No-Fault Case Law

The relevant facts of this case include an action brought by a surgical supplies company to recover no-fault benefits from an insurance company, as well as the insurance company's motion for summary judgment to dismiss the complaint. The main issue decided by the court was whether the insurance company's motion for summary judgment should have been granted, and if the company demonstrated its prima facie entitlement to summary judgment. The holding of the court was that the insurance company failed to demonstrate entitlement to summary judgment due to inconsistency in its affidavit and that there was an issue of fact regarding the authenticity of signatures on peer review reports submitted in support of the motion. Therefore, the court reversed the order granting summary judgment, denied the insurance company's motion, and allowed the case to proceed.

The court considered the dispute between Bath Medical Supply, Inc. and Utica Mutual Insurance Company regarding the recovery of assigned first-party no-fault benefits. The main issue decided was whether the evidence presented by Bath Medical Supply, Inc. was sufficient to establish a prima facie case in their favor. The court held that Bath Medical Supply, Inc. failed to establish the admissibility of the claim forms as business records, and therefore, did not establish a prima facie case. As a result, the court affirmed the judgment dismissing Bath Medical Supply, Inc.'s complaint against Utica Mutual Insurance Company.

The main issue in this case was whether the court was correct in granting the defendant's cross motion to strike the complaint pursuant to CPLR 3126 due to the plaintiff's failure to comply with a so-ordered stipulation. The court held that the judgment should be reversed and so much of the order entered December 19, 2005 as granted the defendant's cross motion to strike the complaint pursuant to CPLR 3126 should be vacated. The court found that the so-ordered stipulation did not schedule the plaintiff's examination before trial (EBT) for a specific date, only stating that it should occur on or before a certain date. As such, the defendant failed to establish that the plaintiff breached the stipulation and therefore, the defendant's cross motion should have been denied. The court also noted that the defendant's cross motion was served slightly later than the date set by the court, but it was served more than 4 months before the motion and cross motion were returnable, and the plaintiff did not demonstrate any prejudice as a result of the delay.

The court considered the fact that the provider in this case had established a prima facie case to recover assigned first-party no-fault benefits. The main issue decided was whether the December 2005 order, deciding a summary judgment motion in a prior case between the parties, should have collateral estoppel effect in the present action. The court held that the provider failed to show that the identical issues were decided in the prior action, and that the defendant met its burden of proving that the loss did not arise out of an insured incident. Therefore, the judgment to dismiss the complaint was affirmed.

The relevant facts considered by the court were related to a healthcare provider's attempt to recover first-party no-fault benefits from an insurance company. The main issue in dispute was whether the insurance company's time to pay or deny the claims had been tolled due to the plaintiff's assignor's failure to appear at scheduled examinations under oath. The court held that the insurance company failed to establish that its denial of claim forms were timely and, therefore, it was not precluded from raising the defense of the assignor's failure to appear for an examination under oath. However, the insurance company was not precluded from asserting the defense that the alleged injuries did not arise out of an insured incident, and the documents submitted by the insurance company were sufficient to demonstrate this defense. As a result, the judgment was reversed, and the order granting the plaintiff's motion for summary judgment was vacated.

The relevant facts considered by the court were that A.B. Chiropractic, P.C. was seeking to recover first-party no-fault benefits for injuries sustained by their assignor, Edwin Ramirez, and Utica Mutual Insurance Company argued that the injuries did not arise out of an insured incident. The main issue decided was whether Utica Mutual Insurance Company provided enough evidence to demonstrate that there was an issue of fact as to whether the injuries arose from an insured incident. The holding of the court was that the documents submitted by Utica Mutual Insurance Company, including witness statements, transcripts, and affidavits, were sufficient to demonstrate that their defense was based on a founded belief that the alleged injuries did not arise from an insured incident. Therefore, the judgment in favor of A.B. Chiropractic, P.C. was reversed, and their motion for summary judgment was denied.

The court considered the facts of a case where a provider sought to recover assigned first-party no-fault benefits from an insurance company. The insurance company had paid the provider at a reduced rate based on the workers' compensation fee schedule, while the provider contended that the amounts charged were reasonable and within the prevailing fees in the area. The main issue decided was whether the insurance company's use of the workers' compensation fee schedule to determine the amount payable to the provider was proper. The court held that the insurance company had established its entitlement to summary judgment by showing that it timely mailed its denial of claim forms, and that it was proper for the insurance company to use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which the provider was entitled to receive. Therefore, the insurance company's motion for summary judgment dismissing the complaint was granted.

The court considered a case where medical service providers were seeking to recover first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance company's failure to pay or deny the claims within the prescribed period and failure to establish that the period was extended precluded it from raising most defenses. The holding of the court was that the insurance company's failure to pay or deny the claims within the prescribed period and failure to establish that the period was extended precluded it from raising most defenses, resulting in summary judgment being awarded to the medical service providers on certain claims. The court also found that the insurance company's submissions were insufficient to raise a triable issue of fact with respect to certain claims, and thus summary judgment was awarded to the medical service providers on those claims. The case was remanded for the calculation of statutory interest and attorney's fees.

The court considered the facts that the medical services company was seeking first-party no-fault benefits for services rendered to an individual, and that the case was dismissed due to the plaintiff's lack of readiness to proceed. The court decided that the case was dismissed on default, and that the plaintiff did not adequately demonstrate a reasonable excuse for the default or a meritorious cause of action. The court further held that the dismissal was correct because the plaintiff failed to sustain its burden in failing to calendar the trial date, and thus affirming the earlier judgment.

The relevant facts of this case involve a lawsuit brought by State Farm Mutual Automobile Insurance Company against several professional medical corporations and individuals for common-law fraud and unjust enrichment. State Farm alleged that the defendant professional corporations were fraudulently incorporated and owned and controlled by unlicensed individuals in violation of applicable statutes and regulations. State Farm also alleged that the defendant professional corporations were not entitled to receive payments for no-fault claims submitted as they were not solely owned and controlled by a licensed medical physician and the services provided were not rendered by employees. The main issues decided by the court were whether the defendant professional corporations were entitled to collect no-fault benefits for charges submitted to the plaintiff, and whether the third and fourth causes of action asserted by the plaintiff stated viable claims for declaratory relief. The court held that the plaintiff's withholding of payments to defendant professional corporations for services rendered by independent contractors was a justiciable controversy capable of disposition in an adversarial context, and that the plaintiff's causes of action stated viable claims for declaratory relief. Therefore, the motion by the defendants to dismiss the third and fourth causes of action was denied.