No-Fault Case Law

The court in this case had to decide on a motion to reargue the court's decision regarding the timeliness of the defendant's denial of plaintiff's claim. Plaintiff Jesa Medical Supply, Inc. sought payment of first-party no-fault benefits from defendant American Transit Insurance Co. The court held that the defendant's denial was one day late, not two days late because Presidents' Day, a legal holiday, should have been excluded in computing the time needed for the verification request. According to 11 NYCRR 65-3.5 (b) and 11 NYCRR 65-3.8 (j), defendant's request for additional verification within 15 business days would exclude legal holidays from the calculation of the number of days required to submit the additional verification requests. Therefore, the motion to reargue was granted, and the case was set down for trial on the sole issue of medical necessity.

The court considered the defendant's motion for summary judgment dismissing the complaint, based on the fact that they had made a prima facie showing that two separate requests for an independent medical examination ("IME") of plaintiff's assignor were duly mailed to the assignor and that the assignor failed to appear for the examination. The main issue was whether the defendant was entitled to summary judgment dismissing the complaint, and the court held that they were. The court noted that the defendant was not required to produce the applicable automobile insurance policy in order to establish that the mandatory personal injury endorsement included an IME provision. Therefore, the defendant's motion for summary judgment was granted and the complaint was dismissed.

The court considered the plaintiffs' motion for summary judgment on the complaint, which sought recovery of overdue assigned first-party no-fault benefits. The main issues decided were whether the plaintiffs were entitled to partial summary judgment on the issue of liability for recovery of these benefits, and whether plaintiff Carnegie Hill Orthopedic Services was entitled to judgment as a matter of law on overdue assigned first-party no-fault benefits. The court held that the plaintiffs were entitled to partial summary judgment on the issue of liability for the first cause of action, and plaintiff Carnegie Hill Orthopedic Services was entitled to judgment as a matter of law on the second and third causes of action seeking recovery of overdue assigned first-party no-fault benefits. The court ordered the matter to be remanded for apportionment between the plaintiffs of the damages on the first cause of action, as the plaintiffs had failed to establish such apportionment in their motion papers.

The court considered the motion brought by the plaintiff, a chiropractic medical provider, to recover assigned first-party no-fault benefits from the defendant insurance company. The plaintiff sought leave to enter a default judgment when the defendant failed to appear or answer the complaint. However, the motion was unopposed and was ultimately denied by the Civil Court. On appeal, the Appellate Term affirmed the denial of the motion, as the plaintiff's papers did not demonstrate a prima facie entitlement to judgment as a matter of law, as required by CPLR 3215 (f). The court also stated that the plaintiff was not entitled to alternative relief seeking a finding for all purposes in the action that it had established its prima facie case. The Appellate Term modified the order to provide that the plaintiff's motion was denied with leave to renew upon proper papers.

The court considered the facts that a provider (Triangle R, Inc.) had moved for summary judgment to recover assigned first-party no-fault benefits from GEICO Insurance Company. GEICO opposed the motion, stating that the action was premature because it was commenced before GEICO had received responses to its outstanding verification requests. The main issue decided was whether the action by the provider was premature due to GEICO not receiving the requested verification. The holding of the case was that GEICO's appeal was deemed to be from the judgment, and it was reversed without costs. The court vacated the order, denied the provider's motion for summary judgment, and granted GEICO's cross motion for summary judgment dismissing the complaint without prejudice to the provider's commencement of a new action.

The main issues in this case concerned a provider's attempt to recover first-party no-fault benefits from an insurance company, which had denied the claim on the basis that the treatments were not medically necessary. The court considered the sworn peer review report and the sworn independent medical examination report by the insurance company's chiropractors, which provided a factual basis and medical rationale for their determination that the treatments were not medically necessary. The court held that the insurance company's moving papers made a prima facie showing that they were entitled to judgment as a matter of law, shifting the burden to the provider to raise a triable issue of fact. The provider's affidavit in opposition to the insurance company's motion was found to be insufficient to raise a triable issue of fact, as it merely consisted of a conclusory statement by the affiant, the doctor who had provided the treatments, reaffirming his opinion that the disputed services were medically necessary. Therefore, the court reversed the lower court's decision, vacated the previous order, and granted the insurance company's motion for summary judgment while denying the provider's cross motion for summary judgment.

The Appellate Division of the Supreme Court in the Second Department denied an appeal from a lower proceeding, which means the lower court's decision was sustained. The case involved a petition to vacate an arbitration award arising from a previous dispute between Judy Chin and State Farm Insurance Company. The court affirmed the arbitrator's award, rejecting petitioner's claims that it was based on insufficient evidence or failed to address specific evidence. The court found that the award was reasonably based and supported by the evidence, and therefore not subject to being vacated. Consequently, the court held that the arbitration award, as modified, was justified and did not violate the standards for vacating or modifying arbitration awards.

The relevant facts considered in this case were that We Care Medical had filed a lawsuit against GEICO Insurance Company to recover assigned first-party no-fault benefits. We Care Medical moved for summary judgment, while GEICO cross-moved for summary judgment dismissing the complaint. The main issues decided were whether the documents annexed to We Care Medical's motion for summary judgment were admissible as business records, and whether GEICO had timely denied the claim at issue based on lack of medical necessity. The holding of the case was that We Care Medical established its prima facie case and was awarded summary judgment on its first cause of action. However, GEICO established its prima facie entitlement to summary judgment with respect to We Care Medical's third cause of action, and We Care Medical failed to raise a triable issue of fact with respect to this cause of action, therefore GEICO's cross motion for summary judgment was granted.

The main issue in this case was whether the services provided by the plaintiff were medically necessary, as the defendant argued that they were not. The court considered the affidavit of the plaintiff's billing collection supervisor, as well as the affirmed peer review reports submitted by the plaintiff in support of their motion for summary judgment. The District Court initially granted the plaintiff's motion, but the Appellate Term reversed the decision, finding that the peer review reports provided a sufficient factual basis and medical rationale to demonstrate the existence of an issue of fact as to medical necessity. Therefore, the plaintiff's motion for summary judgment was denied, and the decision of the District Court was reversed.

The relevant facts considered by the court were that Beal-Medea Products, Inc. was seeking to recover first party no-fault benefits from GEICO General Insurance Co. The main issue decided was whether the supplies provided to Beal-Medea Products' assignor, Michael Perez, were medically necessary. The court held that the defendant, GEICO, failed to establish a factual basis and medical rationale for its asserted lack of medical necessity. The court also discussed the admissibility of testimony by substitute peer doctors, and held that the substitute peer doctor's testimony is permissible if limited to the basis for denial as set forth in the original peer review. The court ultimately ruled in favor of the plaintiff, Beal-Medea Products, awarding them $563.04, plus costs, disbursements, statutory interest, and statutory attorneys fees.