No-Fault Case Law

The main issue in the case was whether Comfort Supply, Inc. had established its prima facie case to recover assigned first-party no-fault benefits in its motion for summary judgment. The court considered the affidavit annexed to the motion papers, which stated the general practice of delivery of supplies to eligible injured persons, but did not specify the method of delivery used in this case. As a result, the court denied plaintiff's motion for summary judgment, holding that the affidavit did not establish that the supplies at issue had been delivered to plaintiff's assignor. Therefore, the order denying plaintiff's motion for summary judgment was affirmed. The decision was made by the Supreme Court of the State of New York, Appellate Term, Second Department on December 21, 2011.

In this case, the court considered a dispute between Jesa Medical Supply, Inc. and Progressive Insurance Co. over first-party no-fault benefits. Jesa Medical Supply, Inc. had provided medical supplies to an individual, Shirline Wilkinson, and sought to recover assigned benefits from Progressive Insurance Co. In response, Progressive Insurance Co. denied the claims, arguing that the supplies were not medically necessary. The main issue decided by the court was whether the supplies provided by Jesa Medical Supply, Inc. were medically necessary. The court ultimately held in favor of Progressive Insurance Co., granting their cross motion for summary judgment and dismissing the complaint, as they had demonstrated that there was a lack of medical necessity for the supplies. The court's decision was based on the fact that the medical supplies were determined to be not medically necessary by an affirmed peer review report submitted by Progressive Insurance Co. This decision was reached on December 21, 2011.

The court considered the case of Queens Brooklyn Medical Rehab, P.C. seeking to recover first-party no-fault benefits from Lancer Insurance Company. The main issue in the case was that the medical provider did not comply with a conditional order of preclusion, leading to the dismissal of the complaint. The court decided that the judgment to dismiss the complaint was affirmed because the medical provider failed to provide full and complete responses to the defendant's discovery demands and did not clearly indicate the non-existence of management, lease, or billing agreements as ordered by the court. As a result, the court found no basis to disturb the judgment and affirmed the dismissal.

The relevant facts that the court considered in this case were an action by a medical center to recover assigned no-fault benefits, an appeal from an order granting the motion, and a cross motion for summary judgment. The main issue decided by the court was that the plaintiff failed to establish its prima facie entitlement to summary judgment because the affidavit submitted in support of the motion did not lay a sufficient foundation to establish that the claim form could be used as proof. Additionally, the court found that the defendant was not entitled to summary judgment dismissing the complaint because it did not establish that the assignor was not an eligible injured person. The holding of the case was that the order was modified by providing that the plaintiff's motion for summary judgment was denied, and the cross motion for summary judgment was affirmed. The case of Richmond Univ. Med. Ctr. v New York Cent. Mut. Fire Ins. Co. was decided on December 19, 2011, by the Appellate Term, Second Department. The court ruled that the plaintiff failed to establish entitlement to summary judgment and that the defendant was not entitled to summary judgment dismissing the complaint.

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.