No-Fault Case Law

The relevant facts the court considered in this case were that the plaintiffs were providers seeking to recover assigned first-party no-fault benefits, and the defendant's motion to dismiss the complaint and the plaintiff's cross-motion for summary judgment. The main issue decided by the court was whether the defendant should be precluded from asserting a defense due to its failure to timely deny the claim, which was the determination of whether the plaintiff's assignor was in the course of employment at the time of the accident. The holding of the case was that the defendant was precluded from asserting the defense, and the plaintiffs' motion for summary judgment was granted, with the matter being remitted to the District Court for the calculation of statutory interest and an assessment of attorney's fees.

The court considered whether the defendant insurance company timely denied the plaintiffs' claims based on the assignor's eligibility for workers' compensation benefits. The main issue was whether the defense of the assignor's eligibility for workers' compensation benefits was subject to preclusion, and whether the insurance company timely denied the claims within the required 30-day determination period. The holding was that the insurance company was precluded from raising its defense of workers' compensation eligibility for certain claims because it did not deny those claims within the 30-day determination period. As a result, the court granted summary judgment in favor of the plaintiffs for those claims and remitted them to the District Court for further assessment. For the remaining claims, the court remitted the motion for summary judgment to be held in abeyance pending an application to the Workers' Compensation Board for a determination of the parties' rights under the Workers' Compensation Law.

The relevant facts the court considered in this case were that the plaintiffs, medical service providers, were seeking to recover first-party no-fault benefits from the defendant insurance company. The defendant objected to the admission of documents attached to the plaintiffs’ moving papers as business records, and also argued that the matter should be held in abeyance pending an application to the Workers' Compensation Board to determine the parties' rights under the Workers' Compensation Law. The court had to decide whether the documents submitted by the plaintiffs were admissible as business records and whether the matter should be held in abeyance pending a determination by the Workers' Compensation Board. The holding of the court was that the plaintiffs did not establish a prima facie case for entitlement to summary judgment, as the documents submitted were not admissible, and therefore their motion for summary judgment was denied. The judgment awarding the plaintiffs a sum of $19,357.03 was reversed, and the order granting their motion for summary judgment was vacated.

The relevant facts the court considered were the denial by a no-fault insurance company of claims for first-party benefits by providers, based on the eligibility of the claimant for workers' compensation. The main issue was whether the matter should be submitted to the Workers' Compensation Board due to mixed questions of law and fact regarding availability of workers' compensation benefits, which fell under the board's primary jurisdiction. The holding of the court was that there was a question of fact as to whether the claimant was acting as an employee at the time of the accident, which needed to be resolved by the Board in the first instance. Therefore, the motion of the plaintiffs for summary judgment was to be held in abeyance pending a determination by the Board, and a prompt application to the Board was required to determine the parties' rights under the Workers' Compensation 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.