No-Fault Case Law

The relevant facts of the case included an assignee seeking to recover first-party no-fault benefits for medical equipment provided to its assignors following automobile collisions. The defendant obtained declaratory judgments in a different court that absolved them of financial responsibility for any claims arising from the incidents of the collisions. The main issue decided was whether the default judgments rendered plaintiff's action "without merit." The holding was that the default judgments did not collaterally estop the plaintiff from recovering in this action, as the judgments were obtained on default and there was no actual litigation of the issues and, therefore, no identity of issues. The matter was remitted to the Civil Court for a determination of the remaining branch of defendant's motion.

The main issue in this case was whether a provider could recover assigned first-party no-fault benefits from an insurance company. The court decided that the insurance company's cross motion to compel the provider to provide discovery, including the production of Dr. Ronald Collins for a deposition, should be granted, except for matters that were palpably improper or privileged, and the provider's motion for summary judgment should be denied. The court found that the insurance company had established its entitlement to depose the provider's owner, Dr. Ronald Collins, as well as to obtain answers to its interrogatories and documents responsive to its notice for discovery and inspection. As a result, the provider's motion for summary judgment was denied without prejudice to renewal pending the completion of the aforementioned discovery, and the insurance company's cross motion for an order compelling the provider to provide discovery was granted.

The relevant facts considered in this case include a provider's failure to serve complete responses to the defendant's discovery demands within the required 45 days, as stipulated in a so-ordered stipulation. This stipulation included the provision that if the provider failed to comply, they would be precluded from offering any evidence in any subsequent motion or at trial. The main issue decided in this case was whether the provider's failure to comply with the stipulation constituted a conditional order of preclusion, which became absolute upon the provider's failure to comply. The holding of the court was that the so-ordered stipulation did constitute a conditional order of preclusion, and since the provider failed to demonstrate an excusable default and a meritorious cause of action, they were precluded from establishing a prima facie case. As a result, the court granted the defendant's motion for summary judgment, dismissing the complaint.

The court considered the plaintiff's motion for summary judgment for no-fault benefits, or alternatively, for an order of preclusion, as well as the defendant's cross-motion for dismissal of the claim of plaintiff Naik on grounds of an Examination Under Oath (EUO) default. The main issues decided were whether the plaintiff's motion established their entitlement to judgment as a matter of law and whether the defendant's cross-motion for dismissal of the claim of plaintiff Naik on grounds of EUO default was warranted. The court held that the plaintiff's moving papers failed to establish their entitlement to judgment as a matter of law and that the defendant was entitled to summary judgment dismissing plaintiff Naik's complaint on grounds of an EUO default. Additionally, the court rejected the defendant's argument that Dr. Gegerson's claim must fail due to lack of causation, as there was at least a triable issue as to causation.

The court considered the issue of whether the Commercial Small Claims Part had subject matter jurisdiction to try a no-fault case when there was a specific No-Fault Part in New York City Civil Court. The claimant was an assignee for an individual patient seeking recovery of no-fault benefits from the defendant insurance company. The defendant argued that the cases should be dismissed for lack of subject matter jurisdiction because the claimant became an assignee of a claim that originally belonged to an individual, not a commercial entity. The claimant relied on a prior case to argue that the Small Claims Part was the proper forum to resolve the cases. The court ultimately held that the Small Claims Part did not have subject matter jurisdiction and transferred the cases to the No-Fault Part for proper adjudication. The No-Fault Part was considered the proper forum to bring actions of this nature.

Relevant facts considered by the court included plaintiff's allegation that the defendant's application for medical provider first-party no-fault benefits was procedurally barred due to its late filing. The main issue was whether the 120-day requirement for filing the notice of trial in court practice should be applied to this summary judgment motion. The court held that the reference in the statute to the note of issue should not be treated as a reference to the notice of trial and that the 120-day requirement for summary judgment relief is not applicable in District Court practice. As a result, the defendant's application was not barred as untimely. Issues relating to the summary judgment on the merits included partial denial of plaintiff's claim, application of ground rule 11 of the medical fee schedule, and disallowance of portion of plaintiff's claims for services provided on various dates. The defendant's motion for summary judgment was granted for certain portions of the plaintiff's claim, except for those described as of two specific dates in 2000.

In the case of Quality Psychological Services, P.C. v Mercury Insurance Group, the court considered the denial of a claim by the defendant on the grounds of lack of medical necessity. The main issue decided was whether the denial of the claim form had been timely mailed and whether the defendant had made a prima facie showing of its entitlement to summary judgment dismissing the complaint. The court held that the defendant's affidavit sufficiently established the timely mailing of the denial of claim form and made a prima facie showing of its entitlement to summary judgment. However, the plaintiff submitted a letter of medical necessity sworn to by the psychologist who had examined the assignor, which raised a triable issue of fact as to the medical necessity of the services rendered. As a result, the court modified the order to deny plaintiff's cross motion for summary judgment and affirmed the order without costs.

The court considered the circumstances surrounding the default judgment entered in favor of the provider for first-party no-fault benefits, and the subsequent motion by the defendant to vacate the judgment and underlying order. The main issues decided by the court were whether the defendant established a reasonable excuse for its default and a meritorious defense to the action in order to vacate the judgment. The court held that the defendant had provided a reasonable excuse for its default, as well as a meritorious defense to the action, based on its detailed explanation of the oversight and its standard office practices and procedures. As a result, the Civil Court's decision to vacate the default judgment and order, and to grant the defendant's prior cross motion for summary judgment dismissing the complaint, was affirmed by the court.

The relevant facts in this case involved an action by a provider to recover assigned first-party no-fault benefits. The Civil Court granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment dismissing the complaint. The main issues decided by the court included the admissibility of documents submitted by the plaintiff, the timely mailing of denial of claim forms and verification requests by the defendant, and the failure of the plaintiff to provide information requested in the verification requests. The holding of the court was that the plaintiff was entitled to summary judgment on some causes of action, but the defendant was entitled to summary judgment on others. The judgment was therefore reversed, and the case was remitted to the Civil Court for further proceedings on specific causes of action.

The relevant facts considered by the court were that the plaintiff was seeking to recover the amount paid in no-fault benefits as a result of injuries sustained by its insureds in a motor vehicle accident. The defendant failed to timely appear or answer, resulting in a default judgment being entered against him. After a stipulation in 2007, the default judgment was vacated and the defendant's affidavit was deemed his answer. The case was set for trial, but the defendant failed to appear, resulting in the reinstatement of the default judgment. The main issue decided was whether the Civil Court improvidently exercised its discretion in determining that the defendant established a reasonable excuse for his default and a meritorious defense to the action. The holding of the court was that the Civil Court did not improvidently exercise its discretion in determining that the defendant had established both a reasonable excuse for his default and a meritorious defense to the action. The court affirmed the order to vacate the default judgment, stating that public policy favors the resolution of cases on the merits.