No-Fault Case Law

The court considered the fact that the plaintiff was injured while driving a vehicle insured by the defendant and that the defendant initially paid for her chiropractic treatment but ceased doing so after an independent medical examination found no further treatment necessary. The main issue decided was whether the plaintiff had the right to bring the present action to recover benefits, and the court held that the defendant waived their right to assert that the plaintiff lacked standing as an affirmative defense. Therefore, the order granting the defendant's motion for summary judgment dismissing the complaint was reversed, and the motion was denied.

The relevant facts in the case were that the plaintiffs filed a lawsuit seeking to recover first-party no-fault benefits for medical services rendered. The defendant, an insurance company, argued that the plaintiffs were ineligible for reimbursement of these benefits because they were operated in violation of state licensing requirements. After a nonjury trial, the court found in favor of the plaintiffs and awarded them the principal sum of $4,223.17, ruling that the defendant had failed to establish, by clear and convincing evidence, that the plaintiffs were ineligible for reimbursement. The defendant appealed, arguing that it only needed to establish its defense by a preponderance of the evidence, but the court found that the evidence at trial was insufficient to establish the violation of state licensing requirements. Additionally, the court determined that interest on the claims began to accrue from 30 days after the claims were submitted to the insurer for payment, and that the awarding of compound interest was not in error. The court ultimately affirmed the judgment in favor of the plaintiffs.

The relevant facts in this legal case involve an action for first-party no-fault benefits, in which the defendant insurance company failed to pay or deny a claim within the prescribed 30-day time period. The plaintiff moved for summary judgment, but the defendant requested a stay of trial as there was a pending criminal case against the plaintiff's assignor. The court found that the defendant had issued a request for verification and that the plaintiff's response lacked proof that the injury-causing accident resulted from the intoxication of the plaintiff's assignor. The court held that there was a basis for applying CPLR 3212 (f), allowing for a denial of the motion until necessary disclosure for the defense was obtained. The plaintiff's motion was denied, but they were granted leave to renew upon the completion of discovery. The defendant was also granted leave to renew its application for summary judgment upon the completion of discovery.

The court considered the issue of whether an insurer may use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such services. The court held that an insurer may do so and that the provider, in this case, was not entitled to any additional reimbursement on the claims that exceeded the proper rate of reimbursement under the fee schedule for acupuncture services rendered by a chiropractor. The court also considered charges for services where there was a lack of medical necessity, and granted summary judgment in favor of the insurer on those charges due to a lack of evidence to rebut the insurer's findings. The court concluded that the insurer's motion for summary judgment was properly denied as to a remaining claim in dispute.

The relevant facts of the case were that the plaintiff, a medical provider, sued for first-party no-fault benefits and the defendant insurance company moved for summary judgment to dismiss the complaint. The main issues were whether the denial of claim forms were timely mailed and whether the services rendered by the plaintiff were medically necessary. The holding of the court was that the denial of claim forms were timely mailed, and the defendant's peer review report established a lack of medical necessity for the services at issue. The court also found that the plaintiff did not need the medical records from other providers to raise a triable issue of fact, and therefore failed to establish a basis to defeat the defendant's motion for summary judgment. The decision was modified to grant the branch of the defendant's motion seeking summary judgment dismissing the complaint.

The relevant facts considered by the court in the case of Davidov Medical, P.C. v Firemans Fund Insurance Company involved a provider seeking to recover assigned first-party no-fault benefits. The defendant contended that it had already paid the bills at issue, and moved for summary judgment dismissing the complaint. The main issue decided was whether the defendant had made a prima facie showing that it had paid the specific bills alleged by the plaintiff in its complaint to be outstanding. The holding of the court was that the defendant did not make a prima facie showing that it had paid the four specific bills alleged by the plaintiff, and therefore the defendant's motion for summary judgment dismissing the complaint was denied.

The court considered a case in which W & Z Acupuncture, P.C. as Assignee of LaFontant Abelard appealed an order from the Civil Court of the City of New York, Queens County. The order had adjourned plaintiff's motion for summary judgment and defendant's cross motion for summary judgment, and also required plaintiff to provide discovery. The court dismissed the appeal as academic due to the subsequent dismissal of the action by the Civil Court for the plaintiff's failure to produce the court-ordered discovery. The main issue decided was the dismissal of the action rendering the appeal academic. The holding of the case was that the dismissal of the action rendered the appeal academic, in line with previous case law.

The relevant facts considered by the court included a motion by the defendant to vacate the notice of trial and strike the action from the trial calendar, due to the plaintiff's failure to complete discovery. The main issue decided by the court was whether the plaintiff should be directed to comply with the defendant's outstanding discovery demands. The holding of the appellate term was that the defendant's motion to vacate the notice of trial and strike the matter from the trial calendar was valid and justified, as the plaintiff had failed to complete discovery. The court also determined that the doctrine of laches did not warrant a denial of the defendant's motion, and that the plaintiff must comply with the Civil Court's direction to provide responses to the defendant's discovery demands, except as to matters which are privileged or palpably improper.

The main issue in this case was whether the plaintiff had provided requested verification in a timely manner as required for a no-fault insurance claim. The court considered the fact that the defendant had timely mailed verification requests to the plaintiff and that the plaintiff had failed to provide the requested verification. The court also addressed the argument by the plaintiff that the verification requests were not received, which was contradicted by the defendant's claims examiner's affidavit. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was granted, as the plaintiff had not demonstrated that it had provided the requested verification, making the action premature. Therefore, the court reversed the order and granted the motion for summary judgment dismissing the complaint.

The court considered a case where a provider was seeking to recover assigned first-party no-fault benefits from an insurance company, with the main issue being whether the medical services rendered were medically necessary. The provider moved for summary judgment, while the insurance company cross-moved for summary judgment dismissing the complaint. The Civil Court found that the provider had established its prima facie case, and that the insurance company had timely denied the claim, leaving the medical necessity of the services as the sole issue for trial. The insurance company submitted a medical peer review report which showed a lack of medical necessity for the services, and this showing was unrebutted by the provider. As a result, the insurance company's cross motion for summary judgment dismissing the complaint was granted.