No-Fault Case Law

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.

The court considered the fact that the defendant had timely denied the plaintiff's claim and submitted affirmations and reports demonstrating the lack of medical necessity for the supplies at issue. The main issue decided was whether the supplies provided to the plaintiff's assignor were medically necessary. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint should have been granted, as their showing that the supplies were not medically necessary was unrebutted by the plaintiff. Therefore, the court reversed the order and granted the defendant's cross motion for summary judgment dismissing the complaint.

The relevant facts considered by the court were that the New York Hospital Medical Center of Queens was seeking to recover assigned first-party no-fault benefits from Statewide Insurance Company. The main issue decided by the court was whether the hospital had established its prima facie entitlement to summary judgment in the case. The court held that the hospital had failed to demonstrate that the NF-5 hospital facility form or the UB04 was the hospital's business record and therefore admissible as proof that the services were rendered, affirming the denial of plaintiff's motion for summary judgment.

The relevant facts of this case involved an action by a provider to recover assigned first-party no-fault benefits. The defendant in the case moved for summary judgment dismissing the complaint based upon the plaintiff's assignor's failure to appear for independent medical examinations (IMEs). The main issue decided in the case was whether the defendant had properly denied the plaintiff's claims based on the assignor's failure to satisfy a condition precedent to coverage. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was granted, as the defendant had submitted sufficient evidence to establish that the plaintiff's assignor had failed to appear for the scheduled IMEs, and therefore the defendant was not precluded from raising the issue of the assignor's failure to satisfy the condition precedent to coverage.

The court considered the denial of claim form, the affirmed peer review report, and the timely mailing of the denial of the claim. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the case was that the defendant's unopposed motion for summary judgment dismissing the complaint should have been granted, as the defendant established its prima facie entitlement to summary judgment.

The New York and Presbyterian Hospital sought compensatory claims from Country-Wide Insurance Company after treating Joaquin Benitiez who was hurt in an automobile accident. The insurance company did not receive the required written notice 30 days after the accident, as stated in the New York insurance regulations. The hospital then submitted a claim 40 days after the accident which prompted the insurance company to deny the hospital's claim, as they had not been given adequate notice. While both parties filed for summary judgement, Presbyterian won initially. However, upon reviewing a number of regulations set forth in the New York insurance regulations, the Court found that these regulations did not support the hospital's claim. Therefore, the hospital was not entitled to no-fault benefits. According to the 30-day notice of accident requirement in the New York insurance regulations, the hospital could not recover no-fault benefits despite the timely submission of the required proof of claim. This was also in line with the goals of New York no-fault automobile insurance system.

The court considered the denial of the defendant's cross motion for summary judgment to dismiss the complaint. This was an action by a provider to recover assigned first-party no-fault benefits, and the defendant's motion was denied. The main issue decided was whether the defendant established that there was a lack of medical necessity for the claims. The holding of the case was that the branches of defendant's cross motion seeking to dismiss the first, second, third, fourth, fifth, eighth and ninth causes of action were granted, and the order was affirmed. Additionally, the branch of defendant's cross motion seeking the dismissal of the sixth cause of action was denied as the defendant had not demonstrated that the medical necessity defense was preserved.

The court considered the denial of claim form that was timely mailed by the defendant, which denied the claim on the ground of lack of medical necessity. The defendant submitted a sworn peer review report, which provided a factual basis and medical rationale for the conclusion that there was a lack of medical necessity for the services at issue. As a result, the defendant established its prima facie entitlement to judgment as a matter of law, shifting the burden to the plaintiff to rebut the defendant's showing. The main issue decided was whether the defendant had established that the services were not medically necessary, and whether the plaintiff had rebutted this showing. The court held that the defendant's showing that the services were not medically necessary was unrebutted by the plaintiff, and as a result, the defendant's motion for summary judgment dismissing the complaint was granted.