No-Fault Case Law

The relevant facts of the case involved a Supreme Court judgment against the plaintiff's assignor in a previous action related to a motor vehicle accident. The plaintiffs in this case, seeking to recover assigned first-party no-fault benefits, were found to be barred from relitigating the claim due to the doctrines of res judicata and collateral estoppel. The main issue decided by the court was whether the plaintiffs were allowed to pursue their claim for first-party no-fault benefits when a judgment in a prior action had already established that there was no coverage. The holding of the case was that the plaintiffs were barred from relitigating the claim pursuant to the doctrine of res judicata, and the defendant's motion to dismiss was properly granted and affirmed.

The court considered a motion by defendant Mercury Ins. Co. seeking summary judgment with respect to four bills for services rendered by Bronze Acupuncture, P.C. The issue was whether the denial of claim forms denying the subject claims on the ground of lack of medical necessity were timely mailed and whether there was a lack of medical necessity for the services at issue. The court held that the denial of claim forms were timely mailed and that the papers submitted by defendant established a lack of medical necessity for the services, while the opposing affidavit by plaintiff's treating acupuncturist failed to raise a triable issue of fact as to medical necessity. Therefore, defendant's motion for summary judgment dismissing the claims at issue was granted.

The court considered a motion to dismiss a complaint or, alternatively, for summary judgment determining that the defendant's denial of claim form was timely mailed. The main issues were whether the plaintiff's failure to file the summons with proof of service within 14 days of service warranted dismissal, and whether the defendant established that its denial of claim form was timely mailed. The holding was that the dismissal of the action without prejudice was not warranted, as the plaintiff had requested nunc pro tunc relief, and such relief should have been granted. Additionally, the defendant did not establish that its denial of claim form was timely, so the motion to dismiss the complaint was properly denied. The decision to grant nunc pro tunc relief and deny the motion to dismiss the complaint was affirmed.

The main issues in this case were whether the court should dismiss the action due to a violation of the New York City Civil Court Act and whether the defendant's motion to dismiss should be granted. The plaintiff in this case failed to file a summons with proof of service, as required by the Civil Court Act, within the time period required. The defendant had moved to dismiss the action due to this failure but the plaintiff requested nunc pro tunc relief, which is retroactive relief. The court ultimately granted this relief and denied the defendant's motion. However, Judge Golia dissented, arguing that the plaintiff should not have been given the nunc pro tunc relief due to intentional failures and misrepresentations and that the action should have been dismissed without prejudice. The other judges on the court disagreed and voted to affirm the lower court's order, modified to provide nunc pro tunc relief to the plaintiff.

The court considered the fact that Post Traumatic Medical Care, P.C. was seeking to recover no-fault benefits from The Travelers Home and Marine Insurance Company. The main issue decided was whether plaintiff's affidavit was sufficient to establish personal knowledge and lay a foundation for the admission of documents as business records. The holding of the case was that the affidavit submitted by plaintiff's medical billing manager was insufficient to establish personal knowledge of plaintiff's practices and procedures, therefore failing to make a prima facie showing of entitlement to summary judgment. As a result, the Civil Court's decision to deny plaintiff's motion for summary judgment was affirmed.

The court considered the fact that the plaintiff, a medical services provider, sought to recover no-fault benefits for services rendered by independent contractors. The main issue decided was whether the plaintiff was entitled to recover these benefits as a provider under Insurance Department Regulations. The court held that where a billing provider seeks to recover no-fault benefits for services not rendered by it or its employees, but rather by independent contractors, it is not considered a "provider" of the medical services within the meaning of the regulations. The judgment granting the defendant's motion for summary judgment dismissing the complaint was affirmed.

The relevant facts in this case included a dispute over whether the defendant had properly denied the claim on the grounds that the supplies provided were not medically necessary, and the verification requests that had been sent. The main issue was whether the defendant had tolled the prescribed 30-day period for determining the claim, and whether the denial of the claim was properly issued. The holding of the court was that the judgment in favor of the plaintiff was reversed without costs, the order granting the plaintiff's motion for summary judgment was vacated, and the plaintiff's motion was denied. The court found that the defendant had properly tolled the claim determination period, and the motion for summary judgment was denied based on the existence of an issue of fact as to the medical necessity of the supplies provided.

The relevant facts considered in this case were that the plaintiff sought to recover first-party no-fault benefits from the defendant for medical services provided to an assignor who was involved in an automobile accident. The defendant argued that the underlying insurance policy was retroactively cancelled and deemed void ab initio due to misrepresentations made by the insured. The main issue decided was whether the retroactive cancellation of the insurance policy was valid, and the holding of the case was that under New Jersey law, no-fault benefits are unavailable when sought as part of an insured's first-party claim for benefits under their own policy of insurance declared void because of material misrepresentations made to the insurer. The court found that the misrepresentations made by the insured were material and warranted the retroactive cancellation of the insurance policy, and as a result, the plaintiff, standing in the shoes of its assignor, could not recover first-party no-fault benefits from the defendant. Therefore, the defendant's motion for summary judgment was granted and the action was dismissed.

The main issue in this case was whether plaintiff, Careplus Medical Supply, Inc., was entitled to summary judgment in their action to recover first-party no-fault benefits. The court considered the affidavit submitted by plaintiff's president and medical biller, which failed to establish that the documents annexed to plaintiff's moving papers were admissible pursuant to CPLR 4518. As a result, the court held that plaintiff failed to make a prima facie showing of its entitlement to summary judgment and therefore denied plaintiff's motion. Therefore, the holding of the case was that plaintiff's motion for summary judgment was properly denied.

The court considered the plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The defendant had served the plaintiff with various discovery demands and argued that the plaintiff did not make a prima facie showing of entitlement to judgment. The defendant also claimed that the plaintiff's motion should be denied because the plaintiff's owner failed to appear for examinations under oath and failed to respond to discovery demands seeking information about the plaintiff's eligibility for reimbursement of benefits. The main issue decided was whether the plaintiff made a prima facie showing of entitlement to summary judgment, and the court held that the plaintiff failed to do so because the affidavit submitted by the plaintiff's billing manager did not establish that the documents annexed to the plaintiff's motion were admissible. Therefore, the court affirmed the order denying the plaintiff's motion for summary judgment.