No-Fault Case Law

The court considered a motion for summary judgment in a case brought by Axis Chiropractic, PLLC as assignee of Ricargo Herrera against GEICO General Insurance Company to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had made a prima facie showing of entitlement to summary judgment, with the court ultimately holding that the plaintiff failed to do so. The court found that the affidavit submitted in support of the motion for summary judgment did not demonstrate personal knowledge of the plaintiff's business practices and procedures, therefore rendering it legally insufficient. As a result, the court affirmed the denial of the plaintiff's motion for summary judgment. No other issues were considered by the court in this case.

The main issue in the case of Points of Health Acupuncture, P.C. v Lancer Insurance Company was whether the defendant had established the timely mailing of denial of claim forms and examination under oath (EUO) scheduling letters, as well as the plaintiff's failure to appear for scheduled EUOs. The court considered that the defendant had established the timely mailing of the EUO scheduling letters with respect to certain claims, and thus was entitled to partial summary judgment dismissing these claims. However, the court found that the defendant had failed to establish the timely mailing of verification requests with respect to other claims, thus precluding the defendant from raising most defenses for these claims. The court also found that plaintiff's cross motion for summary judgment was premature, and that the defendant was entitled to compel the plaintiff to respond to discovery requests. Therefore, the court reversed the order, granted partial summary judgment to the defendant, denied the plaintiff's cross motion for summary judgment, and remitted the matter to the Civil Court for further proceedings on the remaining claims.

The relevant facts of the case were that Yklik, Inc. was seeking to recover assigned first-party no-fault benefits from GEICO Ins. Co. The main issue decided was whether GEICO had timely denied the claims at issue on the ground of lack of medical necessity. The holding of the court was that defendant established that it had timely denied the claims at issue on the ground of lack of medical necessity, and the peer review reports submitted in support of defendant's cross motion for summary judgment set forth a factual basis and medical rationale for the determinations that there was a lack of medical necessity for the supplies furnished. Plaintiff failed to raise a triable issue of fact, and the court reversed the order, denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint.

The court considered whether the insurance company, the defendant, had timely denied the provider's claims based on the failure of the provider's assignor to appear for an examination under oath (EUO). The main issue was whether the defendant had demonstrated that its initial and follow-up requests for verification were timely and whether the assignor had failed to appear for the EUOs. The holding of the court was that the defendant failed to establish that the EUO scheduling letters were timely mailed, and therefore, failed to demonstrate that the 30-day claim determination period was tolled. As a result, the defendant failed to establish that its denial of claim forms were timely, and thus, was not precluded from raising as a defense the failure of plaintiff's assignor to appear for an EUO. Therefore, the judgment in favor of the plaintiff was affirmed.

The relevant facts considered by the court were that Astoria Wellness Medical, P.C. was seeking to recover assigned first-party no-fault benefits, but the defendant argued that the acupuncture services were rendered by a professional service corporation owned by a doctor who was not licensed to perform acupuncture. The main issue decided in this case was whether the plaintiff was eligible for reimbursement of the no-fault benefits because the acupuncture services were allegedly rendered by a licensed acupuncturist employed by the plaintiff. The court ultimately affirmed the lower court's decision to grant the defendant's motion for summary judgment and deny the plaintiff's cross motion as moot, based on a similar case with similar facts. Therefore, the holding of the case was that the defendant's motion for summary judgment dismissing the complaint was affirmed.

The court considered the fact that Alfa Medical Supplies, Inc. was seeking to recover first-party no-fault benefits as the assignee of two individuals, Zoila Correa and Miriam Soto. GEICO General Insurance Company denied the claims on the grounds of lack of medical necessity. The main issue decided was whether Alfa Medical Supplies, Inc. provided sufficient evidence to establish its entitlement to summary judgment. The holding of the case was that Alfa Medical Supplies, Inc. failed to provide sufficient evidence to establish its entitlement to summary judgment for its claims as the assignee of Zoila Correa and Miriam Soto. Therefore, the motion for summary judgment was denied, and the judgment in favor of Alfa Medical Supplies, Inc. was reversed.

The main issue in this case was whether respondent's injuries in a workplace accident qualified as an "accident arising out of such [underinsured] motor vehicle's ownership, maintenance or use." The court ultimately held that the injuries fell within the scope of the parties' agreement because, despite the vehicle not being in motion at the time of the incident, the coworker had used the vehicle to transport the sheet metal to the junkyard after work. This usage was found to present a causal connection between the coworker's use of the vehicle and respondent's injuries. Additionally, the court pointed out that the parked vehicle being utilized as a storage bin for sheet metal did not constitute ongoing vehicle activity and, thus, did not compel a conclusion that the vehicle was in use when the respondent was injured. However, a dissenting opinion was also issued, disagreeing with the majority's broad interpretation of vehicle usage and arguing that respondent's injuries were not related to the use of the motor vehicle.

The relevant facts of the case were that the plaintiff had notified the defendant, his no-fault insurance carrier, of an accident in January 2002, with the latter denying coverage for the claim in July 2002. Plaintiff then commenced an action for breach of contract and dealing in bad faith almost six years later. After defendant served an answer on August 28, 2008, plaintiff rejected it because it was not verified, and a second answer served on September 4, 2008 was rejected as untimely. Supreme Court granted defendant's motion—giving defendant 30 days to file, serve and file proof of service of the second answer—and denied plaintiff's cross motion. The main issues decided were whether there were reasonable excuses for the delay in serving the verified answer and whether the answer set forth a meritorious defense to the claims. The holding of the case was that given the reasonable excuse for the delay, the minimal delay, defendant's expeditious motion to compel acceptance of the answer, the absence of proof that the default was willful or any indication that plaintiff was prejudiced by the delay, and the existence of an arguably meritorious defense, the court decided to grant defendant's motion to extend the time to answer and to compel plaintiff to accept service.

The relevant facts considered by the court were that the defendant had established that it had mailed notices of independent medical examinations (IMEs) to the assignors, and the assignors failed to appear for the IMEs. The main issue decided was whether the plaintiff had raised a triable issue regarding the reasonableness of the requests for IMEs and the assignors' failure to attend. The holding of the case was that the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to comply with a condition precedent to coverage. The court reversed the order of the Civil Court of the City of New York, Bronx County and granted the defendant's motion for summary judgment, with costs, and dismissed the complaint.

The relevant facts of the case were that a healthcare provider claimed first-party no-fault benefits from an insurance company. The insurance company denied the claim on the grounds of lack of medical necessity and that the amount sought exceeded the workers' compensation fee schedule. The main issue in the case was whether the denial of the claim forms was timely mailed and whether the insurance company demonstrated a prima facie showing of entitlement to summary judgment. The holding of the case was that the insurance company demonstrated that the denial of claim forms were timely mailed and made a prima facie showing of entitlement to summary judgment, therefore the court reversed the lower court's decision and granted the insurance company's cross motion for summary judgment dismissing the complaint.