No-Fault Case Law

The court considered the facts that the plaintiff, Citywide Social Work and Psychological Svcs, P.L.L.C., had commenced an action to recover assigned first-party no-fault benefits in the sum of $1,181.63 and that the defendant, Allstate Ins. Co., failed to timely appear and answer. The main issue decided was whether the Civil Court was correct in denying the plaintiff's motion for leave to enter a default judgment and dismissing the complaint pursuant to CPLR 3215 (c). The holding of the court was that when a plaintiff fails to commence proceedings for the entry of a default judgment within one year of the default, the court shall dismiss the action as abandoned unless sufficient cause is shown why the action should not be dismissed, and in this case, the plaintiff failed to demonstrate a reasonable excuse for the delay in timely moving for leave to enter a default judgment and did not proffer any reasonable excuse for its delay, so the order denying the plaintiff's motion and dismissing the complaint was affirmed.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, in an action to recover assigned first-party no-fault benefits. The main issue was whether the defendant was entitled to summary judgment dismissing the complaint. The court held that the defendant's cross motion for summary judgment dismissing the complaint should have been granted, as defendant's showing that the supplies were not medically necessary was unrebutted by the plaintiff. The court also found that defendant had timely denied plaintiff's claims, and the sole issue for trial was the medical necessity of the supplies provided to plaintiff's assignor. Therefore, the defendant's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court in the case included a dispute over whether services rendered to the plaintiff's assignor were medically necessary. The main issue decided was whether the Civil Court erred in precluding the testimony of the defendant's witness, a psychologist who had prepared a peer review report upon which the claim denial was based. The holding of the court was that it was error to exclude the testimony of the psychologist since he was prepared to testify about the factual basis and medical rationale for his opinion, and was subject to cross-examination. As a result, the judgment was reversed and the matter was remitted for a new trial.

The court considered the fact that the plaintiff had filed an answer in November 2003, and had moved for default judgment in February 2004. After a so-ordered stipulation in 2006, the defendant moved to vacate the default judgment and dismiss the complaint. The main issue decided was whether the defendant's conduct in engaging in discovery acted as a waiver of the right to dismiss the complaint pursuant to CPLR 3215 (c). The court held that the defendant's conduct in engaging in discovery was a waiver of their right to dismissal, and therefore affirmed the denial of the branch of defendant's motion seeking to dismiss the complaint.

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.