No-Fault Case Law

The relevant facts considered by the court include a dispute over no-fault benefits between Ave T MPC Corp. and Amica Mutual Insurance Co. The main issue decided was whether defendant's failure to submit a certificate of conformity had been cured and whether the action was premature since defendant had not received the claim forms at issue until after the lawsuit had been commenced. The court held that defendant's submissions supported the determination that defendant had not received any claim forms prior to the commencement of the action and that the action was premature. The court also held that the document annexed to defendant's reply papers was not made by an authorized person pursuant to Real Property Law § 299-a, but that the certificate of conformity could be given nunc pro tunc effect once the proper certificate is obtained. Therefore, the court affirmed the order on certain conditions.

The court considered the plaintiff's motion for summary judgment on default, the defendant's failure to file opposition papers, and the subsequent motion to vacate the order. The main issue decided was whether the defendant had a reasonable excuse for its default and a meritorious defense to the motion. The court held that the defendant's excuse of law office failure was not reasonable under the circumstances presented, as they failed to adequately explain why they did not re-file their opposition papers in the correct Civil Court part after being notified of their filing error. Additionally, the court found that the defendant's failure to submit the opposition papers by the agreed-upon date was de minimis and without prejudice to the plaintiff, and that the plaintiff failed to properly establish their meritorious defense. Therefore, the court affirmed the order denying the defendant's motion to vacate.

The relevant facts considered by the court were that Richmond Radiology, P.C. was seeking to recover assigned first-party no-fault benefits from Travelers Insurance Company. Richmond Radiology moved for summary judgment, while Travelers Insurance Company cross-moved for summary judgment on the grounds of lack of medical necessity. The court denied Richmond Radiology's motion and granted Travelers Insurance Company's cross-motion. Richmond Radiology appealed the decision. The main issue decided by the court was whether there was a lack of medical necessity for the testing performed on Richmond Radiology's assignor. The court held that the affidavit and peer review report of Travelers Insurance Company's chiropractor provided a factual basis and medical rationale for the determination of lack of medical necessity. As Richmond Radiology failed to present an affidavit from a health care practitioner that meaningfully referred to or rebutted the conclusions in the peer review report, the Civil Court properly granted Travelers Insurance Company's cross-motion for summary judgment. Therefore, the judgment was affirmed without costs.

The relevant facts the court considered were that the plaintiff in this case, who was seeking to recover assigned first-party no-fault benefits, filed a notice of trial and a certificate of readiness without responding to the defendant's discovery demands. The main issues decided were the defendant's motion to vacate the notice of trial, plaintiff's cross motion for a protective order, and plaintiff's motion for summary judgment. The court held that the defendant's motion to vacate the notice of trial was properly granted, the plaintiff's delay in moving for a protective order was not excused, and the plaintiff failed to establish its prima facie entitlement to summary judgment. Therefore, the order was affirmed.

The main issues in this case were the plaintiff's motion for summary judgment and the defendant’s cross motion to compel the plaintiff to produce Dr. Ronald Collins for a deposition. The court considered the defendant's request for various forms of discovery and their opposition to the plaintiff’s motion for summary judgment. The court found that the defendant had established its entitlement to depose Dr. Collins and that essential facts necessary to oppose the summary judgment motion were within the plaintiff's possession. As a result, the court reversed the lower court’s decision, granted the defendant’s cross motion to compel the plaintiff to produce Dr. Collins for a deposition, and denied the plaintiff’s motion for summary judgment, without prejudice to renewal following the deposition.

The court considered whether providers were entitled to recover assigned first-party no-fault benefits, as the defendant had timely denied the claims based on eligibility for workers' compensation benefits. The main issue decided was whether there was an issue as to whether the assignor was injured during the course of employment, requiring the matter to be submitted to the Workers' Compensation Board. The holding of the case was that the order was reversed, and the plaintiff's motion and defendant's cross-motion were held in abeyance pending a prompt application to the Workers' Compensation Board for a determination of the parties' rights under the Workers' Compensation Law. If the plaintiffs failed to file proof of such application within 90 days, the complaint would be dismissed.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which had denied the defendant's motion for summary judgment dismissing the fifth cause of action in a first-party no-fault benefits case. The defendant argued that the services rendered were not medically necessary. The court found that the submission of the affirmation executed by the plaintiff's principal was improper, as it did not comply with CPLR 2106, and that the plaintiff failed to proffer any evidence in admissible form which raised an issue of fact. The court reversed the order and granted the defendant's motion for summary judgment dismissing plaintiff's fifth cause of action. The main issue was whether the defendant's denial of the claim form denying the claim at issue on the ground of lack of medical necessity was timely, and whether the plaintiff's submission of the affirmation executed by its principal was proper. The holding was that the defendant's motion for summary judgment dismissing the fifth cause of action was granted, as the plaintiff failed to proffer any evidence in admissible form which raised an issue of fact.

The court considered an appeal from an order of the Civil Court of the City of New York, in which a judgment was entered awarding the plaintiff the principal sum of $1,156.98 in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had properly paid for the services at issue at a rate reduced pursuant to the workers' compensation fee schedule and whether there was a lack of medical necessity for the denied services. The court held that the denial of the claim forms were timely mailed in accordance with the defendant's standard office practices and procedures. Additionally, the court determined that it was proper for the defendant to use the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive for acupuncture services performed by chiropractors. The court also found that there was a lack of medical necessity for the denied services after an independent medical examination took place, and therefore granted the defendant's cross motion for summary judgment dismissing the complaint.

The court considered a case in which a provider was seeking recovery of assigned first-party no-fault benefits. Defendant had alleged that it had properly paid for the services at issue at a reduced rate and denied reimbursement for lack of medical necessity based on an independent medical examination. The main issues decided were whether plaintiff was entitled to summary judgment, whether the denial of claim forms were timely mailed, and whether there was sufficient evidence to dismiss plaintiff's claim for the initial acupuncture visit. The holding of the case was that the plaintiff was entitled to summary judgment for the initial acupuncture visit, but not for the remaining claims. Additionally, the court found that the denial of the fourth and fifth causes of action for lack of medical necessity was justified based on the evidence presented.

The main issues in this case were whether the services provided were medically necessary and if the denial of the claim by the insurance company was timely mailed. The court considered the affidavit submitted by the insurance company's claims division employee, which established that the denial of the claim form was timely mailed in accordance with their standard office practices and procedures. The court also considered the affirmed peer review report by the insurance company's doctor, which set forth a factual basis and medical rationale for the opinion that the services provided were not medically necessary. However, the court found that the plaintiff proffered an affidavit in admissible form from its owner, a chiropractor, which referred to the insurance company's peer review report and sufficiently rebutted its conclusions. Therefore, the court held that a triable issue of fact as to medical necessity existed and reversed the judgment, vacated the order granting the plaintiff's motion for summary judgment, and denied the plaintiff's motion for summary judgment.