No-Fault Case Law

The court considered the defendant's motion for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for an independent medical examination (IME), which was a condition precedent to coverage. The defendant submitted an affidavit showing that the IME notices had been sent to the plaintiff's assignor and that the assignor had failed to appear for the duly scheduled IMEs. Additionally, the denial of claim forms were timely mailed in accordance with the defendant's standard office practices and procedures. The main issue decided was whether the plaintiff's assignor's failure to appear for the IMEs constituted a breach of the insurance policy's conditions. The holding of the court was that the appearance of the assignor at an IME was a condition precedent to the insurer's liability on the policy, and therefore the defendant's motion for summary judgment dismissing the complaint was granted.

The main issue in the case was whether the plaintiff had properly served the defendant with a summons and complaint in a no-fault benefits action. The defendant argued that process had not been properly served because they had not signed and returned the acknowledgment of receipt of the summons and complaint within 30 days. The court considered the fact that the plaintiff had attempted to serve the defendant via mail, but the defendant had not signed and returned the acknowledgment of receipt. As a result, the court held that service of process was not effectuated pursuant to CPLR 312-a, and no personal jurisdiction was acquired. Therefore, the court reversed the lower court's decision and granted the defendant's motion to dismiss the complaint.

The main issue in this legal case was whether the defendant insurance company was entitled to summary judgment based on the assignors' failure to appear at scheduled examinations under oath (EUOs) in a no-fault benefits case. The court considered the fact that the insurance company denied all of the claims at issue on the grounds that the assignors had failed to attend the scheduled EUOs. The court held that in order for the insurance company to make a prima facie showing for entitlement to summary judgment, they had to demonstrate that their initial and follow-up requests for verification were timely mailed, and establish, by an affidavit of one with personal knowledge, that the assignors failed to appear for the EUOs. The court found that the defendant failed to establish a prima facie showing and therefore, the Civil Court properly denied the defendant's cross motion for summary judgment. Consequently, the order was affirmed insofar as appealed from.

The relevant facts considered by the court were that a chiropractic practice was seeking to recover first-party no-fault benefits for services rendered to an assignor who was referred to the practice by a non-party practitioner. The insurance company moved for summary judgment dismissing the complaint, claiming that the referral violated Public Health Law § 238-a prohibiting referrals where the referring practitioner has a financial relationship with the healthcare provider. The main issue decided by the court was whether there was a "financial relationship" between the chiropractic practice and the referring practitioner, as defined by section 238(3) of the Public Health Law. The court determined that there was no evidence to establish a "compensation arrangement" or any payments for the rental or lease of office space between the parties. The holding of the case was that the evidence submitted by the insurance company failed to establish a "financial relationship" between the chiropractic practice and the referring practitioner as required by the Public Health Law. Therefore, the court reversed the order granting the insurance company's motion for summary judgment, denied the motion, and reinstated the complaint.

The court considered the plaintiffs' motion for summary judgment in an action to recover assigned first-party no-fault benefits. Plaintiff Devonshire Surgical Facility established its prima facie entitlement to summary judgment on its claim for $3,000, and plaintiff Carnegie Hill Orthopedic Services, P.C., established its entitlement to summary judgment on its claim for $6,902.18. In opposition, defendant failed to raise a triable issue of fact, and even assuming that defendant issued timely denials of plaintiffs' claims, the peer review report relied upon by defendant to deny plaintiffs' claims was deemed conclusory and failed to set forth sufficient facts to raise triable issues with respect to its defense of lack of medical necessity. The main issue decided was whether the plaintiffs were entitled to summary judgment on their claims for first-party no-fault benefits, and the holding of the court was to reverse the order denying the motion for summary judgment and to grant summary judgment in favor of the plaintiffs in the principal sums of $3,000 and $6,902.18.

The court considered a case involving Devonshire Surgical Facility and Carnegie Hill Orthopedic Services, P.C. seeking to recover first-party no-fault benefits from American Transit Insurance Company. The plaintiffs established their prima facie entitlement to summary judgment on their respective claims for $3,000 and $11,929.08, as defendant's documentary submissions showed that the claims were overdue. The defendant, who was precluded under a stipulation from offering certain evidence pertaining to its defense of lack of medical necessity, failed to raise a triable issue of fact in opposition to the plaintiffs' motion for summary judgment. As a result, the court reversed the lower court's order and granted summary judgment in favor of the plaintiffs for the respective amounts, with the clerk directed to enter judgment accordingly.

The relevant facts of the case involved an action by a provider to recover assigned first-party no-fault benefits. The defendant filed a motion to dismiss the complaint under the statute of limitations, arguing that the action was time-barred. The main issue decided by the court was whether the action was timely and whether the defendant's motion to dismiss was properly granted. The holding of the court was that the defendant did not establish that the action was untimely with respect to certain claims, and therefore the order was modified to deny the motion to dismiss for those specific claims. The court found that defendant did not meet its initial burden of demonstrating that those claims were untimely and that the action was barred by the statute of limitations. The court also did not accept plaintiff's argument that the defendant had failed to lay a proper foundation for the exhibits attached to its motion papers. The dissenting opinion, on the other hand, disagreed with the majority's determination and argued that there was sufficient proof to warrant a finding that the statute of limitations had expired on all claims submitted by the plaintiff.

The court considered a situation in which plaintiff's motion for summary judgment had been granted by the Civil Court and plaintiff had been awarded the principal amount, statutory interest and attorney's fees. The judgment had been entered on November 21, 2008. Defendant subsequently moved to vacate the judgment, arguing that plaintiff was not entitled to the full amount of the judgment because the interest had been improperly calculated. Defendant contended that interest on the claim should only have been calculated from the date the action was commenced on October 5, 2005, while plaintiff computed interest from 30 days after defendant's receipt of the claim forms. The main issue considered by the court was whether the interest on the claims at issue should commence 30 days after defendant's receipt of the claim forms or from the date the claim was presented to the defendant for payment. The holding was that plaintiff's calculations of interest were in error and the order was reversed, defendant's motion was denied and the judgment was reinstated.

The court considered the motion for summary judgment by the defendant, Travelers Property Casualty Ins. Co., in a case involving electro-diagnostic testing performed by Novacare Medical P.C. on an assignor, Winston J. Thorpe. The main issue decided was whether the submission of an affirmed peer review report is sufficient to shift the burden to the plaintiff to submit opposing expert proof in order to defeat an insurer's summary judgment motion. The court held that a conclusory unsubstantiated peer review report is not enough to meet the insurer's initial burden, and that the burden of submitting contrary evidentiary proof is not properly imposed on the opponent until the moving party meets its initial burden. The court also found that the defendant's proof of mailing of its denials was sufficient, and that its fee schedule defense was established, but that the issue of medical necessity would need to be tried.

The main issue in this case was whether the defendant, New York Central Mutual Fire Insurance Company, had provided sufficient evidence that it had mailed notices of independent medical examinations (IMEs) to the assignor, and whether the assignor's failure to attend the IMEs was justified. The court considered the defendant's documentary submissions, which established that the IME notices had been mailed to the assignor and that the assignor had failed to attend the IMEs. The plaintiff, Center for Orthopedic Surgery, LLP, failed to raise a triable issue regarding the reasonableness of the requests or the assignor's failure to attend the IMEs. Therefore, the court held that the defendant had proved the mailing of the IME notices, and the complaint was dismissed. The decision was reversed, and the motion was granted in favor of the defendant.