No-Fault Case Law

The court considered the denial of first-party no-fault benefits for acupuncture services rendered to an individual by Apple Tree Acupuncture, P.C. as Assignee of BILLY McLAUGHLIN from February 1, 2007 through June 27, 2007 and from August 6, 2007 through September 4, 2007 by Interboro Ins. Co. The main issue decided was whether Interboro Ins. Co. was entitled to partial summary judgment with respect to the claims for the acupuncture services. The holding was that Interboro Ins. Co. was not entitled to partial summary judgment on the ground that the amounts sought by Apple Tree Acupuncture exceeded the amounts permitted by the fee schedule, as the denial of the claim forms did not apprise Apple Tree Acupuncture of the ground asserted with "a high degree of specificity." Additionally, Interboro Ins. Co. was not entitled to summary judgment as there were triable issues of fact regarding the medical necessity of the treatment rendered for the remaining claims.

The main issue in the case was whether the defendant's original discovery demands sought production of documents pertaining to a defense that the plaintiff, a provider seeking first-party no-fault benefits, was ineligible to recover such benefits due to being a professional service corporation which failed to comply with applicable state or local licensing laws. The court considered that defendant's original discovery demands did not seek production of documents pertaining to such a defense and determined that the branch of defendant's motion seeking to compel plaintiff to respond to defendant's supplemental discovery demands was premature and should not have been granted. Therefore, the court modified the order to deny that branch of the defendant's motion as premature and affirmed the order in all other aspects. Hence, the holding was that the defendant's motion to compel the plaintiff to respond to supplemental discovery demands was denied as premature.

The court considered the motion for summary judgment made by the defendant to dismiss the complaint filed by Heights Medical Care, P.C., related to a first-party no-fault claim. The main issue decided was whether the defendant was entitled to summary judgment dismissing the claim. The holding of the court was that the defendant was entitled to summary judgment dismissing the plaintiff's claim in the sum of $395.69 since the plaintiff failed to respond to the defendant's timely and proper verification request. The court also determined that the plaintiff's remaining no-fault claims were not ripe for summary disposition, as there were triable issues regarding the defendant's verification and fraud defenses.

The court considered the fact that the plaintiff, Friendly Physician, P.C., as the assignee of Lloy Welds, had filed a motion for summary judgment in order to recover assigned first-party no-fault benefits from the defendant, GEICO Ins. Co. The issue decided in this case was whether the plaintiff had demonstrated its entitlement to judgment as a matter of law. The holding of the court was that while the plaintiff had shown that the bills were submitted to the defendant and set forth the fact and amount of the loss sustained, the sworn statements submitted by the defendant were sufficient to raise a triable issue of fact as to whether the alleged injuries arose out of an insured incident. Therefore, the court reversed the order granting the plaintiff's motion for summary judgment and denied the motion.

The main issue in the case was whether Comfort Supply, Inc. had established its prima facie case to recover assigned first-party no-fault benefits in its motion for summary judgment. The court considered the affidavit annexed to the motion papers, which stated the general practice of delivery of supplies to eligible injured persons, but did not specify the method of delivery used in this case. As a result, the court denied plaintiff's motion for summary judgment, holding that the affidavit did not establish that the supplies at issue had been delivered to plaintiff's assignor. Therefore, the order denying plaintiff's motion for summary judgment was affirmed. The decision was made by the Supreme Court of the State of New York, Appellate Term, Second Department on December 21, 2011.

In this case, the court considered a dispute between Jesa Medical Supply, Inc. and Progressive Insurance Co. over first-party no-fault benefits. Jesa Medical Supply, Inc. had provided medical supplies to an individual, Shirline Wilkinson, and sought to recover assigned benefits from Progressive Insurance Co. In response, Progressive Insurance Co. denied the claims, arguing that the supplies were not medically necessary. The main issue decided by the court was whether the supplies provided by Jesa Medical Supply, Inc. were medically necessary. The court ultimately held in favor of Progressive Insurance Co., granting their cross motion for summary judgment and dismissing the complaint, as they had demonstrated that there was a lack of medical necessity for the supplies. The court's decision was based on the fact that the medical supplies were determined to be not medically necessary by an affirmed peer review report submitted by Progressive Insurance Co. This decision was reached on December 21, 2011.

The court considered the case of Queens Brooklyn Medical Rehab, P.C. seeking to recover first-party no-fault benefits from Lancer Insurance Company. The main issue in the case was that the medical provider did not comply with a conditional order of preclusion, leading to the dismissal of the complaint. The court decided that the judgment to dismiss the complaint was affirmed because the medical provider failed to provide full and complete responses to the defendant's discovery demands and did not clearly indicate the non-existence of management, lease, or billing agreements as ordered by the court. As a result, the court found no basis to disturb the judgment and affirmed the dismissal.

The relevant facts that the court considered in this case were an action by a medical center to recover assigned no-fault benefits, an appeal from an order granting the motion, and a cross motion for summary judgment. The main issue decided by the court was that the plaintiff failed to establish its prima facie entitlement to summary judgment because the affidavit submitted in support of the motion did not lay a sufficient foundation to establish that the claim form could be used as proof. Additionally, the court found that the defendant was not entitled to summary judgment dismissing the complaint because it did not establish that the assignor was not an eligible injured person. The holding of the case was that the order was modified by providing that the plaintiff's motion for summary judgment was denied, and the cross motion for summary judgment was affirmed. The case of Richmond Univ. Med. Ctr. v New York Cent. Mut. Fire Ins. Co. was decided on December 19, 2011, by the Appellate Term, Second Department. The court ruled that the plaintiff failed to establish entitlement to summary judgment and that the defendant was not entitled to summary judgment dismissing the complaint.

The court considered the plaintiff's motion for summary judgment and the defendant's cross motion for summary judgment in a case to recover assigned first-party no-fault benefits. The court found that the plaintiff had established its prima facie case, but that the sole issue for trial was the medical necessity of the services rendered to the plaintiff's assignor. The main issue decided was whether there was a lack of medical necessity for the services rendered, and the court found in favor of the defendant, as the defendant's showing of a lack of medical necessity was not rebutted by the plaintiff. Therefore, the court reversed the order and granted the defendant's cross motion for summary judgment dismissing the complaint.

In the case of Park Slope Medical and Surgical Supply, Inc. as Assignee of IRA FRANKLIN v Progressive Insurance Company, the issue at hand was the preclusion of testimony of defendant's expert witness and the granting of plaintiff's motion for a directed verdict in a nonjury trial. The court found that defendant's expert witness should have been allowed to testify as to the medical necessity of the supplies at issue, limited to the basis for the denial as set forth in the original peer review report. The court also found that a new trial was required, as the denial did not make an explicit or implicit finding that there were any facts established for all purposes in the action. As a result, the judgment was reversed, and the matter was remitted to the Civil Court for a new trial.