No-Fault Case Law

The relevant facts considered by the court were that an action was filed by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the action was barred by the statute of limitations. The holding of the case was that the defendant had not met its initial burden of establishing that the time in which to sue had expired, and therefore the court reversed the order and denied the defendant's motion to dismiss the complaint. The court found that the defendant failed to demonstrate that the bills received were the subject of the action, and therefore the time in which to sue had not expired.

The case involved an action by a medical services provider to recover assigned first-party no-fault benefits. The provider moved for summary judgment, while the defendant insurance company cross-moved for summary judgment, arguing that the plaintiff's assignor had failed to attend independent medical examinations (IMEs). The Civil Court denied both motions, and the defendant appealed the denial of its cross motion for summary judgment. In support of its cross motion, the defendant submitted evidence that the IME requests had been timely mailed and that the plaintiff's assignor had failed to appear for the scheduled IMEs. The defendant also demonstrated that the claim denial forms had been timely mailed. The court held that the assignor's appearance at an IME was a condition precedent to the insurer's liability, and since the assignor failed to satisfy this condition precedent, the insurer properly denied the claims. Therefore, the court reversed the order, granted the defendant's cross motion for summary judgment, and held that the defendant was not precluded from raising the issue of the assignor's failure to satisfy the condition precedent to coverage. The remaining contentions raised on appeal were not reached in light of this determination.

The court considered the defendant's appeal from an order of the Civil Court of the City of New York, Bronx County, which denied its motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant properly mailed initial and follow-up notices of independent medical examinations (IMEs) to the assignor and her attorney, and if the assignor's failure to appear at the IME was reasonable. The court held that the defendant's submissions established prima facie evidence that it properly mailed the IME notices and that the assignor's failure to attend was not reasonable. Therefore, the court reversed the order, granted the defendant's motion for summary judgment, and dismissed the complaint.

The court considered the motion for summary judgment filed by the defendant in relation to a complaint brought by the plaintiff to recover first-party no-fault benefits. The main issue in this case was whether the medical supplies provided by the plaintiff to its assignor were medically necessary. The court held that the defendant's submissions established prima facie that the medical supplies were not medically necessary, and the plaintiff failed to present evidence to raise a triable issue of fact in opposition. Additionally, the court found that the medical report relied upon by the plaintiff was not properly sworn and should not have been considered. Therefore, the court granted the defendant's motion for summary judgment and dismissed the complaint.

The main issues at hand was a no-fault action where the defendant moved for summary judgment to dismiss the case based on the opinions of its peer review doctor, who found that three MRIs were not medically necessary. The plaintiff argued that it needed to obtain copies of the medical records in order to make a proper opposition to the motion. The court found that the plaintiff needed to have access to the underlying medical records and that it may lead to relevant evidence. The plaintiff, being a diagnostic facility, lacked personal knowledge of the facts which established the medical necessity of the MRIs and therefore was entitled to the benefit of the law which stated that facts essential to justify opposition were exclusively within the knowledge and control of the nonparty treating physicians and the defendant's peer review doctor. So, the court had the discretion to deny the defendant's motion for summary judgment or order a continuance to allow the plaintiff to pursue disclosure of the underlying medical records.

The relevant facts of the case involved a dispute between Darlington Medical Diagnostics, P.C. and Praetorian Insurance Company regarding the payment of no-fault benefits. The main issue decided by the court was whether the insurer was obligated to pay or deny a claim for no-fault benefits before receiving verification of the information requested. The court held that the insurer is not obligated to do so and that it had established its prima facie entitlement to summary judgment dismissing the claim as premature, as the plaintiff failed to respond to the insurer's verification requests. The court also found that the plaintiff's denial of receipt of the initial verification letter was insufficient to raise a triable issue, and therefore granted the insurer's motion for summary judgment and dismissed the complaint.

The main issue decided in this case was whether the defendant insurer was entitled to dismissal of the action for payment of no-fault benefits on the grounds of res judicata and collateral estoppel. The court considered the fact that the defendant had brought an action in Supreme Court, Nassau County, seeking declaratory relief, which was granted by default judgment when the plaintiff failed to appear or serve an answer. The court held that the default declaratory judgment had preclusive effect and therefore the plaintiff was barred from relitigating the claim, and granted the defendant's motion to dismiss on the ground of res judicata. The court also considered relevant case law and analysis of applicable law and policies to reach its decision. Ultimately, the court held that the doctrines of res judicata and collateral estoppel are designed to put an end to a matter once it is duly decided, and since the default judgment had not been vacated, it had preclusive effect, and therefore the motion to dismiss was granted.

The court considered the defendant's motion for summary judgment to dismiss the complaint in an action to recover assigned first-party no-fault benefits. The main issue was whether the defendant established prima facie that it mailed notices of independent medical examinations to the assignor and that the assignor failed to appear. The holding of the court was that the defendant's documentary submissions did establish prima facie evidence that the notices were mailed and the assignor failed to attend the exams. In opposition, the plaintiff failed to raise a triable issue regarding the reasonableness of the requests or the assignor's failure to attend the exams, therefore the motion for summary judgment was granted and the complaint was dismissed.

The relevant facts the court considered in MSSA Corp. v Redland Ins. Co. were that MSSA Corp. was seeking to recover assigned first-party no-fault benefits from Redland Insurance Company, and Redland had denied the claims based on lack of medical necessity. The main issues decided were whether Redland's denial of claim forms denying the claims at issue on the ground of lack of medical necessity had been timely mailed and whether the peer review report submitted by Redland was sufficient to establish a lack of medical necessity. The holding of the case was that Redland's motion for summary judgment should have been granted, as their denial of claim forms had been timely mailed and the peer review report, along with an affirmation by the physician who performed the peer review, set forth a factual basis and medical rationale for the conclusion that there was no medical necessity for the medical supplies at issue, and plaintiff had failed to proffer an affidavit from a health care practitioner which meaningfully referred to, let alone rebutted, the conclusions set forth in the peer review report.

The relevant facts the court considered centered around an action by a provider to recover assigned first-party no-fault benefits. Plaintiff moved for summary judgment, but defendant opposed the motion, arguing that the action was premature and that there was a lack of medical necessity for certain claims. The main issues decided were whether the action was premature and whether there was a lack of medical necessity for the claims. The holding of the court was that defendant had not received requested verification for certain claims, making the action premature, and that defendant had demonstrated a lack of medical necessity for another claim, leading to the granting of defendant's cross motion for summary judgment dismissing the complaint.