No-Fault Case Law

The court considered the fact that the defendant had timely mailed its request and follow-up request for verification to the plaintiff, in accordance with the defendant's standard office practices and procedures. The plaintiff's medical biller had denied receipt of the verification requests, but the court found that this did not overcome the presumption that proper mailing had occurred. Since the plaintiff did not serve responses to the verification requests prior to the commencement of the action, the defendant's motion for summary judgment dismissing the complaint was properly granted. The main issue decided was whether the plaintiff's action for recovery of assigned first-party no-fault benefits was premature due to failure to provide requested verification of the claim. The holding of the court was that the judgment granting the defendant's motion for summary judgment was affirmed.

The parties in this case were the Unitrin Advantage Insurance Company and Bayshore Physical Therapy, PLLC. The court decided whether the insurance company could retroactively deny no-fault insurance claims on the basis of the assignors' failure to appear for independent medical examinations (IMEs). The court ruled that the insurance company can retroactively deny claims for failure to appear for IMEs, even if the initial denials were based on lack of medical necessity. Additionally, it was decided that a denial based on the breach of a condition precedent to coverage voids the policy from the beginning. The court also addressed that insurers can request IMEs in accordance with the procedures and timeframes set forth in the no-fault implementing regulations and if the assignors did not appear, the denial of claims is valid. Finally, the court found that the argument that all IMEs must be conducted by physicians was unavailing.

The appellant, GEICO Insurance Company, appealed from a judgment entered in favor of the respondent, Alur Medical Supply, Inc., as the assignee of Gladys Ferrer. The judgment was based on an order by the Civil Court of New York granting the respondent's motion for summary judgment and denying the appellant's cross motion for summary judgment. This case concerned the failure of the appellant's claims examiner to explain handwritten additions to the denial of claim forms. The relevant issues were whether the claim denial forms were timely filed and whether there was a lack of medical necessity for the equipment at issue. The court held that the appellant's claim denial forms were timely filed and that there was a lack of medical necessity for the equipment, shifting the burden to the respondent to rebut this showing, which it failed to do. Therefore, the judgment in favor of the respondent was reversed, and the respondent's motion for summary judgment was denied.

The relevant facts considered by the court were that the Civil Court had awarded the plaintiff $10,196 in no-fault benefits, as well as attorney's fees, and the defendant rejected the proposed judgment and submitted their own calculation for the attorney's fees. The main issue decided was the proper method for calculating attorney's fees in no-fault actions, based on the aggregate of all bills submitted by the provider with respect to each insured, up to a maximum of $850, as determined by the Court of Appeals in LMK Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. The holding of the case was that the clerk's mistake in entering a judgment including attorney's fees in the sum of $4,259.42 was subject to correction by the Civil Court, and the matter was remitted for the entry of a corrected judgment awarding plaintiff attorney's fees in the sum of $850.

The relevant facts the court considered were that the defendant in this action to recover assigned first-party no-fault benefits breached an agreement by serving the cross-motion and opposition after the extended due date. The main issue before the court was whether the defendant could move for leave to renew its adversary's motion on the basis that its cross-motion and opposition, which was rejected and not entertained, constitutes new facts. The holding of the court was that the defendant's untimely responsive papers, once rejected, constituted a default on the part of the defendant in opposing plaintiff's motion. Even if a motion for leave to renew was appropriate, the defendant failed to meet the criteria for relief under either theory. Therefore, the defendant's motion was denied.

The court considered the fact that plaintiff, a professional corporation, sought to recover first-party, no fault benefits for services rendered to its assignor who was injured in an automobile accident in 2002. It also considered the numerous claims submitted by the plaintiff and the subsequent judgment and stay on entry and execution of that judgment due to miscalculated interest. The main issue decided was whether the plaintiff was entitled to its requested interest and whether defendant's motion to vacate or modify the judgment and stay enforcement should be granted. The holding of the case was that the motion to vacate or modify the judgment was denied, but the motion for an order staying enforcement was granted. The court also determined that the plaintiff was not entitled to compound interest and that the interest had been tolled as of a certain date due to plaintiff's unreasonable delay in entering the judgment.

The case involved Utica Mutual Insurance Company filing for a default judgment against Michael Andre Lynton for his involvement in a motor vehicle accident. Although the defendant did not answer the complaint, the court had the duty to review and decide if subject matter jurisdiction was present, and if plaintiff's pleadings and proof justified the granting of a default judgment. The court was faced with the issue of whether plaintiff's complaint amounted to "several causes of action" within the court's jurisdictional limits, specifically involving $15,000 for basic no-fault benefits and $6,000 for uninsured motorist benefits. The court referred to a prior case that determined when separate claims are based on a single occurrence, it constitutes one cause of action, and if the same wrongful act causes injury to a person and property, it can be considered distinct causes of action. Ultimately, the court concluded that plaintiff's claims were indeed separate causes of action and did not exceed the court's jurisdictional limits, thus sustaining subject matter jurisdiction and denying the motion for a default judgment, without prejudice to renewal.

The relevant facts the court considered in St. Vincent's Hosp. & Med. v New Jersey Mfrs. Ins. Co. were that the plaintiff, who was the assignee of a patient, filed a lawsuit to recover no-fault medical payments against the defendant, an insurance company. The plaintiff appealed a trial court's order which had denied its motion for summary judgment on the complaint and granted the defendant's cross motion for summary judgment dismissing the complaint on the ground that the claim was untimely. A main issue decided was whether the defendant issued timely denials of claim in compliance with the law. The holding was that the plaintiff demonstrated its prima facie entitlement to judgment as a matter of law while the defendant failed to raise a triable issue of fact, and, therefore, the Supreme Court should have granted the plaintiff's motion for summary judgment on the complaint and denied the defendant's cross motion for summary judgment dismissing the complaint.

The court considered the fact that the plaintiff, Quality Health Products, was seeking to recover assigned first-party no-fault benefits from the defendant, Country-Wide Ins. Co. The main issue decided was whether the defendant timely denied the plaintiff's claims based on lack of medical necessity. The court held that the plaintiff failed to establish that the claim was not denied within 30 days and also failed to show that the basis for the denial was conclusory, vague, or had no merit as a matter of law. Therefore, the court affirmed the order denying the plaintiff's motion for summary judgment.

The relevant facts considered by the court in this case included the failure of the defendant to sign and return an acknowledgment of service in a no-fault benefits case. The main issue decided was whether the defendant's motion to dismiss the complaint for lack of personal jurisdiction due to defective service should be granted. The holding of the court was that the service was defective and that the defendant's motion to dismiss the complaint should have been granted, ultimately reversing the lower court's decision. The court emphasized that if the acknowledgment of receipt is not mailed or returned to the sender, the sender is required to effect personal service in another manner, and in this case, the plaintiffs did not do so. Therefore, the service was deemed defective.