No-Fault Case Law

The main issue of the case is whether plaintiff Jesa Med. Supply, Inc., can recover first-party no-fault benefits from defendant GEICO Ins. Co. for medical services rendered by plaintiff. The court found that plaintiff had established its prima facie case as to the mailing of its claims for no-fault benefits. Despite defects in the defendant's attorney affirmation, the court did not find them to be substantive enough to warrant summary judgment being granted in favor of the plaintiff. Ultimately, plaintiff's motion for summary judgment was denied in part and granted in part, resulting in a judgment in favor of plaintiff and against defendant in the amount of $16.46, plus statutory costs, interest and attorney fees. Additionally, defendant's cross motion was denied in part and granted in part, resulting in the dismissal of the cause of action for no-fault benefits in the amount of $780.

The relevant facts the court considered in this case were related to a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the provider's assignor failed to attend scheduled chiropractic/acupuncture independent medical examinations (IMEs) and if the letters scheduling said IMEs were timely sent. The holding of the case was that the defendant's motion for summary judgment was granted and the plaintiff's cross motion for summary judgment was denied. The court found that the defendant's motion for summary judgment established that the assignor failed to attend scheduled IMEs and that the letters scheduling the IMEs were timely sent, therefore properly granting defendant's motion for summary judgment and denying plaintiff's cross motion for summary judgment.

The Court considered the issue of whether Great Wall Acupuncture, as the assignee of certain individuals, was entitled to full reimbursement for acupuncture services rendered under a first-party no-fault benefits insurance claim. The main issue was whether the amounts charged by Great Wall Acupuncture for the acupuncture services were reasonable and within the range of the prevailing fees in the geographic area. The Court ultimately held that the insurance company, GEICO, failed to establish that it timely denied the unpaid portion of certain claims and that it was proper for the company to use the workers' compensation fee schedule to determine the amount that Great Wall Acupuncture was entitled to receive for services rendered by its acupuncturist. The judgment in favor of the insurance company was reversed and remitted for a calculation of statutory interest and an assessment of attorney's fees.

The relevant facts considered by the court were that the defendant in this case had lost the file containing the summons and complaint and did not find out about the default judgment until a later date. The main issue decided was whether the defendant had a reasonable excuse for its delay in appearing and answering the complaint, as well as a meritorious defense to the action, and whether the default judgment should be vacated. The holding of the court was that the defendant's failure to answer the complaint was excusable, and the defendant demonstrated a potentially meritorious defense to the claim for services rendered to assignor Patrick Seraphin. Therefore, the court found that the Civil Court had improvidently exercised its discretion in denying the defendant's motion to vacate the default judgment and compel the plaintiff to accept a late answer with respect to the claim for services rendered to Patrick Seraphin.

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.