No-Fault Case Law

The relevant facts considered by the court in Mount Sinai Hospital v State Farm Mutual Automobile Insurance Company were that the hospital rendered health services to Dolly Rahima during a period following a car accident and that the hospital sought payment from State Farm Mutual Automobile Insurance Company for these services. The main issue decided by the court was whether the insurer had failed to pay or issue a timely denial of the claim, thus precluding them from interposing a defense. The holding of the case was that the hospital's motion for summary judgment was granted, as the court found that the insurer neither paid nor issued a timely denial of the claim, and that the injuries sustained by Rahima arose from a reflexive action in a motor vehicle accident and did not "flow directly and immediately from an intended act." Therefore, the insurer was ordered to pay the hospital for the health services provided to Rahima.

The relevant facts considered by the court in this case were that Jesa Medical Supply, Inc. was seeking to recover first-party no-fault benefits for supplies provided to their assignor. The defendant argued that there was no coverage for the accident because it was staged. The main issue decided was whether the plaintiff had established a prima facie case for summary judgment, and whether the defendant had raised a triable issue of fact. The holding of the case was that the plaintiff's motion for summary judgment should have been denied, as the defendant's investigator's affidavit demonstrated a founded belief that the alleged injuries did not arise out of an insured incident. Therefore, the order was reversed and plaintiff's motion for summary judgment was denied.

The main issue in this case was whether a provider could recover first-party no-fault benefits for services rendered by an independent contractor. The court considered the fact that the claim forms for the services at issue stated that they were provided by an independent contractor. The court also considered previous decisions that held that once litigation has commenced, a statement in a claim form that the services were provided by an independent contractor may not be corrected, even if the statement was erroneous. The holding of the court was that the defendant has conclusively demonstrated that the plaintiff is not the provider entitled to the payment of the assigned first-party no-fault benefits, and therefore the defendant's motion to dismiss for failure to state a cause of action should have been granted.

The court considered the timely request for additional verification of a claim, the lack of response by the plaintiff, and timely denial of two claims for medical services by the defendant. The main issue decided was whether the defendant had established its entitlement to summary judgment and whether the plaintiff had failed to comply with discovery demands. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was granted and the plaintiff's motion for summary judgment and cross motion for a protective order were denied. The Court also affirmed the denial of defendant's motion to dismiss the complaint based upon plaintiff's failure to comply with discovery demands.

The court considered the case of Daniel C. Cox D.C., P.C. v Erie Ins. Co., in which the plaintiff, a medical provider, sought to recover payment of first-party no-fault benefits for chiropractic services provided to its assignor, Valerie Lesniowski. The main issue decided was whether the defendant, Erie Insurance Company, was required to pay for the medical services provided by the plaintiff. The court held that the defendant was indeed required to pay for the medical services, as it was found to be necessary and causally related to the motor vehicle accident. This case highlights the importance of insurance companies fulfilling their obligations to pay for necessary medical services under first-party no-fault benefits.

The relevant facts considered by the court in this case included the injuries sustained by the subrogor in an automobile accident, for which the plaintiff insurer seeked reimbursement for medical expenses and workers' compensation benefits paid on behalf of the subrogor. The main issue decided was whether the action was governed by the law of Maryland or New Jersey, as the subrogor initially received temporary workers' compensation benefits in Maryland but ultimately pursued his claim and received a final award in New Jersey. The court held that the action was governed by the law of New Jersey, and that while most of plaintiff's subrogation claims for medical expenses and workers' compensation payments were not recoverable under New Jersey law, the entitlement to reimbursement for disability payments in excess of a certain sum could not be determined until a more fully developed record was available.

The court considered the facts of R.E.G. Flushing Medical PC providing medical services to Hector Gomez after an auto accident in Queens, New York. Plaintiff sought no-fault payments from Gomez's insurer, defendant Integon National Ins. Co. d/b/a GMAC Ins. Co, but the defendant denied the claims based on North Carolina law. The main issue decided was whether the defendant could lawfully avoid paying plaintiff's no-fault claims based on their denials. The court held that North Carolina law governed the substantive issues presented and rejected the defense set forth in the denials, granting judgment to the plaintiff, R.E.G. Flushing Medical PC.

The court considered an action to recover no-fault medical payments under an insurance contract, where Nyack Hospital was seeking judgment against Allstate Insurance Company for failing to pay or deny the claim within the requisite 30-day period. The main issue was whether Nyack Hospital, as the assignee of Rochelle Ferguson, was entitled to summary judgment on its cause of action to recover the no-fault insurance medical payments. The holding of the court was that the plaintiffs made a prima facie showing that Nyack Hospital was entitled to judgment as a matter of law, and the defendant failed to raise a triable issue of fact in opposition to the motion. Therefore, the court reversed the order denying summary judgment and granted that branch of the plaintiff's motion which was for summary judgment on the first cause of action.

The relevant facts of this legal case are that a provider, Rogy Medical, P.C., sought to recover first-party no-fault benefits from GEICO Insurance Company. Rogy Medical moved for summary judgment in the Civil Court of the City of New York, which was granted on November 19, 2009. GEICO Insurance Company opposed the motion, arguing that the services provided lacked medical necessity and that the provider billed in excess of the workers' compensation fee schedule. The main issue decided by the Appellate Term was whether there was a triable issue of fact with respect to the lack of medical necessity for the services and the amount billed in excess of the fee schedule. The holding of the case was that GEICO Insurance Company demonstrated the existence of a triable issue of fact with respect to both causes of action, and therefore the judgment in favor of Rogy Medical, P.C. was reversed, the order was vacated, and the motion for summary judgment was denied.

The court considered the appeal from an order granting the plaintiff's motion for summary judgment in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the documents annexed to the plaintiff's moving papers were admissible pursuant to CPLR 4518. The court held that the affidavit submitted by the plaintiff's billing administrator was sufficient to establish that the documents were admissible. However, the court reversed the judgment, vacated the order granting plaintiff's motion for summary judgment, and denied plaintiff's motion, based on the failure of the plaintiff's assignor to appear for an examination under oath, which was deemed the same as a previous case.