No-Fault Case Law

The relevant facts the court considered were that the plaintiff, Bath Medical Supply, Inc., was seeking to recover assigned first-party no-fault benefits, but the defendant, Harco National Insurance Company, had denied the claim based on the assignor's eligibility for workers' compensation benefits. The main issue decided was whether the Workers' Compensation Board had the authority to determine whether the assignor was entitled to workers' compensation benefits. The holding of the case was that the Workers' Compensation Board did have the authority to make this determination, but the District Court should not have dismissed the complaint and referred the matter to the Board. Instead, the court ordered that the complaint be reinstated and the plaintiff's motion be held in abeyance pending a prompt application to the Workers' Compensation Board for a determination of the parties' rights under the Workers' Compensation Law.

The court considered the denial of claim forms by the defendant which were based on lack of medical necessity and were timely mailed according to the defendant's standard office practice. In support of defendant's motion for summary judgment dismissing the complaint, defendant provided an affirmed peer review report by a doctor as well as an affidavit executed by the chiropractor who performed the second peer review. The documents set forth a factual basis and medical rationale for the peer reviewers' opinions that the medical equipment provided was not medically necessary. Defendant's motion for summary judgment dismissing the complaint was granted, as plaintiff failed to submit any evidence to rebut defendant's showing of a lack of medical necessity and as plaintiff's objections to defendant's papers lack merit. Therefore, the order denying defendant's motion for summary judgment dismissing the complaint was reversed and defendant's motion for summary judgment dismissing the complaint was granted.

In this case, St. Barnabas Hospital sought to recover no-fault medical payments under two insurance contracts. Allstate Insurance Company issued a denial of claim within 30 days, but the denial was found to be defective. Allstate sought to vacate the judgment in favor of St. Barnabas Hospital, but the court held that the denial was defective, Allstate failed to demonstrate a meritorious defense, and the judgment in favor of St. Barnabas Hospital was upheld. Therefore, the Supreme Court ruled in favor of St. Barnabas Hospital in the amount of $4,309.64. The main issues decided were the timeliness and validity of Allstate's denial of claim, and the main holding of the case is that the denial was defective, and the judgment in favor of St. Barnabas Hospital was upheld.

The court considered the claim by Delta Diagnostic Radiology, P.C. as assignee of Frank Louigarde to recover assigned first-party no-fault benefits. The main issues decided were whether the claim was untimely because it was submitted more than 45 days after the services were rendered, and whether plaintiff's motion for summary judgment was premature due to failure to respond to defendant's discovery demands. The holding of the court was that although the claim was submitted late, the defendant waived its right to deny the claim based on the 45-day rule because it failed to communicate that late submission of the proof of claim could be excused. The court also found that defendant failed to demonstrate that discovery was needed to show the existence of a triable issue of fact, and as such, the judgment in favor of plaintiff was affirmed.

The main issues in this case were whether the defendant should be granted leave to amend its answer to include the defense of fraudulent incorporation and whether the plaintiff should be compelled to produce its owner, Valentina Anikeyeva, for a deposition. The court considered whether the proposed affirmative defense of fraudulent incorporation was devoid of merit or palpably insufficient as a matter of law, as well as whether the plaintiff's contention that the defense of fraudulent incorporation must be asserted in a timely denial of claim form was valid. The holding of the case was that the Civil Court did not err in granting the defendant's application for leave to amend its answer and in compelling the plaintiff to produce its owner for a deposition, as the proposed defense was not devoid of merit, and the deposition testimony of Ms. Anikeyeva regarding the plaintiff's corporate structure was considered material and necessary. The court held that prejudice or surprise resulting directly from the delay would be necessary to disallow the Mallela defense, and as such, the analysis regarding the defense of fraudulent incorporation was unwarranted.

The relevant facts involved in the case were a dispute over first-party no-fault benefits being sought by a medical provider. The main issues considered by the court were whether the plaintiff had established its entitlement to summary judgment in seeking these benefits, and whether the defendant had raised a triable issue of fact to dispute the plaintiff's claim. The holding of the case was that the plaintiff had not sufficiently established its entitlement to summary judgment, and that the defendant had indeed raised a triable issue of fact, therefore the plaintiff's motion for summary judgment was denied. The court declined the defendant's request to search the record and grant summary judgment in their favor.

The court considered the motion for summary judgment by plaintiff Richmond Radiology, P.C. to recover no-fault benefits from defendant GEICO Insurance Company. The main issue decided by the court was whether there was a triable issue of fact as to the medical necessity of the services provided, as raised by defendant's opposition to the motion. The holding of the court was that the doctor performing the peer review did not conclude that he had insufficient information, but rather raised a triable issue of fact based on the lack of substantiation in the reports and documents reviewed. As a result, plaintiff's motion for summary judgment was properly denied, and the court declined defendant's request for summary judgment. Therefore, the order denying plaintiff's motion for summary judgment was affirmed.

The main issue in this case was whether the defendant, GEICO Ins. Co., was entitled to summary judgment dismissing the complaint brought by Radiology Today, P.C. as the assignee of Charles Rawlins, to recover assigned first-party no-fault benefits. The court considered the fact that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs), and the defendant had moved for summary judgment based on this failure. The defendant submitted evidence that the IME notices were properly addressed and mailed, and the medical professionals who were to perform the IMEs confirmed that the plaintiff's assignor failed to appear. The court ultimately held that the defendant's unopposed motion for summary judgment dismissing the complaint should have been granted.

The main issue in this case was whether the MRIs provided by the plaintiff were medically necessary, as the defendant argued that they were not based on a peer review report. The court considered whether the documents annexed to the plaintiff's motion for summary judgment were admissible as business records, and determined that they were, shifting the burden to the defendant to demonstrate the existence of a triable issue of fact. The defendant provided evidence in admissible form to demonstrate the existence of a triable issue of fact as to medical necessity, based on an affirmed peer review report. As a result, the court held that the judgment in favor of the plaintiff was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion for summary judgment was denied. The court declined to grant summary judgment to the defendant.

The court considered an action by a provider to recover assigned first-party no-fault benefits, wherein the parties had consented to have the case marked off the trial calendar in March 2007. In August 2008, the plaintiff moved to restore the case, but the Civil Court denied plaintiff's motion "with leave to renew upon a proper showing/reasonable excuse as to why plaintiff did not move to restore within one year of the case being marked off the trial calendar." The main issue decided was whether an action that has been marked off the trial calendar, whether by consent of the parties or stricken by the court, which is not restored to the calendar within one year, may only be restored thereafter if the plaintiff demonstrates a meritorious cause of action and a reasonable excuse for the delay in moving to restore the case. The holding of the case was that the plaintiff failed to satisfy the requirements for restoration, and therefore, the order denying the motion to restore the case to the trial calendar was affirmed.