No-Fault Case Law

The main issue in the case was whether the defendant had established that the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). The court considered the affidavit of the defendant's investigator, which established that the plaintiff's assignor had indeed failed to appear for the scheduled EUOs. The holding of the case was that since an appearance at an EUO is a condition precedent to the insurer's liability on the policy, and the defendant had established that the plaintiff's assignor had failed to appear for the EUOs, the judgment denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed. The case was decided by the Appellate Term, Second Department.

The relevant facts considered by the court were that the defendant, Allstate Insurance Company, sought to strike the plaintiff's notice of trial in an action to recover assigned first-party no-fault benefits, compelling the plaintiff to produce certain tax documents. The main issue decided was whether the defendant's motion to strike the notice of trial to compel the plaintiff to produce tax documents was warranted. The court held that the defendant's motion papers were sufficient to establish special circumstances warranting the disclosure of the plaintiff's tax documents and affirmed the order to strike the notice of trial. The decision was based on the defendant's detailed and specific reasons for believing that the plaintiff was ineligible to recover no-fault benefits due to failure to meet applicable state and local licensing requirements.

The main issue in this case was whether the defendant, American Transit Insurance Company, had timely denied the plaintiff's claim for first-party no-fault benefits based on a lack of medical necessity for the supplies provided to the plaintiff's assignor. The court found that the defendant had demonstrated that it had timely denied the claim and had provided an affirmed peer review report which showed a lack of medical necessity for the supplies at issue. The court held that the defendant's showing that the supplies were not medically necessary was not rebutted by the plaintiff, and therefore, the defendant's cross motion for summary judgment dismissing the complaint should have been granted. As a result, the order denying the defendant's cross motion for summary judgment was reversed and the defendant's cross motion for summary judgment dismissing the complaint was granted.

The main issues in the case were whether the denial of first-party no-fault benefits by the defendant insurance company on the basis of lack of medical necessity and improper fees charged was valid. The court considered the $3,119.44 claim of South Bronx Medical, P.C. which was denied based on lack of medical necessity, and the $6,500.12 claims of Altercare Acupuncture, P.C. which was denied on the ground of improper fees charged. The trial court granted an oral motion by plaintiffs South Bronx Medical, P.C. and Altercare Acupuncture, P.C. for a directed verdict in their favor before the defendant had rested. The appellate court dismissed the appeal, stating that an oral ruling at trial, even if memorialized into a writing, is not appealable unless it is incorporated into an order or judgment. Therefore, the holding of the case was that the appeal was dismissed.

The relevant facts in this case were that Superior Medical Equipment & Supply, as the assignee of Ravin Smith, was seeking to recover first-party no-fault benefits from Merchants & Businessmens Mutual Ins. Co. The main issue decided by the court was whether the defendant was entitled to summary judgment dismissing the complaint. The court held that the defendant had established its prima facie entitlement to summary judgment by providing an affidavit stating that the involved vehicle was not insured by the defendant until three weeks after the accident. However, the burden shifted to the plaintiff to raise a triable issue of fact, which they did by arguing that the owner of the vehicle directed his insurance broker to have the vehicle added to the existing insurance policy with the defendant. This created an issue of fact as to whether the broker had the authority to represent the defendant, and as a result, the defendant's motion for summary judgment was properly denied. Therefore, the order denying the motion for summary judgment was affirmed.

The court considered a motion for summary judgment in a case where a provider was seeking to recover assigned first-party no-fault benefits, but the defendant claimed that a previous declaratory judgment barred the recovery of benefits due to staged automobile incidents. The main issue decided was whether the declaratory judgment barred the plaintiff from recovering benefits for the specific incident in question, which was not listed in the judgment. The court held that the defendant's motion for summary judgment should have been denied, as the motion papers failed to establish that the action was barred by the declaratory judgment. As a result, the order to grant summary judgment was reversed, the complaint was reinstated, and the matter was remitted to the Civil Court for further proceedings.

The court considered the fact that both the appellant and the respondent filed motions for summary judgment to recover first-party no-fault benefits. The main issue decided was whether the respondent should be precluded from offering evidence in this matter and if the claims should be dismissed. The holding of the case was that the respondent's cross motion for summary judgment dismissing the complaint was granted to the extent of dismissing the claims in the amounts of $341.34, $195.50, and $795. The court found that the respondent demonstrated that its claim denial forms were timely mailed and that there was a lack of medical necessity for certain medical supplies, and therefore granted the cross motion for summary judgment to dismiss those specific claims. The court also found that there was an issue of fact regarding the timeliness of one of the appellant's claims, and therefore denied the respondent's cross motion for summary judgment as to that claim.

The court considered the facts of a trial in which a provider was attempting to recover first-party no-fault benefits that had been assigned to them. The trial court granted the defendant's motion for a directed verdict and dismissed the complaint, finding that the plaintiff had not established that the claim was overdue. The plaintiff's witness's testimony was not based on personal knowledge, and as a result, the judgment was affirmed. The main issue decided was whether the plaintiff had provided sufficient evidence to establish that the claim was overdue, and the holding of the court was that they had not, leading to the affirmation of the judgment.

The court considered the case of a medical provider seeking to recover first-party no-fault benefits, where the insurer had denied the claim based on lack of medical necessity. The main issue was whether the medical services provided to the plaintiff's assignor were medically necessary. The court held that the insurer's cross motion for summary judgment dismissing the complaint should have been granted, as the peer review report submitted by the insurer demonstrated a lack of medical necessity for the services, and the plaintiff's doctor had failed to meaningfully rebut the conclusions in the report. Therefore, the court reversed the order and granted the insurer's cross motion for summary judgment dismissing the complaint.

The court considered the plaintiff's appeal from an order of the Civil Court of the City of New York, Kings County, which granted the defendant's motion to dismiss the complaint if the plaintiff failed to respond to discovery demands within 45 days and produce its owner for an examination before trial within 60 days. The main issue decided was whether the Civil Court improvidently exercised its discretion in granting the defendant's motion to dismiss the complaint pursuant to CPLR 3126. The holding of the case was that the Civil Court did not improvidently exercise its discretion, and therefore, the order was affirmed.