No-Fault Case Law

The main issue in this case was whether the peer review report submitted by the defendant established a lack of medical necessity for the services rendered. The court found that the defendant's showing of a lack of medical necessity was not rebutted by the plaintiff. Additionally, the court found that the defendant's NF-10 denial of claim forms were timely, a finding which the plaintiff did not challenge. Ultimately, the court held that the defendant's cross motion for summary judgment dismissing the complaint should have been granted based on the lack of medical necessity and the timely denial of claim forms. Therefore, the order of the Civil Court was reversed and the defendant's cross motion for summary judgment dismissing the complaint was granted.

The court considered the circumstances surrounding a stipulation of settlement entered into by the parties following the entry of a default judgment against the defendant. The main issue was whether the stipulation of settlement should be vacated, and if the default judgment should be vacated as well. The holding of the court was that the stipulation of settlement should not be vacated as neither mutual mistake nor fraudulent inducement had been established. However, the court decided that the default judgment should not be vacated, and instead granted the defendant's motion for an order directing entry of a satisfaction of the judgment. The court emphasized that strict enforcement of a stipulation of settlement is essential to the management of court calendars and the integrity of the litigation process.

The main issues decided in the case were whether the denial of a claim for medical services was timely mailed by the insurance company and whether the medical services provided were determined to be medically necessary. The court considered the affidavit from the insurance company’s representative regarding the mailing procedure, as well as the peer review report which stated that there was a lack of medical necessity for the services at issue. The court held that the insurance company had established its prima facie entitlement to summary judgment by timely mailing the denial of claim form and providing a peer review report supporting the lack of medical necessity for the services. The court reversed the lower court’s decision and granted the insurance company’s cross motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in this case were that Shoreline Healing Acupuncture Group, P.C., as an assignee of TANIA STEVENS and LA TEY STEVENS, had moved for summary judgment to recover first-party no-fault benefits. American Transit Insurance Company, the defendant, cross-moved for summary judgment to dismiss the complaint on the grounds that the plaintiff's assignors had failed to comply with a condition precedent to coverage by failing to appear for an independent medical examination (IME). The main issue decided was whether the plaintiff's submission of its bills to the defendant was late and whether the assignors had failed to appear for a scheduled IME. The court held that the appearance of an assignor at an IME is a condition precedent to the insurer's liability on the policy, and as such, the defendant's motion for summary judgment dismissing the complaint should have been granted. Therefore, the court reversed the order, granted summary judgment in favor of the defendant, and limited the issues for trial.

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.