No-Fault Case Law

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.

The main issue in this case was whether the medical services at issue were medically necessary, and this issue was decided in the negative. The court considered evidence submitted by the defendant, including denial of claim forms and affirmed peer review reports, which established a lack of medical necessity for the services. Plaintiff failed to submit written opposition to the cross motion for summary judgment, and therefore, failed to rebut defendant's showing of lack of medical necessity. As a result, the court reversed the order and granted defendant's cross motion for summary judgment dismissing the complaint. This decision was made by the Appellate Term, Second Department on December 10, 2010.

The court considered the denial of a claim for medical supplies on the basis of lack of medical necessity, which was timely mailed in accordance with the defendant's standard office practices and procedures. The defendant submitted an affirmed peer review report with a factual basis and medical rationale for the doctor's opinion that there was a lack of medical necessity for the supplies at issue. Plaintiff did not oppose the cross motion, and therefore failed to raise a triable issue of fact as to whether the supplies were medically necessary. The main issue decided was whether the denial of the claim for medical supplies was based on a lack of medical necessity, and whether the plaintiff had raised a triable issue of fact on that issue. The holding was that the defendant's cross motion for summary judgment dismissing the complaint was granted, reversing the prior decision.

The relevant facts that the court considered were that the plaintiff sought to recover assigned first-party no-fault benefits and moved for summary judgment. The defendant opposed the motion, arguing that the plaintiff failed to establish prima facie entitlement to judgment as a matter of law. The main issue decided was whether the plaintiff made a prima facie showing of entitlement to summary judgment. The court determined that the plaintiff failed to do so and reversed the judgment, vacated the previous orders, and remitted the matter to the Civil Court for all further proceedings on the complaint. The holding of the court was that the plaintiff's motion for summary judgment should have been denied, and that defendant's motion and plaintiff's cross motion regarding the proper method of calculating attorney's fees and statutory interest should have been denied as academic.

The court considered a dispute between a medical provider and an insurance company regarding first-party no-fault benefits. The provider claimed that the insurance company failed to pay claims, while the insurance company argued that the fees charged were in excess of the workers' compensation fee schedule and that the treatments were not medically necessary. The main issues decided were whether the documents submitted by the provider were admissible, whether the insurance company's denials of claim forms were timely mailed, and whether the fees charged and treatments provided were in accordance with the workers' compensation fee schedule and medically necessary. The holding of the case was that the insurance company failed to specify the reimbursement rates that formed the basis for its determination of excess billing, and that the provider failed to rebut the conclusions set forth in the independent medical examination report regarding the medical necessity of the treatments. Therefore, the insurance company's cross motion for summary judgment dismissing the claims was granted, while certain branches of the provider's motion for summary judgment were vacated and denied.

The main issues in this case were whether personal jurisdiction was properly obtained over the defendant, a Florida insurance company, in an action to recover assigned first-party no-fault benefits, and whether the defendant's motion to dismiss pursuant to CPLR 3211 (a) (8) was improperly made after defendant had served its answer. The court considered that the plaintiff had the burden of proving that jurisdiction had been properly obtained and that the defendant's motion was mislabeled as a motion to dismiss pursuant to CPLR 3211 instead of CPLR 3212. The holding of the court was that the plaintiff failed to establish jurisdiction over the defendant and that the defendant's motion to dismiss was improperly made after serving its answer, but that the defect should be disregarded if it caused the plaintiff no prejudice. The court also held that the Civil Court did not improvidently exercise its discretion in refusing to allow the plaintiff to submit a late notice of claim to Motor Vehicle Accident Indemnification Corporation (MVAIC) because MVAIC is not a party to the instant action and the Civil Court has no jurisdiction over it. Therefore, the order was affirmed without costs.

The main issues in this case included whether the court had personal jurisdiction over the defendant, United Automobile Ins. Co. who was a Florida insurance company accused of failing to pay first-party no-fault benefits in the State of New York. The plaintiff, Viviane Etienne Medical Care, P.C., attempted to prove personal jurisdiction by serving the summons and complaint to the Chief Financial Officer of the State of Florida pursuant to the long-arm statute. However, the defendant denied conducting any business in the State of New York and moved to dismiss the complaint based on lack of personal jurisdiction. The plaintiff failed to establish that proper jurisdiction existed, and the court found no merit to the plaintiff's contention regarding the defendant's motion to dismiss. The court affirmed the order without costs and upheld the decision to dismiss the complaint due to lack of personal jurisdiction over the defendant. In summary, the court considered the lack of personal jurisdiction over the defendant and the plaintiff's failure to prove that jurisdiction had been properly obtained. The main issue decided was whether the court had jurisdiction over a Florida insurance company being accused of failing to pay first-party no-fault benefits in the State of New York. The holding of the case was that the court did not have personal jurisdiction over the defendant, and the order to dismiss the complaint was affirmed without costs.