No-Fault Case Law

The relevant facts in this case involved an action by a provider to recover assigned first-party no-fault benefits. The Civil Court granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment dismissing the complaint. The main issues decided by the court included the admissibility of documents submitted by the plaintiff, the timely mailing of denial of claim forms and verification requests by the defendant, and the failure of the plaintiff to provide information requested in the verification requests. The holding of the court was that the plaintiff was entitled to summary judgment on some causes of action, but the defendant was entitled to summary judgment on others. The judgment was therefore reversed, and the case was remitted to the Civil Court for further proceedings on specific causes of action.

The relevant facts considered by the court were that the plaintiff was seeking to recover the amount paid in no-fault benefits as a result of injuries sustained by its insureds in a motor vehicle accident. The defendant failed to timely appear or answer, resulting in a default judgment being entered against him. After a stipulation in 2007, the default judgment was vacated and the defendant's affidavit was deemed his answer. The case was set for trial, but the defendant failed to appear, resulting in the reinstatement of the default judgment. The main issue decided was whether the Civil Court improvidently exercised its discretion in determining that the defendant established a reasonable excuse for his default and a meritorious defense to the action. The holding of the court was that the Civil Court did not improvidently exercise its discretion in determining that the defendant had established both a reasonable excuse for his default and a meritorious defense to the action. The court affirmed the order to vacate the default judgment, stating that public policy favors the resolution of cases on the merits.

The court considered the claim for first-party no-fault benefits by a provider for supplies provided to the assignor. The main issue decided was whether the denial of the claim due to the medical necessity of the supplies was justified. The court held that the defendant's cross motion for summary judgment dismissing the complaint was granted as they sufficiently established the timely mailing of the denial of the claim form and provided an affirmed peer review report with a factual basis and medical rationale for the opinion that the supplies were not medically necessary. Since the plaintiff failed to rebut this showing, the defendant's cross motion for summary judgment dismissing the complaint was granted. No other issue was decided in this case.

The main issue in this case was whether the professional health services provided by the plaintiff were medically necessary, as defendant moved for summary judgment dismissing the complaint on the ground that they lacked medical necessity. Defendant established their entitlement to summary judgment by timely mailing the claim denial form and submitting a sworn peer review report of its psychologist, which set forth a factual basis and medical rationale for the opinion that the professional health services were not medically necessary. In opposition to the motion, the plaintiff failed to raise a triable issue of fact, as the psychologist's affirmation submitted by plaintiff did not meaningfully refer to or rebut the conclusions set forth in the peer review report. Therefore, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.

The relevant facts that the court considered in this case include the plaintiff commencing four actions against the defendant to recover assigned first-party no-fault benefits and subsequently moving for summary judgment in each action. The parties stipulated to adjourn the motions until November 30, 2007, and the defendant agreed to serve its opposition papers by September 30, 2007. The defendant served its opposition papers in November 2007, but the Civil Court would not consider them as they were deemed untimely. As a result, the court granted the plaintiff's motions for summary judgment on default. The main issues that were decided in this case include whether the defendant had a reasonable excuse for the default and a meritorious defense to the action, as well as whether the defendant could seek leave to renew the prior motions upon which it defaulted. The holding of the case was that the defendant's excuse for the default was found to be disingenuous and insufficient to justify the default. As a result, the branch of the defendant's motion seeking to vacate its default was affirmed. Additionally, the defendant was not allowed to renew a motion upon which it defaulted, and therefore the court affirmed the branch of the defendant's motion seeking leave to renew.

The court considered a case in which a medical provider sought to recover no-fault benefits from an insurance company. The medical provider moved for summary judgment, while the insurance company cross-moved for summary judgment or sought to compel examinations before trial. The court denied the medical provider's motion for summary judgment and granted the insurance company's cross motion to the extent of permitting the company to serve discovery requests upon the medical provider, while preserving the provider's right to object to those requests. The main issue decided in the case was whether the medical provider established its entitlement to summary judgment, and whether the insurance company demonstrated its entitlement to compel examinations before trial. The court held that the medical provider did not establish its prima facie entitlement to summary judgment, as the affidavit submitted in support of the motion was insufficient to establish personal knowledge of the provider's practices and procedures. The court did not address the issue of whether the insurance company was entitled to compel examinations before trial, as the Civil Court did not grant such relief. The holding of the case was that the appellate court affirmed the lower court's decision to deny the medical provider's motion for summary judgment and to grant the insurance company's cross motion to the extent of permitting discovery requests, while preserving the medical provider's right to object to those requests.

The main issue in this case was whether the petition to vacate a master arbitrator's award, which upheld an arbitrator's award denying the petitioner's claim for assigned first-party no-fault benefits, should be granted. The court considered the fact that the papers submitted by the petitioner were insufficient on their face to warrant the granting of any relief, as the only document submitted in support of the petition was not properly affirmed under the penalties of perjury. The court held that the petition to vacate the master arbitrator's award should be denied without prejudice to renewal upon proper papers, as the document submitted by the petitioner was insufficient as an affirmation. Therefore, the order granting the petition to vacate the master arbitrator's award and directing the entry of judgment in favor of the petitioner was reversed.

The relevant facts the court considered were that the petitioner AutoOne Insurance Company made a showing that the offending vehicle was insured by Nationwide Mutual Fire Insurance Company. Nationwide submitted evidence that they had disclaimed coverage for the vehicle based on their insured's failure to cooperate in the investigation. The main issue decided was whether Nationwide validly disclaimed coverage. The holding of the case was that the matter was remitted to the Supreme Court, Westchester County, for an evidentiary hearing to determine the issue of whether Nationwide validly disclaimed coverage, and thereafter, for a new determination on the branch of the petition which was to permanently stay arbitration.

The case involved an action to recover no-fault medical payments under two insurance contracts. The plaintiff, New York and Presbyterian Hospital, demonstrated that necessary billing forms were sent to and received by the defendant, Country-Wide Insurance Company, and that payment of no-fault benefits was overdue. The payment submitted by the hospital within 45 days after services were rendered satisfied the written notice requirement, as outlined in the regulation. The insurer failed to raise a triable issue of fact in opposition. The Supreme Court properly granted the plaintiff's motion for summary judgment and denied the insurer's cross motion, resulting in a judgment in favor of the hospital for $56,235.43.

The court considered an action by providers to recover assigned first-party no-fault benefits, and their failure to respond to the defendant's combined discovery demands within the applicable time periods. B.Y., M.D., P.C. moved for a protective order, claiming that the disclosure sought by the defendant was "oppressive" in scope. The court denied the motion for a protective order as untimely and granted the defendant's cross motion seeking dismissal. The main issue was whether the court should dismiss the complaint as a sanction against the plaintiff for failure to comply with court-ordered discovery, and whether the information sought was privileged or palpably improper. The holding of the court was that the failure of B.Y., M.D., P.C. to timely challenge the propriety of the defendant's discovery and inspection or timely object to defendant's demand for verified written interrogatories obligated it to produce the information sought, except as to matters which are privileged or palpably improper. The court also granted the defendant's cross motion to compel said plaintiff to comply with the discovery demands to the extent of compelling said plaintiff to produce the documents and information demanded and to serve responses within 60 days.