No-Fault Case Law

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.

The main issue in this case was whether the trial court erred in granting plaintiff's motion for summary judgment and denying defendant's cross motion for summary judgment in an action to recover assigned first-party no-fault benefits. The court considered the fact that a preliminary injunction had been issued by the Supreme Court, Queens County, staying "all pending and future actions" in "New York Civil and District Courts" involving the plaintiff and plaintiff's assignor. The Appellate Term, Second Department, held that in light of the preliminary injunction issued by the Supreme Court, the parties were foreclosed from proceeding any further in the action. As a result, the appeal by the defendant was stricken from the general calendar, and the decision of the trial court was not reached.

The court considered the fact that the plaintiff was seeking first party no-fault benefits for medical services rendered, and that the claim was not paid within the required thirty days. The main issue decided was whether the defendant was entitled to summary judgment, and the court held that they were not. The court found in favor of the plaintiff, stating that the plaintiff had shown sufficient evidence that the claim was not paid within the required time period, and that the denial of the claim was not issued within the required time frame. The court also noted that the defendant's excuse for the delay in denying the claim was not sufficient.

The main issues considered in this case were whether the affidavit submitted by the defendant employee complied with CPLR 2309(c) and whether the defendant was entitled to summary judgment dismissing the action to recover first-party no-fault benefits. The court found that while the affidavit established the defendant's entitlement to summary judgment, it did not comply with the requirements of CPLR 2309(c) as it failed to include a certificate demonstrating that the notary administered the oath as prescribed by the laws of the State of New Jersey. The holding of the court was that the defendant's motion for summary judgment to dismiss the complaint was granted on the condition that the defendant files and serves an affidavit with the appropriate certificate within 60 days, and if they fail to do so, the order is affirmed.

The relevant facts considered by the court in this case included the plaintiff's motion for summary judgment, the denial of the defendant's cross motion for summary judgment, and an appeal by the defendant. The main issues decided included the defendant's contention about the mailing of claims and plaintiff's prima facie entitlement to summary judgment. The court held that the defendant failed to establish that the assignor failed to appear for independent medical examinations, and therefore, the plaintiff was entitled to summary judgment upon its fourth through tenth causes of action. The court also held that the defendant established a prima facie showing of its entitlement to summary judgment dismissing the plaintiff's second and third causes of action, and since the plaintiff failed to demonstrate the existence of a triable issue of fact, the defendant was entitled to summary judgment dismissing those causes of action. Finally, the court decided to affirm the judgment in favor of the plaintiff and to grant the defendant's cross motion for summary judgment to the extent of dismissing the plaintiff's second and third causes of action.

The relevant facts considered in this case were that Amercure Acupuncture, P.C. as assignee of Taylor Franklin, moved for summary judgment to recover assigned first-party no-fault benefits from GEICO Ins. Co. Defendant opposed the motion on the ground that it had properly reimbursed plaintiff for licensed acupuncture services at the rate consistent with the amount paid for acupuncture services provided by licensed chiropractors. The main issue decided was whether the defendant had issued timely denials of the claims. The holding of the court was that the judgment and order were reversed and vacated, and the plaintiff's motion for summary judgment was denied. The court granted summary judgment to the defendant, dismissing the complaint and concluding that the defendant had fully paid the amount owed to the plaintiff, based on the workers' compensation fee schedule.

The court considered the fact that the defendant had not received responses to its outstanding verification requests before the action was commenced. The main issue decided was whether the action was premature because of this, and the court held that the action was indeed premature. The court reversed the judgment, vacated the order entered, denied the plaintiff's motion for summary judgment, and granted the defendant's cross motion for summary judgment dismissing the complaint, without prejudice to the plaintiff commencing a new action.