No-Fault Case Law

The relevant facts considered by the court were that Crossbay Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from Nationwide Mutual Insurance Co. The main issue decided in this case was whether Crossbay Acupuncture, P.C. was entitled to summary judgment in their favor. The holding of the court was that Crossbay Acupuncture, P.C. was entitled to summary judgment as they had established their prima facie entitlement to such relief under the Insurance Law. The court found that since Nationwide Mutual Insurance Co. did not submit opposing papers, the Civil Court had improperly denied Crossbay Acupuncture, P.C.'s unopposed motion for summary judgment. The order was reversed, and the matter was remitted to the Civil Court for the calculation of statutory interest and an assessment of attorney's fees.

The relevant facts considered by the court were that Pan Chiropractic, P.C. was suing Mercury Insurance Co. to recover assigned first-party no-fault benefits, and Mercury Insurance Co. denied the claim based on a peer review report. The main issue before the court was whether there was a question of fact as to the medical necessity of the services provided. The holding of the court was that the affidavit submitted by the defendant's claims representative sufficiently established the timely mailing of the denial of the claim form, and that defendant made a prima facie showing of its entitlement to summary judgment dismissing the complaint. The court reversed the order and granted defendant's cross motion for summary judgment dismissing the complaint. The burden was shifted to plaintiff to raise a triable issue of fact in opposition to the defendant's cross motion, which the court found was not done with the evidence presented.

The main facts in the case were that AKS Medical, as the assignee of Kisha Snipes, brought an action to recover first-party no-fault benefits from Progressive Insurance Company. AKS Medical moved for summary judgment on its fifth cause of action, seeking to recover $398.61. In opposition, Progressive Insurance Company argued that it never received the claim. The main issue decided was whether AKS Medical had established its prima facie entitlement to summary judgment by proving the submission of the claim form to Progressive Insurance Company. The court held that AKS Medical failed to establish submission of the $398.61 claim to Progressive Insurance Company and therefore denied summary judgment on its fifth cause of action.

The relevant facts that the court considered were that 563 Grand Medical, P.C. filed a petition to vacate a master arbitrator's award that upheld the denial of its claim for reimbursement of assigned first-party no-fault benefits. The court denied the petition, stating that the papers submitted by petitioner were insufficient on their face to warrant the granting of any relief. The main issue decided was whether the document submitted by the petitioner in support of the petition was sufficient as an affirmation, and the court held that it was not. The court affirmed the order of the Civil Court, without costs, stating that a special proceeding should terminate in a judgment, not an order.

The court considered the facts of a case where a medical supply company, acting as the assignee of a claimant, was seeking to recover first-party no-fault benefits from an insurance company. The main issue was whether the action was premature because the provider had commenced the action before the insurance company received responses to its verification requests. The court held that the insurance company had timely mailed requests for verification and follow-up requests for verification, and since the provider did not serve responses to the verification requests prior to commencing the action, the insurance company's cross motion to dismiss the action as premature should have been granted. Therefore, the judgment was reversed, the order granting the provider's motion for summary judgment was vacated, the provider's motion for summary judgment was denied, and the insurance company's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court in the case were that Dr. Albert Davydov had filed a lawsuit to acquire no-fault benefits for dental services provided as an assignment of benefits. After the non-jury trial took place, the Civil Court ruled in favor of Dr. Davydov in the total sum of $6,569.27. Following this decision, the defendant appealed the judgment that was made and was later entered. The issue at hand was with regards to the standing of Dr. Davydov to prosecute the case since the assignment of the no-fault benefits form was in favor of Dr. Albert Davydov, DDS, P.C. rather than Dr. Albert Davydov, DDS. The court held that the defendant could not contest the validity of the assignment of benefits due to their failure to timely seek verification and therefore, the judgment was affirmed.

The case involves a life insurance policy issued by John Hancock Life Insurance Company of New York to defendant Shavy Hirsch insuring the life of her stepmother Rivka Landau. Landau applied for the policy on December 11, 2006, and she was diagnosed with breast cancer on December 14, 2006. The policy was delivered on December 26, 2006, and the first premium was paid on December 28, 2006. In 2008, John Hancock discovered the cancer diagnosis and commenced an action to rescind the policy in December 2008. The main issue in the case was whether the policy was void because Landau and Hirsch failed to disclose material health information at the time of the application or because there had been a deteriorative change in Landau's health between the time of the application and the issuance of the policy which required notification to the insurer. The court held that John Hancock's motion for summary judgment was granted and that the policy was declared null and void because an express condition precedent to coverage under the policy was not met. Therefore, John Hancock did not have to pay any benefits or perform under the policy.

The main issue decided by the court in this case was whether the recent Court of Appeals decision in Fair Price Medical Supply Corp. V. Travelers Indemnity Co., 10 NY3d 556 (2008) requires an insurer to deny a claim on the grounds that the assignor was involved in an accident while on the job and that workers compensation is hence primary within 30 days, or whether that defense is not subject to the preclusion rule. The court held that the defense that a "claimant is eligible for workers compensation" is not a coverage defense but rather a "statutory offset" which must be contained in a timely denial. It also held that the defense of workers compensation is not subject to preclusion and a no-fault insurer is only obligated to pay no-fault benefits if the workers compensation carrier denies liability for benefits. The court granted summary judgment to the plaintiff with respect to the defense of workers compensation, but the case proceeded to trial on the issue of medical necessity.

The relevant facts considered were that the plaintiff, as the assignee of medical benefits of a for-hire vehicle operator, filed a claim for no-fault insurance benefits for injuries arising from an automobile accident. The defendant argued that the claim should be covered by Workers' Compensation Insurance from the New York Black Car Operators' Injury Compensation Fund and not under the No Fault Insurance Law. The main issue decided was whether the defendant was entitled to summary judgment based on the argument that the claim should be covered under Workers' Compensation Insurance. The holding of the court was that the defendant failed to meet the required prima facie showing of entitlement to judgment as a matter of law to support its summary judgment motion, and therefore, the defendant's motion for summary judgment was denied in its entirety.

The relevant facts of the case were that Media Neurology P.C. provided medical treatment to Jerome Ajodhasingh following a car accident, and Liberty Mutual Insurance Company denied payment for the treatment on the grounds it was not medically necessary. The principal of Media Neurology, German Laufer, was indicted on charges of no-fault insurance fraud. Liberty Mutual sought to compel Laufer's deposition more than 3 years after the Notice of Trial was filed, citing the indictment as an unusual and unanticipated circumstance necessitating the discovery. The court held that since Liberty did not raise fraud as a defense in a timely served denial, they were precluded from raising it as a defense at trial, and Laufer's deposition was not material or relevant to the action. Therefore, Liberty's motion to compel Laufer's deposition was denied.