No-Fault Case Law

The court considered an appeal from an order that denied the defendant's motion for summary judgment dismissing the plaintiff's second, third, fifth, sixth, and eighth causes of action in a case involving the plaintiff's attempt to recover assigned first-party no-fault benefits. The defendant argued that the medical services provided were not medically necessary and submitted peer review reports as evidence. The court found that the defendant had established a prima facie entitlement to summary judgment for the second, third, fifth, and eighth causes of action, as the peer review reports supported the lack of medical necessity. However, the defendant's motion did not shift the burden with respect to the sixth cause of action. The plaintiff's submission of an affirmation from its principal was deemed improper as it did not raise an issue of fact, and the court granted the defendant's motion to dismiss the second, third, fifth, and eighth causes of action.

The court considered a provider's claim to recover assigned first-party no-fault benefits, which was denied by the defendant insurance company on the ground of lack of medical necessity. The defendant's unopposed motion for summary judgment dismissing the complaint was denied by the Civil Court, leading to the appeal. The defendant's denial of claim forms, which were based on lack of medical necessity, were deemed timely and sufficient. Additionally, the defendant submitted a sworn peer review report that provided a factual basis and medical rationale for the lack of medical necessity. The court ultimately reversed the lower court's decision and granted the defendant's motion for summary judgment, as the plaintiff's health care practitioner's affidavit failed to meaningfully rebut the conclusions in the peer review report.

The main issue in this case was whether the defendant had a reasonable excuse for its default in responding to an action to recover assigned first-party no-fault benefits and if they had a meritorious defense to the action. The defendant argued that the delay was due to the process of the claim file being transferred to the insurance company that had just purchased the subject insurance policy from the defendant. The court found that the defendant failed to provide a reasonable excuse for its default as they had knowingly failed to take any action with respect to the lawsuit for approximately eight months. Therefore, the court reversed the order and denied the defendant's motion to vacate the default judgment. The holding of the case was that the Civil Court had improvidently exercised its discretion in granting the defendant's motion to vacate the default judgment.

The relevant facts considered by the court included a provider seeking to recover first-party no-fault benefits for healthcare services rendered to an assignor, as well as the argument by the insurance company that the assignment should be revoked due to misrepresentations by the assignor. The main issue decided by the court was whether the insurance company's defense was valid, and if the provider should be allowed to recover for services rendered to the assignor. The holding of the case was that the insurance company's defense failed as a matter of law, as the assignor could not unilaterally revoke the assignment after the services were rendered. Additionally, the court found that the insurance company did not demonstrate that the subject insurance policy was cancelled, and the documents submitted were not sufficient to warrant summary judgment dismissing the complaint. Therefore, the court denied the provider's motion for partial summary judgment on certain conditions.

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.