No-Fault Case Law

The court considered that the Civil Court granted the petition to vacate an arbitration award and awarded petitioner Preferred Medical Imaging, P.C. unpaid no-fault benefits in the principal sum of $912. The main issue decided was whether the arbitration award was supported by a reasonable hypothesis and was in line with settled law. The holding of the court was that the arbitration award was properly vacated, as the court concluded that it was not "supported by a reasonable hypothesis and was contrary to what could be fairly described as settled law." The court also noted the respondent-appellant's three and a half year delay in perfecting the appeal.

The court considered an appeal from a denial of summary judgment by the Civil Court of the City of New York, Kings County, in a case involving a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company had filed a motion for summary judgment, arguing that the injuries of the provider's assignor did not arise out of an insured incident. The main issue was whether the insurance company had made a prima facie showing that the injuries did not arise out of an insured incident, shifting the burden to the provider to raise a triable issue of fact. The court held that the insurance company had made a sufficient showing through the affidavit of its insured, and since the provider failed to raise a triable issue of fact in opposition to the motion, the insurance company's motion for summary judgment was granted. In summary, the relevant facts considered by the court included the affidavit of the insurance company's insured stating that she had not hit any pedestrians, and the main issue decided was whether the insurance company had made a prima facie showing that the injuries did not arise out of an insured incident. The holding was that the insurance company had made a sufficient showing, and therefore its motion for summary judgment was granted.

The relevant facts the court considered in this case was that the plaintiff, a medical provider, filed a complaint to recover no-fault benefits for a claim submitted to the defendant in 2000. The defendant moved to dismiss the complaint on the grounds that it was time-barred by the six-year statute of limitations. The main issue decided by the court was whether the defendant's second pre-answer motion to dismiss was procedurally defective, as the plaintiff argued. The holding of the court was that a subsequent motion to dismiss pursuant to CPLR 3211 (a) does not violate the single motion rule set forth in CPLR 3211 (e), and the order granting the defendant's motion to dismiss the complaint was affirmed.

The court considered the issue of whether the plaintiff had submitted a timely notice of claim for a first-party no-fault benefits. The main issue decided was whether the plaintiff had failed to provide a "reasonable justification of the failure to give timely notice." The holding of the case was that the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment was affirmed. The court determined that the plaintiff had failed to submit a timely notice of claim and had also failed to provide a reasonable justification for the untimely notice, and therefore, the order was affirmed.

The court considered the denial of claim forms and verification requests by the defendant, which were found to be proper and timely. The denial of claim forms included all the necessary information called for in the prescribed form. The main issue decided was regarding the denial of the claim forms and the verification requests, and whether they were proper and timely. The court determined that they were, and as a result, denied the branch of plaintiff's motion seeking summary judgment in their favor. The holding of the case was that the denial of claim forms and verification requests were proper and timely, and as a result, the motion seeking summary judgment in favor of the plaintiffs was denied.

In the legal case Mia Acupuncture, P.C. v Mercury Ins. Co., the court heard a case by a provider to recover assigned first-party no-fault benefits. Defendant requested to conduct an examination before trial of the plaintiff, and when the assignor failed to appear for the deposition, defendant moved to dismiss the complaint. The main issue decided by the court was whether party status could be imputed to the assignor based on the assignment of no-fault benefits to the provider, and if the assignor was under the plaintiff assignee's control. The holding of the court was that the CPLR 3126 (3) dismissal sanction for disclosure violations applies only to the violations of parties and not nonparties. The court found that by virtue of the assignment, the eligible injured persons have divested themselves of their interest, and similarly, a provider's party status cannot be imputed to the assignor by virtue of an assignment. Therefore, the Civil Court properly denied the motion for sanctions against plaintiff pursuant to CPLR 3126.

The relevant facts the court considered in Crotona Heights Medical, P.C. v GEICO Ins. Co. were that the plaintiff, as an assignee, sought to recover first-party no-fault benefits, and the defendant had paid the claims and accrued interest underlying the first and second causes of action. The main issues decided were whether the plaintiff's affidavit was sufficient to comply with CPLR 4518 and whether the defendant had timely denied the claims at issue on the ground of lack of medical necessity. The holding of the case was that the branch of the plaintiff's motion seeking summary judgment upon the third and fourth causes of action was denied, and the defendant's cross motion for summary judgment dismissing the plaintiff's third and fourth causes of action was granted.

The relevant facts considered by the court were that plaintiff commenced an action to recover first-party no-fault benefits as an assignee of two individuals, with claims arising from two separate accidents. The main issue decided was defendant's motion to sever the claim of each assignor into separate actions, pursuant to CPLR 603. The court held that defendant's motion to sever the claims of each assignor into separate actions should have been granted because the necessity and reasonableness of the medical services rendered for each claim were likely to raise few, if any, common issues of fact. The decision was reversed and defendant's motion to sever the claims was granted.

The main issues in this case were whether the denial of the claim seeking to recover the sum of $425.44 (plaintiff's fifth cause of action) on the ground of lack of medical necessity was timely and whether there was a lack of medical necessity with respect to plaintiff's $425.44 claim. The court considered the affidavits submitted by the defendant, which established that the denial of the claim was timely and that there was a lack of medical necessity. The court also considered the opposition papers from the plaintiff's treating chiropractor, who submitted an affidavit stating that the treatment was medically necessary, without setting forth any facts to support the conclusion. The holding of the case was that defendant's cross motion for summary judgment dismissing the plaintiff's fifth cause of action was granted, as defendant's affidavits were deemed sufficient to establish a lack of medical necessity and plaintiff's opposition papers failed to raise a triable issue of fact as to medical necessity. The cross motion for summary judgment dismissing plaintiff's fourth cause of action seeking to recover the sum of $134.80 for services rendered from April 5 to April 17, 2006 was denied, as defendant failed to establish that it had timely denied said claim.

The court considered the appeal from an order of the Civil Court of the City of New York, Queens County, in a case where a provider was trying to recover assigned first-party no-fault benefits. The main issue was whether defendant's cross motion for summary judgment dismissing plaintiff's first cause of action should have been granted. The court held that defendant's cross motion for summary judgment dismissing plaintiff's first cause of action should have been granted. The court found that the affidavits submitted by defendant in opposition to plaintiff's motion and in support of its cross motion, as well as the peer review report of its chiropractor, established that there was a lack of medical necessity for the services rendered, and plaintiff failed to raise a triable issue of fact with respect to that. Therefore, defendant's cross motion for summary judgment was granted.