No-Fault Case Law

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.

The relevant facts considered by the court in this case involved an action by a healthcare provider to recover assigned first-party no-fault benefits. The main issue decided was whether the documents annexed to plaintiff's moving papers were admissible, and whether the defendant had established the timely mailing of denial of claim forms. The holding of the case was that the affidavit submitted by plaintiff's supervisor of medical billing was sufficient to establish the admissibility of the documents, and the defendant had failed to establish the timely mailing of the denial of claim forms. As a result, the defendant was precluded from interposing its defense of lack of medical necessity, and the Civil Court properly granted plaintiff's motion for summary judgment.

The relevant facts considered by the court were that the plaintiff, Excel Radiology Services, P.C., sought to recover assigned first-party no-fault benefits from the defendant, Clarendon National Insurance Co. The defendant appealed an order of the Civil Court granting the plaintiff's motion for summary judgment, and a judgment was subsequently entered in favor of the plaintiff. The main issue decided was whether the defendant had established a triable issue of fact as to whether the injuries suffered by the plaintiff's assignor arose from an insured incident, based on the alleged misrepresentation of the presence of the assignor's daughter in the car at the time of the accident. The holding of the court was that the defendant failed to demonstrate the existence of a triable issue of fact in opposition to the plaintiff's motion for summary judgment, and therefore the judgment in favor of the plaintiff was affirmed.

The main issue in the case was whether Plaintiff sought a declaratory judgment pursuant to CPLR 3001 claiming they were not legally obligated to pay any claims submitted by the defendants due to their wrongful conduct. Specifically, the Plaintiff alleged that the defendants failed to comply with New York State statutes, submitted bills for services not provided, and failed to provide verification and attend EUOs. Plaintiff sought a declaration asserting it was under no obligation to pay any insurance claims submitted by the defendants. The court raised the issue of severance, at least insofar as relief is sought against each of the 12 PC Defendants and the main holding of the case was refusal to extend the "stay" contained in the Order to Show Cause. The court also raised the issue of the party submitting supplemental memoranda on the issue of severance.

The relevant facts considered by the court included an action by a provider to recover assigned first-party no-fault benefits. The provider moved for summary judgment, but the insurance company opposed the motion and cross-moved for summary judgment dismissing the complaint, arguing that the injuries sustained did not arise out of an insured incident. The main issue decided by the court was whether there was a lack of coverage due to the injuries not arising from an insured incident, possibly being sustained in a staged accident. The holding of the case was that while the insurance company demonstrated a "founded belief" to defeat the provider's motion for summary judgment, it failed to submit sufficient evidence to establish, as a matter of law, that the injuries did not arise from an insured incident. Therefore, neither the provider nor the insurance company was entitled to summary judgment. The amended order was modified to deny the insurance company's cross motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in this case were that the defendant had moved for leave to reargue its prior motion for summary judgment dismissing the complaint, which was initially denied due to a lacking certificate of conformity. The main issue decided by the court was whether the defendant's insured's vehicle was involved in the accident in which the plaintiff's assignor was allegedly injured. The holding of the case was that the defendant had established its prima facie entitlement to judgment by showing that its insured's vehicle was not involved in the accident, and the plaintiff failed to rebut the assertions contained in the defendant's insured's affidavit. Therefore, the Civil Court properly granted the defendant's motion for summary judgment dismissing the complaint.

The court considered the issue of the rate of reimbursement for acupuncture treatments provided by licensed acupuncturists, specifically whether the defendant could use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which the plaintiff was entitled to receive for the acupuncture sessions. The main issues decided were whether the defendant had reimbursed the plaintiff at the appropriate rate and whether the plaintiff was entitled to reimbursement for the remaining claims that were denied on the grounds of untimely submission and lack of medical necessity. The holding of the case was that the judgment awarded to the plaintiff in the sum of $1,718.40 was correct and the appeal was dismissed. Therefore, the plaintiff was not aggrieved by the judgment and the appeal was dismissed.