No-Fault Case Law

The main facts considered by the court were that Crossbridge Diagnostic Radiology was seeking first-party no-fault benefits after the insurer, Encompass Insurance, had denied their claim on the grounds that the policy benefits had been exhausted. Crossbridge argued that the denial was untimely and that there was no admissible evidence to establish that the policy benefits were actually exhausted. The main issue decided was whether the evidence presented by Encompass Insurance was admissible and sufficient to establish that the policy benefits had been exhausted. The holding was that the evidence presented by Encompass Insurance was not in admissible form, and therefore did not establish a triable issue of fact. The judgment of the Civil Court granting Crossbridge's motion for summary judgment was affirmed as a result.

The court considered a motion by the plaintiff to compel the deposition of the defendant in a case involving recovery of assigned first-party no-fault benefits. The defendant opposed the motion and cross-moved for a protective order. The main issue was whether the defendant should be compelled to appear for a deposition, and whether the request for a protective order was justified. The holding of the court was that the plaintiff's motion to compel the defendant to appear for a deposition within 30 days was granted, and the branch of the defendant's cross motion seeking a protective order was denied. The court emphasized the importance of full disclosure of all material and necessary facts in the prosecution or defense of an action, and the entitlement to reasonable discovery of any facts bearing on the controversy.

The relevant facts considered in this case involve M.N. Dental Diagnostics, P.C., the plaintiff who started this action to recover first-party no-fault benefits for health services rendered to the plaintiff's assignor, Daniel Burgos, who was involved in a motor vehicle accident on August 4, 2003. At the time of the accident, Burgos was driving a rental car allegedly insured by nonparty Fidelity and Guaranty Insurance Company and was denied no-fault benefits by appellant Government Employees Insurance Company. The main issue decided was whether Burgos' insurer, GEICO, was solely responsible for the payment of first-party benefits, or whether that responsibility would fall on Fidelity, as Manhattan Ford's insurer. The court's decision held that GEICO's denial did not raise an issue of coverage, but rather one of priority of payment which must be resolved through mandatory arbitration. Therefore, GEICO was obligated to pay the no-fault benefits for the health services provided by plaintiff, irrespective of any issues relating to the priority or source of payment.

The main issue decided in this case was whether a provider had established a prima facie showing of entitlement to summary judgment to recover assigned first-party no-fault benefits. The court considered the affidavit submitted by the plaintiff's billing manager and whether the documents annexed to the plaintiff's moving papers were admissible pursuant to CPLR 4518. The court held that the plaintiff had failed to make a prima facie showing of its entitlement to summary judgment. The affidavit submitted by the plaintiff's billing manager failed to establish that the annexed claim form constituted evidence in admissible form. Consequently, the court affirmed the order denying plaintiff's motion for summary judgment.

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.