No-Fault Case Law

The court considered the issue of whether the Commercial Small Claims Part had subject matter jurisdiction to try a no-fault case when there was a specific No-Fault Part in New York City Civil Court. The claimant was an assignee for an individual patient seeking recovery of no-fault benefits from the defendant insurance company. The defendant argued that the cases should be dismissed for lack of subject matter jurisdiction because the claimant became an assignee of a claim that originally belonged to an individual, not a commercial entity. The claimant relied on a prior case to argue that the Small Claims Part was the proper forum to resolve the cases. The court ultimately held that the Small Claims Part did not have subject matter jurisdiction and transferred the cases to the No-Fault Part for proper adjudication. The No-Fault Part was considered the proper forum to bring actions of this nature.

Relevant facts considered by the court included plaintiff's allegation that the defendant's application for medical provider first-party no-fault benefits was procedurally barred due to its late filing. The main issue was whether the 120-day requirement for filing the notice of trial in court practice should be applied to this summary judgment motion. The court held that the reference in the statute to the note of issue should not be treated as a reference to the notice of trial and that the 120-day requirement for summary judgment relief is not applicable in District Court practice. As a result, the defendant's application was not barred as untimely. Issues relating to the summary judgment on the merits included partial denial of plaintiff's claim, application of ground rule 11 of the medical fee schedule, and disallowance of portion of plaintiff's claims for services provided on various dates. The defendant's motion for summary judgment was granted for certain portions of the plaintiff's claim, except for those described as of two specific dates in 2000.

In the case of Quality Psychological Services, P.C. v Mercury Insurance Group, the court considered the denial of a claim by the defendant on the grounds of lack of medical necessity. The main issue decided was whether the denial of the claim form had been timely mailed and whether the defendant had made a prima facie showing of its entitlement to summary judgment dismissing the complaint. The court held that the defendant's affidavit sufficiently established the timely mailing of the denial of claim form and made a prima facie showing of its entitlement to summary judgment. However, the plaintiff submitted a letter of medical necessity sworn to by the psychologist who had examined the assignor, which raised a triable issue of fact as to the medical necessity of the services rendered. As a result, the court modified the order to deny plaintiff's cross motion for summary judgment and affirmed the order without costs.

The court considered the circumstances surrounding the default judgment entered in favor of the provider for first-party no-fault benefits, and the subsequent motion by the defendant to vacate the judgment and underlying order. The main issues decided by the court were whether the defendant established a reasonable excuse for its default and a meritorious defense to the action in order to vacate the judgment. The court held that the defendant had provided a reasonable excuse for its default, as well as a meritorious defense to the action, based on its detailed explanation of the oversight and its standard office practices and procedures. As a result, the Civil Court's decision to vacate the default judgment and order, and to grant the defendant's prior cross motion for summary judgment dismissing the complaint, was affirmed by the court.

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.