No-Fault Case Law

The court considered whether to grant the plaintiff's motion to strike the defendant's answer pursuant to CPLR 3126 to compel the defendant to respond to the plaintiff's demands for written interrogatories and for discovery and inspection. The court also considered the defendant's cross motion to compel a deposition and responses to discovery demands to the extent of compelling plaintiff to respond to certain items of the defendant's supplemental demand for discovery and inspection. The court decided to grant the plaintiff's motion to strike the defendant's answer to the extent of compelling the defendant to respond to the plaintiff's discovery demands and granted the defendant's cross motion to compel certain responses to discovery demands. The holding of the case was that while the plaintiff failed to show a clear willful, contumacious, or bad faith failure to comply with discovery demands, the defendant's cross motion should have been denied as premature, and the defendant was not entitled to a deposition of the plaintiff's owner Valentina Anikeyeva.

The court considered a case involving WJJ Acupuncture, P.C.'s attempt to recover first-party no-fault benefits assigned to it by three individuals. The main issue decided was whether the order for summary judgment in favor of WJJ Acupuncture, P.C. was appropriate, as defendant Utica Mutual Insurance Company argued that the motion for summary judgment was made in violation of a previously ordered stay. The holding of the court was that the judgment was reversed, the order granting plaintiff's motion for summary judgment was vacated, and the matter was remitted to the Civil Court for the calculation of statutory interest and attorney's fees upon one specific claim for assigned first-party no-fault benefits.

In this case, the plaintiffs, a group of insurance companies, sought a preliminary injunction to prohibit several medical treatment facilities and individuals from prosecuting lawsuits and arbitration proceedings against them to recover No Fault first-party medical benefits. The plaintiffs alleged that these facilities and individuals had defrauded them by submitting bills for medical services rendered by corporations not truly owned by holders of medical licenses. The plaintiffs demonstrated a likelihood of ultimate success on the merits based on fraudulent incorporation, as well as irreparable injury if provisional relief was withheld. The court granted the preliminary injunction, finding that equitable relief was necessary to prevent repetitive litigation and arbitration of numerous No Fault claims for reimbursement by medical providers with the same defense of fraudulent incorporation. The plaintiffs' motion for a preliminary injunction was granted, and the parties were instructed to submit affidavits concerning the proper amount of the undertaking at the time of the settlement of the order.

The court considered the complaint filed by certain insurance companies, claiming that they were defrauded by several medical providers and their affiliated management companies, who submitted bills for services under the Comprehensive Automobile Insurance Reparations Act, resulting in payments made by the insurers. The insurers alleged common law fraud, unjust enrichment, illegal fee-splitting, and violations of New York State laws. The main issue was whether the complaint adequately alleged fraud, unjust enrichment, and other causes of action. The holding of the court was that the complaint adequately alleged fraud, unjust enrichment, and other causes of action, denying the defendants' motions to dismiss most of the causes of action while granting dismissal for some damages before April 4, 2002. Additionally, the court ordered the severance of the causes of action against each group of defendants, requiring separate actions to be maintained against each group.

The relevant facts considered by the court in this case were that the plaintiff, a medical provider, was seeking to recover assigned first-party no-fault benefits from the defendant insurance company. The defendant sought to disqualify Gary Tsirelman, Esq., and Gary Tsirelman, P.C. from representing the plaintiff in the case, as Tsirelman was both counsel to and sole owner of the plaintiff medical provider. The main issue decided by the court was whether Tsirelman should be allowed to act as both attorney and witness in the case, and the court held that in a disqualification situation, any doubt should be resolved in favor of disqualification. The court affirmed the order without costs, concluding that the defendant had raised an issue of fact as to whether the plaintiff was eligible to receive reimbursement of first-party no-fault benefits, and that Tsirelman would likely be called as a witness, potentially impacting the credibility of the case. Therefore, the court held that Tsirelman and his law firm were disqualified from representing the plaintiff in the action.

The court considered the issue of whether a medical provider was entitled to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance policy was obtained fraudulently as a result of identity theft, and whether the medical provider's assignor was aware or involved in the fraudulent scheme. The court held that there was no evidence that the assignor participated in or was aware of the fraudulent scheme, and since the insurance company did not cancel the policy prior to the accident, they failed to demonstrate the existence of an issue of fact to defeat the medical provider's motion for summary judgment. The holding of the case was that the lower court's denial of the provider's motion for summary judgment was reversed, and the matter was remitted for the calculation of interest and assessment of attorney's fees.

The plaintiffs in this case, who are assignees of no-fault benefits, brought an action to recover for health services rendered to the beneficiaries of the defendant's no-fault insurance contracts. Each assignor received medical treatment from the plaintiffs after separate automobile accidents. The complaint contained 17 causes of action, but the Supreme Court denied the plaintiffs' motion for summary judgment and granted those branches of the defendant's cross-motion which were to dismiss several of these causes of action. The court concluded that the plaintiffs were barred from recovery due to Workers' Compensation Law § 11, as the assignors were injured during the course of their employment. Upon reargument, the court adhered to its original determination, but the Appellate Division modified the order upon reargument, vacating the original determination and remanding the matter to the Workers' Compensation Board for a new determination. The Supreme Court properly denied the plaintiffs' motion for summary judgment on the complaint, as their entitlement to judgment as a matter of law was not demonstrated.

The relevant facts of the case involved two separate instances where the defendant, Government Employees Insurance Company, requested verification of claims submitted by the plaintiff, Custom Orthotics, Ltd. The plaintiff's attorney responded to the verification requests with identical "compliance letters" in each case. The main issues decided by the court were whether the defendant's verification requests were proper, if the plaintiff's responses to the defendant's verification requests were sufficient, and whether the defendant was obligated to respond further to the plaintiff in some form to communicate its position that the response was insufficient. The court found that the verification requests were proper and reasonable, and in the Graulan matter, the plaintiff's response was found to be sufficient. However, in the Iori matter, the plaintiff's response was found to be insufficient, and the defendant was not obligated to respond further. Therefore, the court dismissed the complaint in the Iori matter as premature.

The relevant facts were that a provider brought an action to recover assigned first-party no-fault benefits, and the defendant appealed from an order granting plaintiff's motion for summary judgment. The main issue decided was whether the plaintiff made a prima facie showing of its entitlement to summary judgment, as the motion was supported by an affidavit of an employee of a third-party billing company that failed to comply with CPLR 4518. The holding of the court was that the judgment was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion for summary judgment was denied, as they failed to make a prima facie showing of entitlement to summary judgment.

The relevant facts considered by the court were that Andromeda Medical Care, P.C. was seeking to recover assigned first-party no-fault benefits from Utica Mutual Insurance Company. The main issue decided was whether the defendant's motion for summary judgment should be granted or denied, and whether the plaintiff's cross motion for summary judgment was proper. The holding of the case was that the defendant's motion for summary judgment was denied, as the affidavits in support of the motion did not comply with CPLR 2309 (c) and thus failed to introduce competent evidence in admissible form. The court also ruled that the plaintiff's cross motion for summary judgment was properly denied, as the billing records did not constitute evidence in admissible form.