No-Fault Case Law

The court considered the defendant's motion to compel Valadimir Alexsandrovich to appear for a deposition and answer questions concerning Bener Wholesale, a non-party, as well as the defendant's demand for discovery regarding claims that Alev Medical Supply, Inc. was involved in a scheme to defraud insurance companies through Bener. The main issue decided was the extent to which a defendant can obtain discovery on defenses that may be precluded from being raised at trial of an action for seeking payment of first party no-fault benefits. The court held that unless a no-fault carrier seeks verification, it has 30 days from the date of receipt of the claim to pay or deny a claim in whole or in part, and that a carrier who fails to deny a claim within 30 days of receipt is precluded from asserting most defenses to the claim. Progressive Insurance Company's motion for discovery was denied by the court with leave to renew upon proper papers, including a copy of the claim and a copy of the denial.

The court considered a motion to dismiss or for summary judgment by defendant Allstate Insurance Company on the grounds that the action was barred by the six-year Statute of Limitation. The plaintiff, a medical service provider, sought to recover $320.30 for services provided to his assignor for injuries sustained in an automobile accident. The relevant issue was whether the action was time-barred and the main issue decided was whether the action was commenced within the applicable statute of limitations. The court held that the complaint was dismissed as it was determined that the action was commenced way beyond the six-year statute of limitations, as the cause of action accrued once the claim became overdue. The court found that the action was not timely and therefore dismissed the complaint.

The relevant facts considered in this case were that the defendant denied the plaintiff's claim after requesting the plaintiff to appear for an examination under oath and the plaintiff failed to appear for the examination. The main issue decided in this case was whether the plaintiff's failure to appear for the examination under oath was a proper basis for the defendant to deny the claim. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was granted because the plaintiff's failure to appear for the examination under oath was a condition precedent to the insurer's liability on the policy, and the claims were timely denied after the plaintiff's failure to appear. Therefore, the court reversed the denial of the defendant's cross motion for summary judgment.

The main issue in this case was whether the plaintiff had standing to recover no-fault benefits for medical services rendered, as the assignment executed by the plaintiff's assignor was in favor of another entity. The court considered the fact that the assignment discrepancy was apparent on its face, but the defendant did not seek verification of the assignment and its denial of the claim did not deny it on the ground that the assignment was defective. Therefore, the court held that the defendant was precluded from litigating this issue. The defendant's doctor testified that the services provided were not medically necessary, and the defendant also admitted a copy of the doctor's affirmed peer review report, which supported this conclusion. The court disagreed with the lower court's finding, and reversed the judgment in favor of plaintiff, directing judgment to be entered in favor of the defendant dismissing the complaint.

The court considered a dispute between a medical provider and an insurance company regarding the eligibility of the plaintiff's assignor for workers' compensation benefits. The insurance company moved for summary judgment to dismiss the complaint, claiming that the assignor was eligible for workers' compensation benefits. The court denied the motion without prejudice and ordered for the defendant's motion for summary judgment to be remitted to the Workers' Compensation Board. The main issue was whether the assignor was eligible for workers' compensation benefits, which was determined to be a matter within the jurisdiction of the Workers' Compensation Board. The holding of the case was that the defendant's motion for summary judgment should have been held in abeyance pending a determination by the Workers' Compensation Board, and that a prompt application to the Board was required in order to determine the parties' rights under the Workers' Compensation Law.

The relevant facts of this case involve an action by three providers seeking to recover assigned first-party no-fault benefits. The defendant moved to dismiss the complaint on the ground of res judicata, arguing that the plaintiffs had previously commenced an identical action, which had been dismissed for failure to comply with a discovery order. The main issue considered by the court was whether the dismissal of the prior action barred the plaintiffs from commencing a second action. The holding of the court was that where a plaintiff's noncompliance with a disclosure order does not result in a dismissal with prejudice, the dismissal resulting from the noncompliance is not a merits determination so as to bar commencement of a second action. As a result, the District Court properly denied the defendant's pre-answer motion to dismiss the complaint based on the doctrine of res judicata.

The court considered an action by a provider to recover assigned first-party no-fault benefits, for which the provider moved for summary judgment and the defendant cross-moved for summary judgment dismissing the complaint. The Civil Court denied both motions, finding that both parties had established certain elements under CPLR 3212 (g) and declaring that medical necessity remained the sole issue for trial. The main issue decided by the court was whether the defendant had established a lack of medical necessity for the medical equipment in question, shifting the burden to the plaintiff to rebut the defendant's showing. The holding of the court was that, since the plaintiff failed to rebut the defendant's evidence of lack of medical necessity, the defendant was entitled to summary judgment, and its cross motion should have been granted.

The court considered the motion for summary judgment by the plaintiff, Riu Chiropractic, P.C., as assignee of Dorothy Braxton, to recover first-party no-fault benefits from defendant, AutoOne Insurance Company. Defendant had cross-moved for summary judgment dismissing the complaint on the grounds that Braxton had failed to appear for scheduled independent medical examinations (IMEs). The court granted plaintiff's motion for summary judgment and denied defendant's cross motion. However, the Appellate Term reversed the judgment, vacated the order, denied plaintiff's motion for summary judgment, and granted defendant's cross motion for summary judgment dismissing the complaint. Defendant established its prima facie case through the submission of an affidavit by its litigation specialist and a supplemental affirmation from its examining physician stating that Braxton had failed to appear for the scheduled IMEs. Therefore, the judgment in favor of the plaintiff was reversed.

The court considered a case in which Park Slope Medical and Surgical Supply, Inc. was seeking assigned first-party no-fault benefits from GEICO Ins. Co. Plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment dismissing the complaint on the ground that the equipment provided was not medically necessary. The Civil Court denied both motions, finding that the sole issue for trial was the medical necessity of the supplies provided. On appeal, the Appellate Term found that plaintiff's doctor's "affirmation" submitted in opposition to defendant's cross motion was sufficient to demonstrate a triable issue of fact as to medical necessity. However, the court determined that a hearing should be held to determine the validity of the signature on the doctor's "affirmation" in order to decide whether defendant's cross motion was rebutted. Therefore, the matter was remitted to the Civil Court for a framed issue hearing to determine the admissibility of plaintiff's doctor's affirmation and for a new determination thereafter of defendant's cross motion.

The relevant facts of the case were that D.S. Chiropractic, P.C. was seeking to recover first-party no-fault benefits from Country-Wide Insurance Company. The Civil Court granted D.S. Chiropractic's motion for summary judgment and denied Country-Wide Insurance's cross motion for summary judgment. Country-Wide Insurance appealed the judgment entered in favor of D.S. Chiropractic, which awarded them $3,553.29. The main issues decided in the case were whether D.S. Chiropractic had established its entitlement to summary judgment and whether Country-Wide Insurance had raised a triable issue of fact. The court also considered whether D.S. Chiropractic had provided the requested information in response to verification requests from Country-Wide Insurance. The court found that D.S. Chiropractic failed to provide the information requested in the verification requests, and therefore the 30-day period within which Country-Wide Insurance was required to pay or deny the claim did not commence to run. The holding of the case was that the judgment in favor of D.S. Chiropractic was reversed, the motion for summary judgment was denied, and Country-Wide Insurance's cross motion for summary judgment dismissing the complaint was granted. Therefore, D.S. Chiropractic was not entitled to recover the requested no-fault benefits from Country-Wide Insurance.