summary judgment was denied and defendant's cross motion for summary judgment dismissing the complaint was granted. Thus, the judgment of the Civil Court was affirmed.

The main issue in this case was whether the supplies in question were medically necessary, as the provider was seeking to recover assigned first-party no-fault benefits. The court considered the affirmed peer review reports, which provided the factual basis and medical rationale for the peer reviewer's determination that there was a lack of medical necessity for the supplies. The court found that the defendant's showing that the supplies were not medically necessary was not rebutted by the plaintiff. Therefore, the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint. The holding of the case was that the supplies were not medically necessary and as a result, the plaintiff's motion for summary judgment was properly denied and the defendant's cross motion for summary judgment dismissing the complaint was properly granted.

The main issue in this case was whether the defendant, Praetorian Insurance Company, was entitled to summary judgment dismissing the complaint brought by MSSA Corp as assignee of Angel Curet to recover first-party no-fault benefits. The court considered whether the defendant's denial of claim form was issued within 30 days of receipt of plaintiff's claim form and if the defendant had tolled its time to pay or deny the claim by timely mailing its request for verification to the plaintiff. The court held that the defendant failed to demonstrate that the claim had been timely denied and that its defense of lack of medical necessity was not precluded. As a result, the court affirmed the order denying the defendant's motion for summary judgment dismissing the complaint.

The case involved a provider's attempt to recover first-party no-fault benefits from an insurance company. The trial court had granted the insurance company's motion to vacate a notice of trial and dismiss the complaint, compelling the provider to respond to the insurance company's discovery demands. After the trial court's order, the complaint was dismissed. The appellate court decided that the dismissal of the complaint rendered the appeal academic, and therefore dismissed the appeal. The main issue decided in this case was the dismissal of the provider's complaint for first-party no-fault benefits and whether this rendered the appeal academic. The court held that the dismissal of the complaint did indeed render the appeal academic, and therefore dismissed the appeal. Holding: The appellate court held that the dismissal of the complaint rendered the appeal academic and therefore dismissed the appeal.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County which had denied the defendant's cross motion for summary judgment dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the defendant had timely denied the claims at issue on the ground of lack of medical necessity and whether the defendant had submitted a peer review report as part of their motion papers which set forth a factual basis and medical rationale for the peer reviewer's determination. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint should have been granted because the plaintiff did not raise a triable issue of fact and failed to submit an affirmation from a doctor rebutting the conclusions set forth in the peer review report. Therefore, the court reversed the order and granted the defendant's cross motion for summary judgment dismissing the complaint.

The main issue in this case was whether the insurance company was justified in denying payment for certain acupuncture services on the grounds that the amounts charged exceeded the workers' compensation fee schedule. The court considered the affidavit submitted by the insurance company's claims examiner, which showed that the company had timely denied certain portions of the provider's claims. The court held that while the affidavit was sufficient to warrant the dismissal of some of the plaintiff's claims, it was not enough to warrant the dismissal of the claim for the initial acupuncture visit, nor to establish that the amounts charged exceeded the relevant rates set forth in the fee schedule. As a result, the court affirmed the decision to deny the insurance company's cross motion for summary judgment dismissing the complaint.

The court considered the plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The court found that the plaintiff failed to establish its prima facie entitlement to that relief by not proving the submission of a claim form and the fact and amount of the loss sustained. The main issue was whether the claim form submitted by the plaintiff constituted prima facie proof of the fact and amount of the loss sustained. The court held that in order for a claim form to constitute prima facie proof, the affidavit submitted by the plaintiff must establish that the claim form is admissible under the business records exception to the hearsay rule. As the plaintiff failed to demonstrate this, the court affirmed the denial of plaintiff's motion for summary judgment.