No-Fault Case Law

The relevant facts the court considered in this case included that the plaintiffs had appealed a Civil Court's denial of the plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits. The court had affirmed the original decision stating that the plaintiffs had established their prima facie entitlement to summary judgment, but the defendant had demonstrated that there was a triable issue of fact. Plaintiffs then moved in the Civil Court to deem certain facts established for all purposes in the action, pursuant to CPLR 3212 (g), and the Civil Court granted this motion. The main issue decided was whether the facts necessary to demonstrate the plaintiff's prima facie case were incontrovertible and could be deemed established for all purposes in the action, which the court held was not the case. The holding of the court was that the Civil Court improperly relied upon the appellate court's prior order in limiting the issues for trial pursuant to CPLR 3212 (g), and accordingly, the branch of the motion for relief pursuant to CPLR 3212 (g) was reversed, and denied.

The court considered the fact that the plaintiff in the case, a provider seeking to recover assigned first-party no-fault benefits, had failed to comply with the defendant's discovery demands within the required time frame. The main issue decided was whether the plaintiff's failure to provide the required discovery warranted the denial of their cross motion for summary judgment and the granting of the defendant's motion to vacate the notice of trial and strike the matter from the trial calendar. The holding of the court was that because the plaintiff had not provided the demanded discovery, the denial of their cross-motion for summary judgment and the granting of the defendant's motion to vacate the notice of trial and strike the matter from the trial calendar were proper. The court also directed the plaintiff to respond to the defendant's discovery demands as required.

The court considered the statute of limitations in a case regarding a provider seeking to recover first-party no-fault benefits from an insurance company. The main issue decided in the case was whether the action was barred by the statute of limitations. The court held that the six-year statute of limitations for contract actions applied to the cause of action, and since the action was commenced six years after the date when the cause of action accrued, it was untimely. The court also determined that the defendant's denial of the claim form did not postpone the payment due date, and the plaintiff failed to raise a triable issue of fact as to whether the defendant's time to pay or deny the claim had been tolled. Therefore, the court reversed the denial of the defendant's motion to dismiss the complaint and granted the motion.

The case involved a medical provider seeking to recover assigned first-party no-fault benefits from an insurance company. The court found that the provider's affidavit and documents were admissible and that the insurance company had received the claims in question. The court also determined that the provider had established that its claims had not been timely paid or denied, entitling the provider to judgment as a matter of law. The insurance company failed to establish that its claim denial forms were timely mailed, and therefore did not raise a triable issue of fact in opposition to the provider's motion for summary judgment. As a result, the court affirmed the judgment in favor of the medical provider.

The case involved a dispute over whether a provider was entitled to recover assigned first-party no-fault benefits for services rendered. The provider appealed from an order of the Civil Court that granted the insurance company's motion for summary judgment to the extent of dismissing the provider's claim for services rendered on specific dates in October and November. The main issue in the case was whether the provider's affidavit, submitted in opposition to the insurance company's motion, was sufficient to raise a triable issue of fact. The court found that the affidavit failed to meet the requirements of CPLR 2309 (b) as it did not contain the necessary statutorily prescribed form of oath, and it affirmed the judgment in favor of the insurance company, dismissing the provider's claim for the specified services.

The case involved three actions for no-fault benefits, with the main issue being whether the denial of claim forms from the defendant could be admitted as party admissions for the limited purpose of establishing that the plaintiff mailed its bills to the defendant. The court considered the testimony of the plaintiff's witness, Vladmir Grinsberg, who could not set forth how the bills were mailed and could not provide any evidence to authenticate the denial of claim forms. The court ruled that the denial of claim forms should only be admitted into evidence upon the laying of a business record foundation, as opposed to documents annexed to a summary judgment motion. The holding of the case was that the defendant's motions for directed verdict in each of the three actions were granted because the plaintiff failed to shoulder its prima facie burden.

The court considered whether a medical services provider, DHD Medical, P.C., was fraudulently incorporated and therefore ineligible for reimbursement of no-fault insurance benefits, and precluded from demanding arbitration. The main issue was whether the defense of fraudulent incorporation was for the arbitrator and not the courts. The court held that the defense of fraudulent incorporation is for the arbitrator and not the courts, and has been the subject of numerous arbitration proceedings. Therefore, the court affirmed the order denying the petition to stay arbitration of claims for no-fault insurance benefits and granting respondent's cross motion to dismiss the proceeding.

The court considered the fact that the plaintiff had failed to appear at scheduled examinations under oath (EUOs) as required by the defendant insurance company. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint on the ground of the plaintiff's failure to appear for EUOs. The court held that the defendant was entitled to summary judgment dismissing the claims in question because the appearance of an eligible injured person's assignee at an EUO upon a proper request is a condition precedent to the assignee's right to recover under the policy. Therefore, the order granting the defendant's motion for summary judgment was affirmed.

The court considered the appeal of Ave T MPC Corp. as Assignee of Juliana Kogan, in a case against Auto One Insurance Company. The main issue decided was whether the provider had established its entitlement to summary judgment for first-party no-fault benefits. The court held that a no-fault provider needs to prove the submission of a claim form, the fact and amount of loss, and either that the defendant failed to pay or deny the claim within 30 days, or that the defendant issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. In this case, the plaintiff demonstrated that the claims were not paid, but failed to demonstrate that the defendant had failed to deny the claim or issued a legally insufficient denial of claim form. As a result, the court affirmed the order denying the plaintiff's motion for summary judgment.

The relevant facts considered by the court were that the defendant denied a provider's claim for first-party no-fault benefits on the ground of lack of medical necessity and also denied a claim on the basis that the assignor had failed to appear for scheduled independent medical examinations. The main issue decided was whether the peer review reports submitted by the defendant were admissible and if the defendant had timely denied the claims on the grounds provided. The court held that the defendant had established its prima facie entitlement to summary judgment upon the claims of lack of medical necessity and that the defendant had timely denied the claim based on the assignor's failure to appear for scheduled IMEs. Therefore, the order of the Civil Court denying the defendant's motion for summary judgment was reversed, and the defendant's motion for summary judgment dismissing the complaint was granted.