No-Fault Case Law

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.

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.