No-Fault Case Law

The main issue in this case was whether the court correctly granted the defendant's motion for summary judgment, dismissing the complaint by a provider seeking to recover assigned first-party no-fault benefits. The court considered the fact that the defendant attached the complaint to its motion papers, as required by CPLR 3212(b), and identified the sole bill at issue. The court also considered the plaintiff's argument that the defendant could not rely on denial of claim forms for certain purposes, but concluded that the burden of proof for the elements of the cause of action lies with the plaintiff. Ultimately, the holding of the court was that the order granting the defendant's motion for summary judgment was affirmed.

The court considered a case where Eagle Surgical Supply, Inc., as an assignee of Cherise Hinton, sought to recover first-party no-fault benefits from QBE Insurance Company. Eagle Surgical Supply moved for leave to enter a default judgment against QBE based on QBE's failure to appear in the action or answer the complaint, and the motion was unopposed. The Civil Court conditionally granted the motion, ordering QBE to serve an answer within 30 days and allowing Eagle Surgical Supply to enter judgment if QBE failed to do so. Eagle Surgical Supply appealed, arguing that its motion should have been granted unconditionally. The main issue decided by the court was whether Eagle Surgical Supply demonstrated its entitlement to have its motion for leave to enter a default judgment granted unconditionally. The court held that Eagle Surgical Supply's motion papers did not meet the required standards, as they did not include a verified complaint or an affidavit by a party with personal knowledge setting forth the factual basis for the claim, as required by CPLR 3215. Therefore, the order of the Civil Court was affirmed, and Eagle Surgical Supply's motion for a default judgment was not granted unconditionally.

The relevant facts of the case involved a provider attempting to recover first-party no-fault benefits from an insurance company. The provider moved to enter a default judgment against the insurance company after they failed to respond to the complaint, but the motion was only conditionally granted, ordering the insurance company to serve an answer within 30 days. The main issue at hand was whether the provider's motion for default judgment should have been granted unconditionally. The court held that the provider's motion papers did not demonstrate their entitlement to have the motion for default judgment granted unconditionally, as they failed to provide a verified complaint or an affidavit from a party with personal knowledge of the facts, as required by the CPLR 3215 (f). Therefore, the appellate court affirmed the order without costs.

The relevant facts considered in this case involve a provider seeking first-party no-fault benefits from an insurance company. The insurance company moved for summary judgment to dismiss the complaint, claiming that some of the claims were denied based on a lack of medical necessity for the services rendered. The provider submitted an affidavit from the treating chiropractor in opposition to the motion. The main issue decided by the court was whether there was a triable issue of fact as to the claims that were denied based on a lack of medical necessity. The holding of the court was that the affidavit of the provider's treating chiropractor raised a triable issue of fact in opposition to the insurance company's prima facie showing, thus affirming the denial of the insurance company's motion for summary judgment.

The main facts of this legal case are that the defendant, Windsor Group Insurance Company, failed to timely appear in an action filed against them by Avir Surgical Supplies, Inc. as the assignee of Cigdem Demirkan to recover no-fault benefits. The defendant served an answer together with discovery demands on the plaintiff more than a year after the case was filed and subsequently filed the answer with the court. About a week later, the defendant served and filed an amended answer and moved to dismiss the complaint as abandoned. The main issue decided by the court is whether the defendant's actions of serving an answer and discovery demands constituted waiver of their right to dismiss the complaint as abandoned under CPLR 3215 (c). The holding of the court was that the defendant's submission of an answer and service of discovery demands acted as a waiver of their right to dismiss the complaint under CPLR 3215 (c), and the court properly denied the defendant's motion to dismiss the complaint as abandoned. The dissenting judge, Golia, however, argued that the case should have been dismissed pursuant to CPLR 3215 (c) since there was no activity in the case for approximately five years and the plaintiff did not show any prejudice or "sufficient cause" why the complaint should not be dismissed.

The relevant facts the court considered in Alrof, Inc. v Nationwide Ins. Co. were that the plaintiff, as an assignee of Cecil Douglas, sought to recover first-party no-fault benefits from the defendant. The main issues decided by the court were whether the defendant was entitled to summary judgment dismissing the complaint and whether the plaintiff was entitled to summary judgment in its favor. The holding of the case was that the plaintiff's motion for summary judgment was denied in its entirety, and the defendant's cross motion for summary judgment dismissing the complaint was granted in its entirety. This was due to evidence that IME requests had been timely mailed and that the plaintiff's assignor had failed to appear for scheduled IMEs. Additionally, the record demonstrated that the defendant had previously timely paid the amount awarded to the plaintiff. Therefore, the judgment was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted in its entirety.

The main issue at hand is whether a no-fault provider has established its prima facie entitlement to summary judgment by proof of submission to the defendant of a claim form, the fact and amount of the loss sustained, and proof that the defendant failed to pay or deny the claim within a 30-day period, or that the defendant had issued a timely denial of claim that was conclusory, vague, or unlawful. The court held that the medical license of the defendant's sole member was suspended in 2007, rendering him disqualified from practicing medicine and continuing as a member of the plaintiff company. This led to the dissolution of the company since there were no remaining members of the professional limited liability company. As a result, the branch of the defendant's motion seeking discovery related to plaintiff's current corporate status was denied. The court also denied the plaintiff's motion for summary judgment on the grounds that plaintiff had failed to establish its prima facie entitlement to summary judgment.

The main facts of the case involved an insurance dispute over first-party no-fault benefits that were assigned to Radiology Today, P.C. The issue before the court was whether New York Central Mutual Fire Insurance Company had failed to establish that Radiology Today did not comply with their requests for verification of the benefits. The court found that the insurance company had submitted evidence showing that they had timely mailed their requests for verification, and that Radiology Today had failed to provide the MRI films that had been requested. As a result, the court held that the 30-day period within which the insurance company was required to pay or deny the claims had not commenced, and therefore Radiology Today's action was premature. The court ultimately reversed the lower court's decision and granted the insurance company's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in this case were that the process server served the summons and complaint upon a clerk employed by the defendant's third-party claims administrator, rather than on an authorized individual. This led to a lack of personal jurisdiction over the defendant. The main issue decided was whether the failure to serve process in an action renders all subsequent proceedings null and void. The holding of the court was that the Civil Court never obtained jurisdiction over the defendant, and therefore, the defendant's motion to vacate the default judgment and dismiss the complaint should have been granted. The order denying the defendant's motion was reversed, and the defendant's motion to vacate the default judgment and dismiss the complaint was granted.

The relevant facts considered in this case were that the plaintiff, W.H.O. Acupuncture, P.C., sought to recover first-party no-fault benefits for services rendered by a licensed acupuncturist to the plaintiff's assignor. The defendant, GEICO General Insurance Co., argued that they had properly reimbursed the plaintiff for these services using the workers' compensation fee schedule for acupuncture services performed by chiropractors. The main issue decided by the court was whether it was proper for the defendant to use the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive for services rendered by a licensed acupuncturist. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint should have been granted, as it was proper for the defendant to use the workers' compensation fee schedule to determine the amount owed to the plaintiff for the acupuncture services. Additionally, the judgment in the case was found to have been improperly prepared and entered, and was reversed by the court.