No-Fault Case Law

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.

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.