No-Fault Case Law

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.

The court considered the facts of the appeal filed against an order denying the defendant's motion for summary judgment dismissing the complaint. The affairs of the regular office practice and procedure of the defendant were detailed; the affidavit of defendant's mail clerk regarding mailing of the denial & requests for additional verification was considered. The court decided that the affidavits of defendant's no-fault claims examiner and mail clerk were sufficient to establish that defendant had timely mailed the additional verification requests. The court considered the medical records and the peer review report which established that there was no medical necessity for the services at issue, and decided that the defendant's peer reviewer took into account the medical records from the plaintiff, as well as other providers who treated the assignor. The decision reversed the order without costs and was in favor of the defendant's motion for summary judgment dismissing the complaint.

The relevant facts considered in this case were the plaintiff's receipt of the defendant's denial for their no-fault claim, and the defendant's defense of lack of medical necessity for the MRI. The main issue decided by the court was whether the defendant's proof of timely mailing of the denial and their proof of lack of medical necessity were sufficient for summary judgment. The court held that the defendant's proof of timely mailing of the denial was not enough to warrant summary judgment, and that the defendant's proof of lack of medical necessity was also not sufficient. Therefore, the court denied the defendant's motion for summary judgment.

The court considered the issue of whether the supplies provided to the plaintiff's assignor were medically necessary in a case involving a claim for first-party no-fault benefits. The defendant made a prima facie showing of entitlement to summary judgment by establishing the timely mailing of the claim denial form and submitting an affirmed peer review report of its doctor, which concluded that there was a lack of medical necessity for the supplies provided. The Civil Court granted the defendant's motion for summary judgment, and the plaintiff's opposition papers failed to rebut the showing that the supplies were not medically necessary. As a result, the court affirmed the order without costs, holding that the defendant's motion for summary judgment dismissing the complaint was properly granted, as the plaintiff failed to rebut the defendant's prima facie showing.

The court considered the denial of a claim for first-party no-fault benefits by the defendant insurance company, which was based on the lack of medical necessity for the services in question. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint brought by the plaintiff, a provider seeking to recover assigned first-party no-fault benefits. The holding of the case was that the defendant insurance company had established its prima facie entitlement to summary judgment by timely mailing denial of claim forms and submitting an affidavit and peer review report demonstrating the lack of medical necessity for the services. The plaintiff failed to raise a triable issue of fact, and therefore the defendant's cross motion for summary judgment dismissing the complaint should have been granted.

The court considered the fact that the plaintiff failed to timely provide ordered discovery responses, resulting in the defendant's motion for summary judgment dismissing the complaint on the ground that the plaintiff was precluded from offering any evidence or testimony at trial. The main issue was whether the so-ordered stipulation functioned as a conditional order of preclusion, and if plaintiff had a reasonable excuse for the failure to comply with the stipulation and the existence of a meritorious cause of action. The court held that the conditional order of preclusion became absolute upon plaintiff's failure to sufficiently and timely comply, and as the plaintiff failed to demonstrate a reasonable excuse for the failure to comply, the Civil Court properly granted the defendant's motion for summary judgment. Therefore, the judgment was affirmed.

The relevant facts in this case include the plaintiff's failure to comply with a previous court ordered stipulation to serve complete verified responses to written discovery demands. The stipulation stated that failure to comply would result in the plaintiff being precluded from offering evidence or testimony at trial. After over a year had passed without plaintiff providing the ordered discovery responses, the defendant moved to dismiss the complaint on the ground that the plaintiff was precluded from offering evidence or testimony at trial and could not establish a prima facie case. In opposition, the plaintiff offered no excuse for its failure to comply with the so-ordered stipulation, only stating that it had finally served the requested responses after the defendant made the motion. The main issue decided in this case was whether the plaintiff's failure to comply with the so-ordered stipulation, which functioned as a conditional order of preclusion, justified the defendant's motion to dismiss the complaint. The court held that the plaintiff's failure to demonstrate a reasonable excuse for the failure to timely comply with the stipulation and the existence of a meritorious cause of action, as required by the conditional order of preclusion, justified the dismissal of the complaint.