No-Fault Case Law

In this case, State Farm Mutual Automobile Insurance Company was seeking a judgment declaring that they had no obligation to pay certain insurance claims for no-fault insurance. The company had alleged that certain professional corporations were not entitled to collect no-fault payments from them as they were unlawfully formed pursuant to New York law. Specifically, one of the defendants was found guilty of health care fraud and mail fraud and was operating acupuncture clinics via professional corporations which were not owned and controlled by a licensed acupuncturist as required by New York law. As a result, State Farm moved for a preliminary injunction restraining the defendants from enforcing against them any judgments obtained from related actions. The courts affirmed the issuance of the preliminary injunction and held that State Farm met its burden of demonstrating that the defendants obtained the judgment as part of "a larger fraudulent scheme" and that the exception to the general rule barring collateral attack applied in this case.

The main issue in this case was whether the defendant demonstrated a reasonable excuse for its default and a potentially meritorious defense to the action in order to vacate a default judgment. The court considered an affidavit by the person alleged to have received service of process, who stated that she always follows defendant's practices and procedures for receipt of process. This person's practices and procedures would have created a record of the instant lawsuit, and the defendant demonstrated that it does not have any such record. The court held that the defendant had established a reasonable excuse for its default and affirmed the order granting the defendant's motion to vacate the judgment and enlarge its time to serve and file an answer.

The court considered whether 21st Century Insurance Company was entitled to summary judgment dismissing the complaint brought by Noel E. Blackman, M.D., as the assignee of Barnes, Omari, in their action to recover assigned first-party no-fault benefits. The main issue decided was whether 21st Century Insurance Company had a duty to pay any no-fault benefits to Noel E. Blackman in any current or future proceeding, and whether the provider was ineligible to collect no-fault benefits. The court held that 21st Century Insurance Company was entitled to summary judgment dismissing the complaint based on a declaratory judgment that declared they had no duty to pay any no-fault benefits to Noel E. Blackman, as the provider was ineligible to collect no-fault benefits. The court also found that the doctrine of res judicata applied, as any judgment in favor of the plaintiff would destroy or impair rights established by the judgment in the declaratory judgment action. Therefore, the court affirmed the order granting the defendant's motion for summary judgment.

The court considered the motion for summary judgment filed by the defendant, who argued that the plaintiff had failed to appear for duly scheduled examinations under oath. The plaintiff, a provider seeking first-party no-fault benefits, cross-moved for summary judgment. The main issue decided by the court was whether the defendant's motion for summary judgment should be granted. The court ultimately denied the defendant's motion and cross-motion, but found that the claims at issue were mailed by the plaintiff and received by the defendant. The holding of the case was that the order, insofar as appealed from, is affirmed.

The relevant facts considered by the court were that the defendant insurance company moved for summary judgment to dismiss the complaint on the basis that the plaintiff medical services provider had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the defendant had timely denied the plaintiff's claim after the plaintiff had failed to appear at both an initial and a follow-up EUO. The holding of the case was that the defendant insurance company's motion for summary judgment dismissing the complaint was properly denied because the defendant did not demonstrate that it was not precluded from raising its proffered defense, and therefore the order was affirmed.

The court considered the defendant's motion for summary judgment and the plaintiff's cross motion for summary judgment. The main issue decided was whether the plaintiff failed to appear for an examination under oath (EUO) scheduled by the defendant, and whether the defendant had demonstrated that the plaintiff failed to comply with a condition precedent to coverage. The court held that the insurer must schedule the EUO within a reasonable time frame and as "expeditiously as possible," and that the plaintiff had attempted to delay the claim over nine months by claiming it needed two months' notice for each scheduled EUO. The court also found that the plaintiff failed to provide evidence to rebut the defendant's showing, and therefore, granted the defendant's motion for summary judgment and dismissed the plaintiff's complaint.

The relevant facts of the case were that Solution Bridge, Inc. brought an action to recover no-fault benefits from GEICO Insurance Company. GEICO moved for summary judgment to dismiss the complaint, arguing that the action was barred by a declaratory judgment entered in a previous action in Supreme Court, Nassau County. They also argued that Solution Bridge had failed to appear for duly scheduled examinations under oath (EUOs). The main issues decided by the court were whether the action was barred by the previous declaratory judgment and whether Solution Bridge had failed to appear for EUOs. The court held that GEICO's motion for summary judgment should have been granted, as any judgment in favor of Solution Bridge would impair rights or interests established by the previous declaratory judgment and that GEICO had established that Solution Bridge failed to appear for the EUOs. Therefore, the court reversed the order and granted GEICO's motion for summary judgment dismissing the complaint.

The court considered the fact that Quality Rehab and P.T., P.C. was seeking to recover first-party no-fault benefits from Tri State Consumers Ins. Co. as the assignee of Amnun Aminov. Tri State Consumers Ins. Co. had moved for summary judgment to dismiss the complaint on the grounds that verification of the claims remained outstanding and that the services at issue lacked medical necessity and the amounts sought exceeded the amounts permitted by the workers' compensation fee schedule. The court decided that defendant had not received all of the requested verification for the claims, making the causes of action premature, and plaintiff failed to raise a triable issue of fact. Additionally, the court found that the services at issue lacked medical necessity and the amounts sought exceeded the amounts permitted by the workers' compensation fee schedule. As a result, the court affirmed the judgment in favor of Tri State Consumers Ins. Co.

The relevant facts the court considered in this case were that the defendant, Tri State Consumers Ins. Co., had moved for summary judgment to dismiss a complaint by a provider to recover assigned first-party no-fault benefits, on the grounds that the services lacked medical necessity and exceeded the amount permitted by the workers' compensation fee schedule. The plaintiff, Jules Francois Parisien, M.D., as Assignee, had cross-moved for summary judgment. Defendant submitted an affirmed report from a doctor who had performed an independent medical examination (IME) of the plaintiff's assignor before the services at issue had been rendered, concluding a lack of medical necessity for further treatment. The Civil Court denied defendant's motion but held that defendant had timely denied plaintiff's claims. The main issue decided in this case was whether the services at issue lacked medical necessity and whether the amount sought exceeded the amount permitted by the workers' compensation fee schedule. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was ultimately granted, as defendant had established a lack of medical necessity for further treatment through the IME report, which was not rebutted by plaintiff. As a result, the defendant's motion for summary judgment dismissing the complaint was granted, and the order was reversed.

The relevant facts considered by the court included a provider seeking to recover assigned first-party no-fault benefits from an insurance company, and the application of the workers' compensation fee schedule. The main issue decided by the court was whether the provider was entitled to recover the principal sum of $1,498.09. The holding of the court was that the judgment awarding the principal sum to the provider was affirmed, with the insurance company being ordered to pay $25 in costs. The court also referenced a previous case involving the same provider and insurer, in which the judgment was affirmed for similar reasons.