No-Fault Case Law

The relevant facts the court considered in this case involved Bedford Park Neurology, P.C. as the assignee of Mario Vasconcellos, seeking to recover first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The main issue decided was whether Bedford Park Neurology, P.C. had standing to recover on a claim form seeking the sum of $2,992, as the claim form only identified a physician as the provider and did not reference the corporation to whom the benefits had been assigned. The court found that the claim form sought to recover payment on behalf of the physician who rendered the services and not on behalf of the corporation, and that the corporation was not entitled to payment based on the claim form submitted. Therefore, the holding of the case was that the branch of the defendant's motion seeking to dismiss so much of the plaintiff's complaint as sought to recover upon the claim form seeking the sum of $2,992 should have been granted.

The relevant facts considered by the court were that the plaintiff sought payment from the defendant for no-fault benefits as an assignee of an individual. The defendant argued that the plaintiff failed to establish a prima facie case and that they had timely denied the bill based on the lack of medical necessity. The main issue decided by the court was whether the plaintiff had established a prima facie entitlement to summary judgment. The court held that the defendant raised a triable issue of fact and as a result, the plaintiff's motion for summary judgment should have been denied. Therefore, the judgment awarding the plaintiff the principal sum of $575.30 was reversed and the defendant's motion for summary judgment was granted.

The court considered an action by a healthcare provider to recover assigned first-party no-fault benefits. The Civil Court granted the provider's motion for summary judgment and denied the insurance company's cross motion for summary judgment, awarding the provider a sum of $292.24. The main issue decided on appeal was whether the documents annexed to the provider's motion for summary judgment were admissible as business records and whether the denial of claim form denying the provider's claim on the ground of medical necessity was timely and valid. The holding of the case was that the documents submitted were admissible as business records, but the denial of claim form was found to be timely and valid, causing the provider's motion for summary judgment to be denied and remanding the case for further proceedings.

The court considered the timing of the verification request and whether the defendant's time to pay or deny the claim had been tolled. The main issue was whether the plaintiff's failure to provide requested verification within 30 days after the initial request meant that the defendant's time to pay or deny the claim did not begin to run. The court held that the 30-day period within which the defendant was required to pay or deny the claim did not commence to run, and therefore the plaintiff's action was premature. The judgment was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted on the ground that the action was premature.

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.