No-Fault Case Law

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.

The court considered the fact that plaintiff J & S Medical Supplies, Inc. brought an action against defendant Republic Western Insurance Co. for first party no-fault benefits. The main issue in the case was whether the action was time-barred. The court held that assuming the defendant qualified as a self-insurer, the plaintiff's action for first party no-fault benefits was governed by a six-year statute of limitations, and was therefore timely commenced. The court affirmed the order of the Civil Court of the City of New York, Bronx County, which denied the defendant's motion to dismiss the action as time-barred.

The court considered a case in which the plaintiff alleged that the defendants had committed slander per se by reporting to the police that the plaintiff had filed a fraudulent claim for no-fault medical benefits for his son. The plaintiff's complaint failed to comply with CPLR 3016(a), which required that a complaint sounding in defamation set forth the particular words complained of. The defendants' motion to dismiss the complaint for failure to state a cause of action was denied by the Supreme Court. However, the Appellate Division reversed that decision, holding that the plaintiff's complaint did not meet the requirements set forth in CPLR 3016(a) and that the motion to dismiss the complaint should have been granted. Therefore, the Appellate Division ruled in favor of the defendants and ordered the dismissal of the complaint.

The main issue in the case New York First Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. involved the defendant's motion seeking to amend the answer to include the defense of fraudulent incorporation and to compel the plaintiff to produce its owner, Valentina Anikeyeva, for a deposition. The Civil Court granted the branches of defendant's motion and directed the plaintiff to produce its owner for a deposition within 60 days of the order, with the consequence of failure to do so resulting in dismissal. Subsequently, the Civil Court entered an order dismissing the complaint with prejudice due to plaintiff's failure to comply with the previous order. The main holding of the case was that the appeal must be dismissed because the right of direct appeal from the previous order terminated with the entry of judgment in the action. Therefore, the appeal was dismissed.

The main issues in this case were whether a provider was entitled to recover assigned first-party no-fault benefits, and whether the defendant insurance company was entitled to a deposition of the owner of the plaintiff corporation. The court considered the defendant's motion to dismiss the complaint due to the plaintiff's inadequate response to discovery demands and failure to produce its owner for a deposition. The main holding of the case was that the defendant was entitled to a deposition of the plaintiff's owner, as the defendant had set forth reasons for believing that the plaintiff may be ineligible to recover benefits as a fraudulently incorporated professional service corporation. The court reversed the order denying the defendant's motion to dismiss the complaint and granted the defendant's motion to direct the plaintiff to produce its owner for a deposition within 60 days.

The relevant facts considered by the court were whether an automobile collision was covered by the plaintiff's insurance policy and whether the injuries purportedly sustained due to the collision were a result of an insurance fraud scheme. The main issue decided was whether the defendant, in order to prove lack of coverage for the alleged injuries, needed to prove, by clear and convincing evidence, that the injuries were a result of an insurance fraud scheme or that the collision was not a covered accident. The court held that in order to prove lack of coverage, the defendant needed to establish, by a preponderance of the evidence, that the collision was not an accident and was instead a deliberate intentional occurrence, regardless of whether it was part of an insurance fraud scheme, and that the coverage was not required to be established by clear and convincing evidence. The court found that the defendant met its burden and the judgment was affirmed.

The relevant facts of this case involved an action by a provider to recover assigned first-party no-fault benefits. The Civil Court granted the provider's motion for summary judgment and implicitly denied the insurer's cross motion for summary judgment. On appeal, the Appellate Term affirmed the judgment, finding that the provider's affidavit and documents established evidence in admissible form and that any deficiency regarding proof of mailing of the claim forms was cured by the insurer's affidavit. The main issues decided in this case were whether the insurer's follow-up requests for verification were premature and without effect, and whether the insurer was precluded from raising certain defenses due to untimely denials of the provider's claims. The court held that the follow-up requests were premature and without effect, and that the insurer was precluded from raising most defenses due to the untimely denials. Additionally, the insurer's submissions were found to be insufficient to demonstrate that the defense of lack of coverage was valid.