No-Fault Case Law

The relevant facts considered by the court in this case included an action to recover assigned first-party no-fault benefits and a direction from the Civil Court for defendant to establish its fee schedule defense. The main issue decided in this case was the appeal from a "decision and order" of the Civil Court, which awarded the plaintiff the sum of $164.01. The holding of the court was that the appeal was dismissed, as the paper in question was not appealable as of right and did not decide a motion made upon notice. Additionally, the court declined to grant leave to appeal and stated that no appeal lies from a decision, leading to the dismissal of the appeal.

The court considered the fact that the plaintiff, a medical provider, was seeking to recover assigned first-party no-fault benefits for medical services rendered, totaling $6,947.81. The defendant insurer moved for summary judgment to dismiss the complaint based on the plaintiff's assignor's failure to appear for orthopedic independent medical examinations (IME's) on two occasions. The main issue decided was whether the defendant's scheduling of the orthopedic IME's complied with the regulation prescribing a statutory 30-calendar-day time frame for timely holding of IME's, and whether the plaintiff had submitted proof of mailing of the prescribed statutory billing forms. The court held that the defendant had failed to demonstrate a prima facie entitlement for summary judgment, as they did not schedule the IME's in a timely manner, and that the plaintiff had also failed to demonstrate a prima facie entitlement for summary judgment, as they had not submitted evidence of mailing of the billing forms. The court also found that the defendant had failed to establish that the prior decisions raised by the defendant under the doctrine of res judicata were a disposition on the merits for the same litigation between the same parties, so they were not a bar to the plaintiff's claims. Therefore, the motion by defendant for summary judgment dismissing plaintiff's complaint was denied, and the plaintiff's cross-motion for summary judgment in the total sum of $6,947.81 was also denied.

The court considered a motion brought by Kemper Independence Insurance Company for a declaration that it is not required to pay no-fault benefits to certain medical providers, as the claimants who assigned their rights under a no-fault insurance policy failed to appear for examinations under oath (EUO). Kemper argued that the defendants breached their obligations under the no-fault policy by failing to appear for scheduled EUOs, while the defendants contended that Kemper's refusal to provide a specific justification for the EUO requests excused their refusal to appear. The court disagreed with Kemper, stating that the insurer must provide a specific objective justification for seeking an EUO during the claims-verification process and that the categorical refusal by Kemper to provide the reasons for requesting an EUO rendered their second request to appear for an EUO unreasonable, thus not forming a basis to deny the benefits claim. The court also ruled that an insurer's obligation to maintain internal standards should be treated as distinct from an insurer's obligation to provide an explanation for a given EUO request. Therefore, the motion of Kemper for summary judgment against the defendant was denied.

The court considered the dispute over unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor Allen on specific dates in 2019. The main issue was whether the services provided were medically necessary and if the insurer had timely denied the claim. The court held that the insurer had timely denied the claim, precluding them from offering evidence of their defense to non-payment and that the plaintiff failed to raise factual issues requiring a trial. As a result, the court granted the insurer's motions for summary judgment and dismissed the plaintiff's complaints in both actions.

The relevant facts in this case involved 27 actions brought by Queens Neurology, P.C. seeking to recover assigned first-party no-fault benefits. The plaintiff corporation was dissolved in 2009 and in 2017, it sought to consolidate the various actions and to substitute a new attorney as its representative. The main issue before the court was whether the plaintiff, as a dissolved corporation, could continue to bring the actions without timely substitution of its attorney. The court found that as a dissolved corporation, the plaintiff was required to be substituted pursuant to CPLR 1017 and had not sought substitution within a reasonable time. Therefore, the court vacated the denial of the plaintiff's motion seeking to substitute a new attorney and vacated the findings that the plaintiff was no longer winding up its affairs, had failed to timely be substituted, and had no standing to bring the motion. The holding of the court was to modify the order, insofar as appealed from, by granting the plaintiff's motion to substitute a new attorney, and by vacating the findings regarding the plaintiff's affairs, timeliness of substitution, and standing to bring the motion.

The relevant facts considered in this case were that Custom Rx Pharmacy sued Country Wide Insurance Company to recover unpaid first party No-Fault benefits for medical prescriptions provided to their assignor Styles, as well as attorneys' fees and statutory interest. The main issue decided by the court was whether Plaintiff had standing and had provided sufficient notice to the insurance company within the required time period. The court found that Plaintiff did not have standing because they failed to provide notice of the accident to the insurance company within thirty days, as required by law. The holding of the court was that Defendant's motion for summary judgment dismissing Plaintiff's complaint was denied, and Plaintiff's cross-motion for summary judgment on its claim against Defendant was also denied. Therefore, the court ruled in favor of the Defendant, Country Wide Insurance Company.

The relevant facts the court considered in this case were that the defendant moved for summary judgment dismissing the complaint on the ground that plaintiffs' assignor had failed to appear for scheduled examinations under oath (EUOs) and independent medical examinations (IMEs). Plaintiff Essential Health Chiropractic, P.C. opposed the motion and cross-moved for summary judgment. The main issue decided was whether defendant had demonstrated its entitlement to summary judgment dismissing Essential's claims based upon the assignor's failure to comply with conditions precedent to coverage. The holding was that the order, insofar as appealed from, is modified by providing that the branch of defendant's motion seeking summary judgment dismissing so much of the complaint as was asserted by plaintiff Essential Health Chiropractic, P.C. is denied.

The court considered the fact that the plaintiff sued the defendant insurance company to recover unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor, as well as the fact that the defendant had commenced an action in Supreme Court against the plaintiff and other nonparty medical service providers. The main issue decided was whether the action was barred by res judicata, and the holding of the court was that the action was indeed barred by res judicata. The court found that the parties and subject matter in the instant matter and the Supreme Court Action were identical, and that any judgment in the plaintiff's favor would adversely affect the rights and interests created by the judgment in the Supreme Court Action. Therefore, the court granted the defendant's motion to dismiss the plaintiff's complaint.

The relevant facts the court considered were that a medical provider, A.C. Medical, P.C., was seeking to recover $3,268.16 in first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The insurance company moved for summary judgment to dismiss the complaint on the grounds that the action was premature due to outstanding verification requests. The medical provider submitted amended bills seeking to recover $2,785.16 for services rendered on November 18, 2016. The main issue decided was whether the submission of amended bills created a new obligation for the insurance company to pay or deny the claims within 30 days, and whether the action was premature. The holding of the case was that the insurance company's motion for summary judgment to dismiss the complaint was granted, as the submission of amended bills did not create a new obligation for the insurance company to pay or deny the claims within 30 days, and the action was deemed premature.

The court considered the fact that the plaintiff failed to file a notice of trial within 90 days after receiving a written demand from the defendant pursuant to CPLR 3216. The main issue decided was whether the defendant's motion to dismiss the complaint for want of prosecution should be granted. The court held that the defendant's motion to dismiss the complaint pursuant to CPLR 3216 should be granted because the plaintiff failed to comply with the 90-day demand by filing a notice of trial, and the plaintiff's claim of law office failure did not rise to the level of a justifiable excuse. Therefore, the court reversed the order denying the defendant's motion to dismiss and granted the motion.