No-Fault Case Law

The plaintiff, NYU Hospital for Joint Diseases, sought to recover no-fault benefits under an insurance contract from Country Wide Insurance Company. The plaintiff claimed that the defendant failed to pay overdue benefits as required under the insurance policy. The court found that the plaintiff established its entitlement to judgment as a matter of law by submitting the necessary billing forms and other documentation. In response, the defendant failed to raise a factual issue as to whether it timely and effectively denied the plaintiff's claim. The court held that the defendant's denial of the claim was fatally defective, and therefore, the defendant's cross motion for summary judgment dismissing the complaint was denied. In conclusion, the judgment in favor of the plaintiff and against the defendant was affirmed.

The main issue in the case was whether the plaintiff, Yklik, Inc., as the assignee of Horacio Bello, was entitled to summary judgment in an action to recover assigned first-party no-fault benefits from GEICO Ins. Co. The court considered the evidence presented by both parties, including whether the defendant had failed to pay or deny the claim within the required 30-day period as stipulated by Insurance Law § 5106 (a). The court ultimately held that the plaintiff had failed to establish its prima facie entitlement to judgment as a matter of law, as it did not demonstrate that the defendant had failed to either pay or deny the claim within the requisite time period. Therefore, the order granting the plaintiff's motion for summary judgment was vacated, and the plaintiff's motion was denied. The dissenting opinion argued that the plaintiff had made a prima facie showing of its entitlement to summary judgment, as it had submitted evidence that the medical supplies had been provided to the assignor, and that the prescribed statutory billing forms had been mailed and received by the defendant insurer and remained unpaid. The dissenting opinion voted to affirm the judgment in favor of the plaintiff.

The court considered two unrelated claims for first party no-fault benefits, in which Allstate Insurance Company was the no-fault carrier for both claims. Lenox Hill Hospital sought payment for treatment provided to Eduardo Marrero and Mount Sinai Hospital sought payment for treatment provided to Gregory Bar. The main issue decided was whether the necessary billing forms and documents had been mailed to and received by Allstate and whether payment was overdue. The court held that the hospitals failed to establish a prima facie entitlement to judgment as a matter of law because they did not submit proof in admissible form sufficient to establish that the necessary billing documents were business records. Additionally, Allstate's defenses of timely denial and failure to respond to verification requests were not proven with sufficient evidence in admissible form, but the denial of the hospitals' claims was upheld.

The relevant facts considered by the court in this case were an action brought by Westchester Medical Center and New York Hospital Medical Center of Queens to recover no-fault benefits under a contract of insurance. New York Hospital Medical Center of Queens sought summary judgment on the second cause of action, and Westchester Medical Center appealed the denial of the motion. The main issue decided by the court was whether the plaintiff, New York Hospital Medical Center of Queens, as an assignee of Merna Ishak, was entitled to judgment as a matter of law on the second cause of action. The holding of the court was that while the plaintiff had demonstrated its entitlement to judgment based on the overdue payment of no-fault benefits, the defendant raised a triable issue of fact as to whether the plaintiff fully complied with the defendant's demand for verification. Therefore, the Supreme Court properly denied the plaintiff's motion for summary judgment on the second cause of action.

The relevant facts considered by the court were that the defendant was appealing an order from the Civil Court that denied its motion for summary judgment dismissing the complaint in an action to recover first-party no-fault medical benefits. The main issue decided by the court was whether the defendant had established prima facie that the notices of the independent medical examinations (IMEs) were properly mailed to the assignor and that he failed to appear for the IMEs. The court held that the defendant's motion for summary judgment was properly denied because it failed to meet its burden of establishing that the notices of the IMEs were properly mailed and that the assignor failed to appear, as required by law. Therefore, the denial of the defendant's motion was required regardless of the sufficiency of the plaintiff's opposition papers.

The relevant facts the court considered in the case were that We Do Care Medical Supply, Inc. was seeking to recover first-party no-fault benefits as the assignee of an individual. Plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint. The main issue before the court was whether the medical supplies at issue were medically necessary. The court held that defendant had timely denied the claim based on a lack of medical necessity, and as a result, defendant's cross motion for summary judgment dismissing the complaint should have been granted. The court found that defendant's showing that the supplies were not medically necessary was not rebutted by plaintiff, and therefore, the complaint was dismissed.

The court considered the appeal from an order of the Civil Court of the City of New York, Queens County, which denied the defendant's cross motion for summary judgment dismissing the complaint in an action to recover assigned first-party no-fault benefits. The main issue in the case was whether the medical supplies provided to the plaintiff's assignor were medically necessary. The court found that the defendant had timely denied the claim based on a lack of medical necessity, and that the defendant's showing that the supplies were not medically necessary was not rebutted by the plaintiff. Therefore, the defendant's cross motion for summary judgment dismissing the complaint was granted, reversing the order of the Civil Court. The holding of the case was that the defendant's cross motion for summary judgment should have been granted, as the plaintiff did not challenge the finding that the defendant had timely denied the claim based on a lack of medical necessity.

The court considered the fact that the plaintiff sought to recover first-party no-fault benefits from the defendant, who defaulted on the case. The plaintiff then moved for a default judgment two years and four months later. The main issue decided was whether the plaintiff had provided a reasonable excuse for the delay in seeking a default judgment and whether the complaint was meritorious. The holding of the case was that the plaintiff's motion for the entry of a default judgment was denied and the defendant's cross motion to dismiss the complaint was granted, as the plaintiff failed to offer a reasonable excuse for the delay in seeking a default judgment and did not demonstrate that the complaint was meritorious.

The court considered a dispute between Radiology Today, P.C. and GEICO General Insurance Company regarding the recovery of assigned first-party no-fault benefits, with GEICO seeking discovery of documents and information related to the propriety of Radiology's incorporation and operation. GEICO alleged that Radiology's incorporation and operation violated state licensing laws under the precedent established in State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 (2005). The main issue was whether Radiology's fraud defenses should be waived due to GEICO's failure to plead a defense based on fraud and whether the discovery demands were overbroad. The court decided that the discovery order was proper as GEICO's motion papers demonstrated the potentially meritorious nature of a Mallela-based defense. Since Radiology failed to timely challenge the discovery demands, the judgment dismissing the complaint was affirmed. The court did not address any other issues.

The case involved Astoria Quality Medical Supply as the plaintiff, seeking to recover assigned first-party no-fault benefits for medical supplies furnished to its assignors who were allegedly injured in a motor vehicle accident. The defendant, State Farm Mutual Automobile Ins. Co., had denied the claim on the grounds that it had not issued an insurance policy to the person who owned the vehicle involved in the accident. The Civil Court initially denied the defendant's motion for summary judgment, stating that triable issues of fact existed. However, the plaintiff later moved for summary judgment and was granted the motion. The Appellate Term, Second Department reversed the judgment, holding that while the defendant's proof did not establish as a matter of law that there was a lack of coverage, it was sufficient to raise a triable issue of fact, and the defendant was not required to describe in detail the steps taken to search its records. Therefore, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion for summary judgment was denied.