No-Fault Case Law

The court considered the defendant's motion to vacate a default judgment and underlying order in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had a reasonable excuse for its default and a meritorious defense to the action in order to vacate the judgment and underlying order. The holding of the court was that the defendant established a reasonable excuse for its failure to oppose the plaintiff's motion for summary judgment and also established an arguably meritorious defense to the action. Therefore, the order to vacate the judgment and underlying order was affirmed.

The court considered a provider's action to recover assigned first-party no-fault benefits, with the defendant arguing that the equipment provided was not medically necessary. The Civil Court granted the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had timely mailed its denial of claim form, and the court found that the affidavit submitted by the defendant failed to establish that its standard office practices and procedures were designed to ensure timely mailing. As a result, the defendant failed to demonstrate that its defense of lack of medical necessity was not precluded. The holding of the case was that the order granting the defendant's motion for summary judgment was reversed and the defendant's motion was denied.

The relevant facts considered by the court in this case include a provider's attempt to recover assigned first-party no-fault benefits and the subsequent vacating of a judgment in the provider's favor, leading to a motion for restitution of amounts paid to the provider. The main issue decided was whether the Civil Court properly ordered the provider to return monies paid by the insurance company and to pay half the cost of the insurance company's expert witness at trial. The holding of the court was that the Civil Court did indeed properly exercise its discretion in ordering the provider to return the monies and also properly directed the provider to move to restore the matter to the trial calendar. The court dismissed the appeal from the portion of the order directing the provider to pay half the cost of the insurance company's expert witness, as it was not sought in the insurance company's motion papers.

The relevant facts of the case include a provider, D & R Medical Supply, Inc., seeking to recover assigned first-party no-fault benefits from Safeco Ins. Co. The Civil Court granted the provider's motion for summary judgment, which was then appealed by the insurance company. The main issue at hand was whether the affidavit submitted by the provider's billing manager in support of their motion for summary judgment was sufficient to establish that the documents annexed to the moving papers were admissible pursuant to CPLR 4518. The appellate court held that the affidavit was insufficient in establishing the admissibility of the documents, and therefore reversed the order and denied the provider's motion for summary judgment.

The court considered the petition of All For Happy Smiles Dental, P.C. to vacate a master arbitrator's award, which had upheld the denial of its claim for reimbursement of assigned first-party no-fault benefits. The main issue decided was whether the denial of the claim for reimbursement was upheld by the master arbitrator. The holding of the case was that the order denying the petition to vacate the master arbitrator's award was affirmed without costs, as the facts in this case were the same as those in other similar cases where the denial of the claims was upheld.

The court considered the claim by Raz Acupuncture, P.C. to recover assigned first-party no-fault benefits. AIG Indemnity Insurance Company moved for summary judgment to dismiss the complaint and denied plaintiff's cross motion for summary judgment. The main issue was whether Raz Acupuncture, P.C. was entitled to reimbursement for acupuncture services rendered and the amount of payment it should receive. The court held that the defendant's denial of claim forms were timely mailed and dismissed plaintiff's complaint with respect to the claims. However, the court also held that defendant did not provide sufficient evidence to dismiss plaintiff's claim for the initial acupuncture visit, and therefore denied part of the motion for summary judgment. The court affirmed the modified order, denying summary judgment for the claim of $139.34 and otherwise dismissing the complaint.

The main issues in Meridan Health Acupuncture, P.C. v Auto One Ins. Co. were whether a Notice to Admit could be used to establish a prima facie cause of action under NY Ins. Law § 5106(a) and whether a written response from the defendant could constitute a statutory admission sufficient to establish a prima facie case. The court considered that the plaintiff offered a Notice to Admit asking the defendant to admit to receiving the claim and assignment for no-fault medical provider services, but the defendant's response neither admitted nor denied the matters requested. The court also considered that the appellate courts were split on this issue, but it had previously allowed Notices of Admit to establish a prima facie cause of action. The holding was that the plaintiff's Notice to Admit had established its prima facie case and as the defendant presented no testimony or alternative evidence to rebut the plaintiff's case, the court entered judgment for the plaintiff in the sum of $3,485.00.

The court considered the arbitration awards issued against State Farm Insurance Company in a mandatory inter-company arbitration proceeding brought by AIU to recover first-party no-fault benefits paid to its insureds as a result of injuries suffered in a multi-vehicle accident. State Farm contended that the awards were arbitrary and capricious and sought to vacate them on that basis. The main issue decided was whether the awards were supported by the evidence and whether the arbitrator had considered the evidence proffered by the parties. The holding of the case was that the awards in the compulsory arbitration proceeding were supported by the evidence, and the decisions by the arbitrator indicated that he had considered the evidence proffered by the parties. Therefore, the court affirmed the order, denying the vacatur of the awards and in effect, confirming the awards.

The court considered the fact that the plaintiff, Eagle Surgical Supply, Inc., was seeking to recover assigned first-party no-fault benefits from the defendant, Utica Mutual Insurance Company. The main issue was whether there was coverage for the claims at issue, as the assignor had allegedly breached a condition precedent to coverage by failing to appear for two properly scheduled examinations under oath (EUOs). The Civil Court granted the defendant's motion for summary judgment and denied the plaintiff's cross motion, finding that the assignor had indeed breached a condition precedent to coverage. The holding of the case was that the EUO scheduling letters, which were sent by the defendant's counsel on behalf of the defendant, were not "nullities" because they clearly informed the assignor that counsel had been retained by defendant and that the letters were being sent on defendant's behalf. The court affirmed the decision without costs.

The relevant facts considered by the court were that Alur Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits, and they moved for summary judgment. GEICO Ins. Co. opposed the motion on the ground that the claim had been submitted more than 45 days after the services had been rendered. The main issue decided was whether Alur Medical Supply, Inc. had established its prima facie entitlement to summary judgment by proving the submission of the claim form to the insurer. The holding of the court was that Alur Medical Supply, Inc. failed to establish its prima facie entitlement to summary judgment, as there were discrepancies between the affidavit and the annexed certificate of mailing, and therefore its motion for summary judgment should have been denied. As a result, the judgment was reversed and plaintiff's motion for summary judgment was denied.