No-Fault Case Law

The main issue in this case was whether the defendant's cross motion seeking summary judgment dismissing the claims for dates of service from May 22, 2006 through June 7, 2006 should have been granted. The court considered the sworn independent medical examination (IME) report submitted by the defendant, which determined a lack of medical necessity for the services at issue. The affidavit from the plaintiff's chiropractor failed to meaningfully refer to or rebut the conclusions set forth in the IME report. The court found that the defendant had established that it had timely denied the claims, a finding which the plaintiff did not dispute, and therefore held that the defendant's cross motion seeking summary judgment dismissing the claims for those dates should have been granted. Ultimately, the court reversed the decision and held in favor of the defendant.

The relevant facts the court considered in this case were that Complete Radiology, P.C. as assignee of Renee Hamer, was seeking to recover first-party no-fault benefits from Progressive Insurance Company. The main issue decided by the court was whether the services rendered were medically necessary. The holding of the case was that the Civil Court did not err in denying both parties' motions for summary judgment, and that the only issue to be determined at trial was the medical necessity of the services rendered. The court also found that defendant's untimely cross motion was considered due to the plaintiff's failure to demonstrate prejudice, and that the peer review report provided by the defendant appropriately supported the denial of plaintiff's motion for summary judgment. The decision of the Civil Court was affirmed.

The court considered the appeal from an order denying a defendant's cross-motion for summary judgment dismissing the complaint in an action by a medical supplier to recover assigned first-party no-fault benefits. The defendant had submitted an affirmed peer review report which stated that there was a lack of medical necessity for the supplies at issue. The court found that the defendant's showing that the supplies were not medically necessary was not rebutted by the plaintiff, and that the defendant had timely denied the claim based on a lack of medical necessity. The main issue decided was whether the defendant's cross-motion for summary judgment dismissing the complaint should have been granted, and the court held that it should have been granted, reversing the lower court's decision. Consequently, the defendant's cross-motion for summary judgment dismissing the complaint was granted.

The court considered the claim by a medical care provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company appealed from an order denying the branch of its motion for summary judgment seeking the dismissal of the provider's claim in the amount of $1,546.20. The main issue decided was whether the services provided by the medical care provider were medically necessary, as supported by an affirmed peer review report submitted by the insurance company. The court held that the insurance company's showing that the services were not medically necessary was not rebutted by the medical care provider, and therefore, the branch of the insurance company's motion seeking the dismissal of the claim in the amount of $1,546.20 should have been granted. Therefore, the court reversed the order and granted the insurance company's motion for summary judgment seeking the dismissal of the provider's claim.

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.