No-Fault Case Law

The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits, and that the defendant had filed a cross motion for summary judgment based on lack of medical necessity. The main issue decided was whether the affidavits submitted by the defendant were sufficient to prove the timely mailing of the denial of claim form. The holding of the court was that the affidavits submitted by the defendant were indeed sufficient to establish that the denial of claim form was timely mailed in accordance with the defendant's standard office practice and procedure. As a result, the court affirmed the order without costs. The court also noted that the plaintiff's remaining contentions were improperly raised for the first time on appeal.

The relevant facts in this case involved a medical supply company seeking to recover no-fault benefits from an insurance company. The medical supply company moved for summary judgment, but the insurance company opposed the motion on the grounds that the patient had failed to appear for scheduled independent medical examinations (IMEs). The insurance company argued that it had timely denied the claims based on this failure. The main issue decided by the court was whether the insurance company's opposition was sufficient to establish that the patient had not appeared for the IMEs, thus justifying the denial of the claims. The court held that the insurance company's affidavits were insufficient to establish that the patient had failed to appear for the IMEs, and as a result, the insurance company failed to raise a triable issue of fact. Therefore, the court affirmed the judgment in favor of the medical supply company.

In this case, First Aid Occupational Therapy, PLLC brought a claim to recover assigned first-party no-fault benefits from Country-Wide Insurance Company. Plaintiff moved for summary judgment, which was granted by the Civil Court. Defendant argued that the action was premature due to plaintiff's failure to provide requested verification for the claims underlying the second, third, and fourth causes of action. Defendant also contended that plaintiff utilized the wrong billing code for the claims underlying the first and fifth causes of action. The Appellate Term held that the action was indeed premature, as defendant's follow-up verification requests were sent before the expiration of the 30-day period within which plaintiff was supposed to respond to the initial requests for verification. Additionally, the Court held that defendant failed to raise a triable issue of fact in admissible evidentiary form with respect to the billing for the services in question. Therefore, the judgment was reversed, and the motion for summary judgment was denied, while the cross motion for summary judgment dismissing the causes of action was granted.

The court considered the facts of a dispute between Innovative Chiropractic and Progressive Insurance Company over the recovery of assigned first-party no-fault benefits. The main issue decided was whether the Civil Court erred in awarding summary judgment to the plaintiff, and whether the defendant should have been granted summary judgment. The holding of the case was that the judgment was reversed, the order granting the plaintiff's motion for summary judgment was vacated, and the plaintiff's motion for summary judgment was granted to the extent of awarding the plaintiff summary judgment on the claim for $33.70 for services rendered on January 19, 2007. Additionally, summary judgment was granted to the defendant dismissing the complaint with respect to the remaining portion of the plaintiff's claim, which sought to recover the sum of $200. The case was remitted to the Civil Court for the calculation of statutory interest and an assessment of attorney's fees on the award of $33.70.

The main issue in this case was whether the provider had submitted sufficient evidence to establish a prima facie case to recover first-party no-fault benefits. The court considered the affirmation of the provider's counsel, an unsigned "affidavit" by the provider's owner, and various documents annexed to the motion for summary judgment. However, the court held that the unsigned "affidavit" did not constitute evidence in admissible form, and the affirmation of the provider's counsel was insufficient to establish the provider's prima facie case. As a result, the court affirmed the lower court's decision to deny the provider's motion for summary judgment. In summary, the court considered the evidence submitted by the provider to support their claim for first-party no-fault benefits. The main issue decided was whether the evidence presented was sufficient to establish a prima facie case. The holding of the case was that the unsigned "affidavit" and the affirmation of the provider's counsel were not enough to establish the provider's prima facie case, and therefore their motion for summary judgment was properly denied.

The court considered a case in which providers were seeking first-party no-fault benefits. The providers moved for partial summary judgment, while the defendant cross-moved for summary judgment dismissing various claims on the ground of lack of medical necessity. The defendant submitted peer review reports and affirmations from doctors showing a lack of medical necessity for the services in question, establishing a prima facie case. The plaintiffs' opposition was insufficient to raise a triable issue of fact, therefore the defendant's cross motion was granted. The holding of the court was that the order of the District Court was affirmed without costs.

The relevant facts considered by the court in this case involved a motion for partial summary judgment by the plaintiffs, who were providers seeking to recover assigned first-party no-fault benefits. The main issue decided by the court was whether the plaintiffs were entitled to partial summary judgment pursuant to CPLR 3212(e) or, in the alternative, CPLR 3212(g). The court denied the plaintiffs' motion for partial summary judgment, and also held the defendant's cross motion in abeyance. The holding of the case was that the order denying the plaintiffs' motion for partial summary judgment was affirmed without costs, based on reasons stated in a related case, B.Y., M.D., P.C., JR Chiropractic, P.C., Oasis Physical Therapy, P.C. and Olga Bard Acupuncture, P.C. a/a/o Beverly Prince v Government Empls. Ins. Co. The decision was unanimous, with all three judges concurring.

In this case, the plaintiff, a medical provider, was seeking to recover first-party no-fault benefits in a motion for "partial summary judgment." The defendant, an insurance company, opposed the motion arguing that there was a lack of medical necessity for the services at issue. The court denied the plaintiff's motion and the appeal followed. The main issue was whether the plaintiff was entitled to "partial summary judgment" to establish their prima facie case with respect to their first cause of action. The court held that the plaintiff was not entitled to "partial summary judgment" pursuant to CPLR 3212 (e) as the relief requested would not conclusively dispose of the merits of the first cause of action or even a part of it. Similarly, relief pursuant to CPLR 3212 (g) was not available to the plaintiff as the court did not deny, or grant in part, a motion which sought summary judgment conclusively disposing of the merits of the cause of action. Therefore, the order denying the plaintiff's motion was affirmed.

The main issue in this case was whether the defendant, State Farm Mutual Automobile Ins. Co., had to prove a defense of lack of medical necessity through a complete set of medical records. The limited medical records submitted to the defendant's peer review doctor showed that MRIs of the claimant's spine and left shoulder were recommended just one day after the accident, but were not performed for several weeks. The court held that the defendant did not meet its burden of proving that the MRIs were unnecessary and inappropriate at the time they were performed. Since the defendant carries the burden on this issue, the court found in favor of the plaintiff, Elmont Open MRI & Diagnostic Radiology, P.C. The court also emphasized that defendant must submit a complete medical record in most cases in order to satisfy its burden.

The main issues decided in this case involved an action to recover no-fault medical benefits under an insurance contract. The defendant, Allstate Insurance Company, appealed from an order and judgment granting the plaintiff's motion for summary judgment on the complaint, and in favor of the plaintiff in the principal sum of $32,086.70. The court considered whether the accident in which the plaintiff's assignor was injured was an insured incident, and whether the defense of lack of coverage is precluded by the defendant's failure to pay or deny the subject no-fault claim within the requisite 30-day period. The holding of the court was that the Supreme Court should have denied the plaintiff's motion for summary judgment on the complaint and granted the defendant's cross motion for summary judgment, dismissing the complaint.