No-Fault Case Law

The relevant facts in this case include the plaintiffs, providers seeking to recover first-party no-fault benefits, filing a motion for summary judgment. In opposition, the defendant argued that the plaintiffs had not established a foundation for the admission of the documents submitted as business records. The District Court denied the motion, citing insufficiency of the affidavit provided by the plaintiffs' billing manager. The main issue decided in this case was whether the plaintiffs had made a prima facie showing of their entitlement to summary judgment. The court held that the affidavit submitted by the plaintiffs' billing manager failed to establish that the documents annexed to the moving papers were admissible under CPLR 4518. The holding of the case was that the plaintiffs' motion for summary judgment was properly denied, as they had failed to make a prima facie showing of their entitlement to summary judgment. The court did not reach any other issues in light of their decision.

The court considered the fact that Careplus Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits from Allstate Insurance Company. Careplus moved for summary judgment, but Allstate argued that Careplus did not make a prima facie showing of entitlement to judgment. The court denied Careplus's motion, stating that the affidavit by Careplus's billing manager did not establish a prima facie case because it did not demonstrate that the documents annexed to Careplus's motion were admissible as business records. The main issue decided was whether Careplus made a prima facie showing of entitlement to summary judgment, and the court held that Careplus failed to do so, as the affidavit submitted by Careplus's billing manager did not establish the admissibility of the documents annexed to Careplus's moving papers. Therefore, the denial of Careplus's motion for summary judgment was affirmed.

The main issues in this case were whether the providers were entitled to recover first-party no-fault benefits and whether the insurer's denial of the claims based on the assignor's failure to appear for scheduled examinations under oath and independent medical examinations was proper. The court considered the evidence submitted by both parties, including the documents annexed to the providers' motion for summary judgment, and the insurer's assertion that the assignor failed to appear for the scheduled examinations. The court held that the providers failed to make a prima facie showing of their entitlement to summary judgment, as the affidavit submitted by their medical biller did not establish the admissibility of the documents. Additionally, the insurer failed to establish by admissible proof that the assignor had not appeared for the scheduled examinations. Therefore, the court modified the order and denied the insurer's cross motion for summary judgment, affirming the decision without costs.

The main issues in this case were whether the plaintiff, New Era Acupuncture, P.C., which sought to recover assigned first-party no-fault benefits, complied with the defendant's discovery demands, and whether the defendant had the right to compel the plaintiff to produce its owner, Valentina Anikeyeva, for an examination before trial (EBT) and to provide certain documents and information sought in the defendant's discovery demands. The District Court denied the defendant's motion to dismiss the complaint based on plaintiff's failure to comply with defendant's discovery demands, and, to the extent that defendant raised specific objections to plaintiff's responses to discovery demands, the District Court also denied the defendant's alternative motion to compel such responses. However, the defendant's subsequent appeal resulted in a modified order that compelled the plaintiff to produce the documents and information demanded in the defendant's discovery and inspection notice and to serve answers providing the information sought in the defendant's demand for verified written interrogatories. The defendant was also entitled to conduct an EBT of Ms. Anikeyeva, as it was asserting a Mallela defense.

The main issue decided in the case was whether a provider was entitled to recover first-party no-fault benefits when the insurance company claimed it did not receive the necessary claim forms. The court's holding was that the provider failed to establish its entitlement to summary judgment because it did not prove that it mailed the claim forms to the insurance company. The court found that the provider's primary doctor and principal shareholder's affirmation and attorney's affirmation were insufficient to establish either actual mailing of the claim forms or a standard office practice or procedure designed to ensure that items are properly addressed and mailed. Therefore, the district court's denial of the provider's motion for summary judgment and granting of the insurance company's cross motion for summary judgment was affirmed.

The court heard an appeal from an order denying a provider's motion for summary judgment in a case to recover assigned first-party no-fault benefits. The defendant had denied the claim due to a lack of medical necessity and argued that documents submitted by the plaintiff were not admissible as business records. However, the court found that the defendant failed to establish the lack of medical necessity as a defense and that the plaintiff's motion for summary judgment should be granted. The court held that the documents were indeed admissible as business records and remitted the matter to the District Court for the calculation of statutory interest and an assessment of attorney's fees pursuant to Insurance Law § 5106(a) and the regulations thereof.

The court considered a case where a medical supply company was seeking to recover no-fault benefits through an assigned claim. The main issue was whether the company was entitled to summary judgment for unpaid bills when the insureds failed to appear for independent medical examinations. The court held that the medical supply company was entitled to summary judgment for the unpaid bills, as the insurer failed to prove proper mailing of the examination scheduling letters and also failed to establish that the insureds did not appear for the examinations. As a result, the court reversed the lower court's decision, granted summary judgment for the unpaid bills, and remanded the case for the calculation of statutory interest and attorney's fees.

The court considered the denial of the plaintiff's no-fault claim by the defendant, Liberty Mutual Insurance Co., based on the results of an independent peer review. The main issue decided was whether the defendant's NF-10 form sufficiently apprised the plaintiff of the factual basis for the denial. The court held that the NF-10 form did provide enough information to inform the plaintiff of the basis for the denial, in accordance with 11 NYCRR 65-3.8[b][4]. Additionally, the court found that the initial peer review report relied upon by the defendant, along with additional documentation received from the plaintiff, raised a triable issue as to the medical necessity of the services and tests performed by the plaintiff. Therefore, the court affirmed the amended order of the Civil Court, denying the plaintiff's motion for summary judgment.

The court considered the issues of whether plaintiff Cambridge Medical, P.C. was required to comply with defendant Adirondack Insurance Exchange's discovery demands, and whether plaintiff's alleged owner, Eileen S. Debbi, M.D., should be compelled to testify regarding the ownership and operation of the plaintiff. Defendant contended that Dr. Debbi was not the true owner of Cambridge Medical, and that the real owner was Mark Levitan of Nissa Management, Inc. Plaintiff opposed, arguing that the deposition was sought to harass and delay the trial. The court held that plaintiff was bound by Article 31 of the CPLR, which grants as of right discovery in all civil plenary proceedings, and granted defendant's motion to compel the production of Dr. Debbi for examination before trial and to respond to defendant's discovery demands. Plaintiff's application for a protective order was denied.

The relevant facts of the case were that the plaintiff, a medical provider, was seeking to recover first-party no-fault benefits from the defendant insurance company. The plaintiff moved for summary judgment and the defendant cross-moved for summary judgment dismissing the complaint. The District Court denied the plaintiff's motion on the grounds that the affidavit by the plaintiff's billing manager did not establish that the documents annexed to plaintiff's motion were admissible as business records. The court also granted the defendant's cross motion for summary judgment as to plaintiff's claim for $230.09 and denied the defendant's cross motion for summary judgment as to plaintiff's claim for $1,572.26. The main issue that was decided in this case was whether the plaintiff had made a prima facie showing of its entitlement to summary judgment. The holding was that the plaintiff failed to make a prima facie showing of its entitlement to summary judgment since the affidavit submitted by the plaintiff's billing manager did not establish that the documents annexed to plaintiff's moving papers were admissible pursuant to CPLR 4518. As a result, the court affirmed the lower court's decision to deny the plaintiff's motion for summary judgment with respect to the claim for $1,572.26.