No-Fault Case Law

The court in this case considered the fact that the plaintiff, Hastava & Aleman Associate, brought a no-fault action against State Farm Mutual Auto Insurance Company, regarding the issue of Examination Under Oath (EUO). The plaintiff alleged that State Farm willfully delayed and/or refused to pay no-fault benefits to its client, Lionel McIntyre, who was injured in a car accident and received treatment from the plaintiff. The main issue that the court decided was whether State Farm had the right to demand an EUO from the injured party, and if its refusal to pay benefits was justified. The court held that State Farm was within its rights to demand an EUO from McIntyre and that its refusal to pay benefits was not willful, as the plaintiff's failure to provide requested documents was material and prejudicial to State Farm's ability to investigate the claim. Therefore, State Farm did not violate any provisions of the no-fault regulations and was entitled to the relief requested.

The relevant facts to this legal case are that the claimant was injured in an automobile accident and sought no-fault benefits from her insurer. After one arbitration award was issued in her favor, she also sought supplementary uninsured motorist benefits, which were denied by the arbitrator. The claimant then sought to vacate or modify the supplementary uninsured motorist arbitration award, claiming that her insurer was collaterally estopped from relitigating the issue of causation. The main issue in this case was whether or not the award with respect to supplementary uninsured motorist benefits violated public policy and whether it exceeded the arbitrator's power. The holding of this case was that the motion to vacate or modify the arbitration award was denied and the original award was confirmed. It was determined that despite the fact that a prior arbitration award was inconsistent with the subsequent award, this alone was not an enumerated ground for vacating or modifying the award. Arbitrators are not required to provide reasons for their decisions, and as such, the supplementary uninsured motorist arbitrator was not required to state that he had considered the contention of collateral estoppel.

The court considered the defendant's submission in support of its staged accident defense, as well as its reliance on a policy exclusion defense. The main issue decided was whether the defendant's submission was sufficient to establish a "founded belief that the alleged injury did not arise out of an insured incident" and whether the policy exclusion defense was precluded due to the defendant's failure to timely deny the claims. The holding of the case was that the defendant's submission was insufficient to establish a "founded belief" and that any policy exclusion defense was precluded due to the defendant's failure to timely deny the claims. The appellate court affirmed the order of the Civil Court of the City of New York, Bronx County which granted the plaintiff's motion for summary judgment.

The relevant facts the court considered in this case involved an insurance carrier's failure to adhere to the time limits for requesting follow-up verification in a no-fault insurance case. The main issue decided by the court was whether an insurance carrier should be subject to greater penalties for submitting a late follow-up verification request than for submitting a late additional verification request. The court held that the insurance carrier should not be subject to greater penalties for submitting a late follow-up verification request than for submitting a late additional verification request. The court concluded that the regulations do not contain a punitive provision for an insurer who does not make a follow-up verification request within the 10-day period and that the penalties should be consistent across both types of verification requests. Consequently, the court granted the defendant's motion for summary judgment and dismissed the case.

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.