No-Fault Case Law

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.

In this case, the plaintiff, GZ Medical and Diagnostic, P.C., was seeking to recover first-party no-fault benefits from defendant Mercury Ins. Co. The defendant moved for partial summary judgment to dismiss plaintiff's second and third causes of action on the grounds that the medical services provided were not medically necessary. Defendant submitted evidence to support their position, including a peer review report from their doctor. The plaintiff opposed the motion, arguing that there was a question of fact as to medical necessity and that they did not have access to all the necessary information and documents to effectively rebut the defendant's position. However, the court found that the plaintiff failed to raise a triable issue of fact and that defendant's motion for partial summary judgment should be granted. Therefore, the court reversed the original decision and granted defendant's motion for partial summary judgment dismissing plaintiff's second and third causes of action.

The Court considered the denial of the plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment, based on the failure of the plaintiff to provide requested verification in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had properly requested verification pursuant to Insurance Department Regulations, as the plaintiff argued that the defendant failed to prove it had properly requested verification. The Court held that the action was premature due to the plaintiff's failure to provide requested verification, and rejected the plaintiff's argument that the defendant failed to submit a copy of its initial verification request. Therefore, the judgment was affirmed without costs.

The main issue in the case was whether St. Vincent Medical Care, P.C. had properly established a prima facie case in its action to recover assigned first-party no-fault benefits, and whether the defendant, Country Wide Insurance Company, had standing to bring the action due to a defective assignment of benefits form. The court held that the documents annexed to St. Vincent's motion for summary judgment were admissible as business records and established the mailing of the bills. Additionally, the court held that the defendant waived any defenses based on the assignment of benefits form, as it did not timely object to the form or seek verification of the assignment. The court also found that the defendant tolled the 30-day statutory time period within which it had to pay or deny plaintiff's claims, rendering the action premature. The judgment was reversed, and the matter was remitted to the Civil Court for entry of an appropriate judgment upon plaintiff's seventh cause of action.

The relevant facts of the case involved a provider seeking first-party no-fault benefits for injuries sustained by a pedestrian who was allegedly hit by the insured's car. The provider sued the insurance company after the company sought to establish an affirmative defense that the injuries did not arise from an insured incident. The main issue decided was whether the insurance company had sufficient evidence to establish its defense. The holding of the court was that the insurance company had sustained its burden of proof, and the provider failed to raise a triable issue of fact, so the court properly granted the insurance company's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in this case include the medical services provided to Orlando Lainez-Rodriguez after an automobile accident on June 16, 2008. The main issue decided by the court was the medical necessity of the services provided to the assignor. The court examined the admissibility of expert testimony from Dr. Lown and the peer review reports from Dr. Schechter, as well as the sufficiency of the disclosure notice provided by the defendant. The holding of the court was that the peer review reports were not admissible as business records, but Dr. Lown's testimony and opinion based on the peer review reports were admissible and accepted by the court. The court ultimately found in favor of the defendant, dismissing the case and ruling that the services provided were not medically necessary.

The relevant facts in this case included a provider seeking to recover assigned first-party no-fault benefits. The defendant argued that there was a lack of medical necessity for the services at issue. The main issue decided in the case was whether the defendant was entitled to summary judgment dismissing the plaintiff's third and fifth causes of action. The court held that the defendant's submission of denial of claim forms and an affirmation by the doctor who performed the independent medical examination established that there was no medical necessity for the services at issue in plaintiff's third and fifth causes of action, and therefore the defendant's cross motion seeking summary judgment dismissing said causes of action should have been granted.