No-Fault Case Law

The main issue in this case was whether the defendant was entitled to summary judgment in a lawsuit brought by the plaintiff seeking to recover first-party no-fault benefits. The defendant appealed the trial court's decision to grant summary judgment to the plaintiff and deny the defendant's cross motion for summary judgment to dismiss the complaint. The court considered evidence submitted by the defendant, including an affidavit from an employee of Crossland Medical Services, P.C. and an affidavit from the defendant's litigation examiner, which established that the scheduling letters for independent medical examinations and the denial of claim forms had been timely mailed and that the plaintiff's assignor had failed to appear for the scheduled examinations. As a result, the court held that the defendant had established its entitlement to judgment as a matter of law and reversed the trial court's decision, granting the defendant's cross motion for summary judgment and dismissing the complaint.

The court considered the fact that Metrostar, Inc. was seeking to recover first-party no-fault benefits that were assigned to it, and that Electric Insurance Company denied the claims on the basis that Metrostar's assignor failed to attend scheduled independent medical examinations. The main issue decided was whether Electric Insurance Company was entitled to summary judgment dismissing the complaint based on the failure of Metrostar's assignor to attend the IMEs. The court held that Electric Insurance Company was not entitled to summary judgment because the affidavits submitted were insufficient to establish the proper mailing of the IME scheduling letters. Therefore, the order denying Electric Insurance Company's cross motion for summary judgment was affirmed.

The court considered the fact that plaintiff, Psychology YM, P.C., was seeking to recover first-party no-fault benefits, but had not responded to verification requests from the defendant, Progressive Northeastern Ins. Co., prior to commencing the action. The main issue decided was whether defendant's motion for summary judgment dismissing the complaint as premature was properly granted, and whether plaintiff's cross motion for summary judgment should be denied. The court held that the affidavit of defendant's litigation representative established that timely verification requests had been mailed in accordance with standard office practices, and since plaintiff did not respond to these requests prior to commencing the action, the motion for summary judgment was properly granted. Therefore, the court affirmed the order without costs.

The relevant facts the court considered were that a medical care provider was seeking to recover first-party no-fault benefits from an automobile insurance company. The only issue for trial was whether the services rendered to the plaintiff's assignor on December 23, 1999 were medically necessary. The court heard testimony from the defendant's doctor, who opined that the medical services provided were not medically necessary, and a peer review report concluded that there was a lack of medical necessity. The plaintiff did not call any witnesses in rebuttal. The main issue decided was whether the services rendered were medically necessary. The holding of the court was that the evidence provided by the defendant's doctor and the peer review report was sufficient to establish that the services rendered were not medically necessary, and therefore the judgment dismissing the complaint was affirmed.

The court considered the facts of a medical insurance company's motion for summary judgment dismissing a complaint filed by Socrates Medical Health, P.C. on behalf of Juan Acevedo to recover assigned first-party no-fault benefits. The insurance company's submissions established its proper mailing of notices of independent medical examinations (IMEs) and that the assignor failed to appear. In opposition, Socrates Medical Health, P.C. failed to raise a triable issue regarding the reasonableness of the requests or the assignor's failure to attend the IMEs. The main issue decided was whether the insurance company's submissions established a prima facie case for the motion for summary judgment, and whether Socrates Medical Health, P.C. was able to raise a triable issue for the denial of the motion. The holding of the case was that the order of the Civil Court of the City of New York, Bronx County denying the insurance company's motion for summary judgment was reversed, with costs, and the motion was granted and the complaint was dismissed.

The court considered the provider's action to recover assigned first-party no-fault benefits, and specifically focused on defendant's denial of claim forms and its reasons for denial. The main issues decided included the timeliness of the denial of claim forms, and the reasons for denial with regard to specific claims. The court held that plaintiff's motion for summary judgment was denied with respect to certain claims, and defendant's cross motion for summary judgment dismissing the complaint was granted to the extent of dismissing one of the claims. The court also found that defendant demonstrated it had timely mailed IME requests and that plaintiff's assignor had failed to appear for duly scheduled IMEs, entitling defendant to summary judgment dismissing the claim relating to that.

The court considered the argument by a provider to recover assigned first-party no-fault benefits from an insurance company which had reimbursed the provider using the workers' compensation medical fee schedule. The main issue decided was whether the insurance company had properly reimbursed the provider the amount to which it was entitled for the acupuncture services it had rendered. The court held that the insurance company's contention that the amounts charged by the provider exceeded the relevant rates set forth in the workers' compensation fee schedule was not sufficiently established. The court declined to take judicial notice of the workers' compensation fee schedule since the applicable portion of the fee schedule was not annexed to the defendant's papers. As a result, the court denied the plaintiff's cross motion for summary judgment and modified the order accordingly.

The court considered the fact that defendant had timely mailed the NF-10 denial of claim forms based on standard office practices and procedures. It was also determined that defendant's peer reviewer's reliance on medical records of other providers did not render the peer review report inadmissible. Plaintiff challenged the peer reviewer's reliance on various medical records, but since some of the records were prepared by the plaintiff, they may not challenge the reliability of those records. The main issue decided was whether defendant was entitled to summary judgment dismissing the complaint, and the court held that the order to dismiss the complaint was affirmed. Plaintiff's cross motion was properly denied and the attorney's affirmation was insufficient to establish plaintiff's entitlement to judgment as a matter of law.

The main issue in this case was whether the court should dismiss the complaint filed by Five Boro Psychological Services, P.C. as the assignee of David Ran, in their action to recover assigned first-party no-fault benefits from Allstate Ins. Co. Defendant Allstate Ins. Co. moved to dismiss the complaint pursuant to CPLR 3211 (a) (2) and to stay the trial pending resolution of the motion. The Civil Court granted a stay pending determination of the motion, and as the plaintiff submitted no papers in opposition to defendant's motion by the new return date, the order granting defendant's motion to dismiss the complaint was deemed to have been entered upon default. Therefore, the court held that plaintiff's appeal must be dismissed, as no appeal lies by the defaulting party.

The case of Westchester Med. Ctr. v Progressive Cas. Ins. Co. involved an action to recover no-fault benefits from an automobile insurance policy. The main issue to be decided was whether the plaintiff, Westchester Medical Center, was entitled to summary judgment in three causes of action, each seeking benefits as an assignee of a different individual. The court held that the plaintiff made a prima facie showing of entitlement to judgment on the second cause of action, as there was no opposition raised by the defendant. However, the court found that the defendant had submitted proof to deny the claim for the first cause of action, and records showed that the third cause of action was paid within the required 30-day period. Therefore, the court decided that the plaintiff was not entitled to summary judgment on the first and third causes of action. The order was therefore modified to reflect this decision.