No-Fault Case Law

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.

The court considered the fact that the plaintiff, Nordique Medical Services, P.C., failed to comply with a conditional order of preclusion by not serving complete responses to the defendant's discovery demands within the required 45 days. The main issue decided was whether the plaintiff should be precluded from offering any evidence in any subsequent motion or at trial as a result of their failure to comply with the conditional order of preclusion. The holding of the case was that the conditional order of preclusion became absolute upon the plaintiff's failure to comply, and the plaintiff was required to demonstrate an excusable default and a meritorious cause of action in order to avoid the adverse impact of the conditional order of preclusion. Since the plaintiff failed to do so, they were precluded from establishing a prima facie case, and the defendant's motion for summary judgment dismissing the complaint was granted.

The court considered the defendant's motion to compel the plaintiff to provide information sought in defendant's interrogatories and notice for discovery and inspection and to require plaintiff's witnesses to appear for depositions, as plaintiff had not complied with these demands. The main issue decided in the case was whether the defendant was entitled to these discovery requests in the absence of plaintiff challenging their propriety. The holding of the case was that the Civil Court should have granted defendant's cross-motion to compel plaintiff to provide the information sought, with the exception of requests that were improper or sought privileged information. The defendant was also entitled to examinations before trial, and the argument by the plaintiff regarding the Civil Court's subject matter jurisdiction was deemed to lack merit. The order of the Civil Court was affirmed.

The relevant facts of the case included an assignee seeking to recover first-party no-fault benefits for medical equipment provided to its assignors following automobile collisions. The defendant obtained declaratory judgments in a different court that absolved them of financial responsibility for any claims arising from the incidents of the collisions. The main issue decided was whether the default judgments rendered plaintiff's action "without merit." The holding was that the default judgments did not collaterally estop the plaintiff from recovering in this action, as the judgments were obtained on default and there was no actual litigation of the issues and, therefore, no identity of issues. The matter was remitted to the Civil Court for a determination of the remaining branch of defendant's motion.

The main issue in this case was whether a provider could recover assigned first-party no-fault benefits from an insurance company. The court decided that the insurance company's cross motion to compel the provider to provide discovery, including the production of Dr. Ronald Collins for a deposition, should be granted, except for matters that were palpably improper or privileged, and the provider's motion for summary judgment should be denied. The court found that the insurance company had established its entitlement to depose the provider's owner, Dr. Ronald Collins, as well as to obtain answers to its interrogatories and documents responsive to its notice for discovery and inspection. As a result, the provider's motion for summary judgment was denied without prejudice to renewal pending the completion of the aforementioned discovery, and the insurance company's cross motion for an order compelling the provider to provide discovery was granted.

The relevant facts considered in this case include a provider's failure to serve complete responses to the defendant's discovery demands within the required 45 days, as stipulated in a so-ordered stipulation. This stipulation included the provision that if the provider failed to comply, they would be precluded from offering any evidence in any subsequent motion or at trial. The main issue decided in this case was whether the provider's failure to comply with the stipulation constituted a conditional order of preclusion, which became absolute upon the provider's failure to comply. The holding of the court was that the so-ordered stipulation did constitute a conditional order of preclusion, and since the provider failed to demonstrate an excusable default and a meritorious cause of action, they were precluded from establishing a prima facie case. As a result, the court granted the defendant's motion for summary judgment, dismissing the complaint.

The court considered the plaintiff's motion for summary judgment for no-fault benefits, or alternatively, for an order of preclusion, as well as the defendant's cross-motion for dismissal of the claim of plaintiff Naik on grounds of an Examination Under Oath (EUO) default. The main issues decided were whether the plaintiff's motion established their entitlement to judgment as a matter of law and whether the defendant's cross-motion for dismissal of the claim of plaintiff Naik on grounds of EUO default was warranted. The court held that the plaintiff's moving papers failed to establish their entitlement to judgment as a matter of law and that the defendant was entitled to summary judgment dismissing plaintiff Naik's complaint on grounds of an EUO default. Additionally, the court rejected the defendant's argument that Dr. Gegerson's claim must fail due to lack of causation, as there was at least a triable issue as to causation.