No-Fault Case Law

The case involves an insurance dispute where Careplus Medical Supply Inc. tried to recover assigned first party no-fault benefits. The insurance company Selective Insurance Company of America denied the claim, arguing that the supplies provided were not medically necessary under New Jersey law. The main issue in this case was the conflict of law between New York and New Jersey law. The Court decided that since most of the factors such as the place of contracting and the domicile of the insurance policyholder were in New Jersey, the law of New Jersey regarding medical necessity should control. Therefore, the Court held that the insurance company could raise the defense of lack of medical necessity as per New Jersey law, meaning that Selective Insurance Company of America could raise a triable issue of fact regarding their denial of the claim. The court affirmed the District Court's decision.

The relevant facts in this case included Midwood Acupuncture, P.C. seeking to recover no-fault benefits from Allstate Insurance Company for acupuncture services performed by its licensed acupuncturist for its assignor, Yensi Alan. The defendant contended that it was entitled to remit payment at the chiropractic rate indicated in the Workers' Compensation Fee Schedule, as it did not specifically address licensed acupuncturists. The plaintiff argued that the defendant was required to reveal its procedures for choosing the rate and the calculation of the amount. The main issue was whether the defendant had proper grounds for denying full payment of the no-fault benefits based upon the Workers' Compensation Fee Schedule for chiropractic services. The court held that based on the credible evidence submitted, the defendant had shouldered its burden of producing a proper grounds for denying full payment of the no-fault benefits, and therefore, judgment was in favor of the defendant and the complaint was dismissed.

The main issue in this case was whether the provider had established a prima facie case to recover assigned first-party no-fault benefits. The court considered the fact that at trial, the provider did not call any witnesses and instead relied on documents and exhibits to establish their case. However, the court held that without testimony from a witness to establish the admissibility of the documents, the provider failed to establish a prima facie case. As a result, the court affirmed the judgment dismissing the complaint, stating that it remained the provider's burden to proffer evidence in admissible form, such as by introducing the claim forms in question and calling a witness to lay a foundation for their admissibility as business records. The court's holding was that the provider did not establish a prima facie case and the insurer was entitled to judgment dismissing the complaint.

The relevant facts in this case pertain to a hospital's claims for reimbursement for medical services provided to a patient involved in an automobile accident. The insurance company seeks to deny the claim based on the patient's failure to attend Examination Under Oath (EUO) requests sent prior to the receipt of a completed claim form. The main issue in the case is whether the notice requirements for verification requests applied to the EUOs noticed prior to the insurance company's receipt of claim forms. The court's holding is that the notice requirements for verification requests do not apply to preclaim EUOs, and that the insurance company was within its rights to request an EUO before receiving the completed claim form. The court also decides that an insurer's timely denial of a claim, based on an insured's failure to appear for a preclaim EUO, constitutes a breach of a condition precedent to payment and is a valid ground upon which to award summary judgment to the defendant.

The court considered the issue of whether the affidavit submitted by the plaintiff's billing manager laid a proper foundation for the admission of the documents annexed to the plaintiff's moving papers in a no-fault benefits case. The plaintiff had brought an action to recover assigned first-party no-fault benefits, and the court had granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment. However, the court found that the affidavit submitted was insufficient to demonstrate the billing manager's personal knowledge of the plaintiff's practices and procedures, and therefore failed to establish a prima facie case. As a result, the court reversed the judgment, vacated the order granting summary judgment to the plaintiff, denied the plaintiff's motion for summary judgment, and remanded the matter to the lower court for further proceedings.

The main issue in the case was whether the plaintiff was entitled to recover no-fault benefits from the defendant. The court considered whether the plaintiff had complied with the defendant's verification requests and whether the plaintiff had established a prima facie case for the creation and mailing of the bill in question. The court held that the burden rested with the plaintiff to properly verify its claim, and that the plaintiff had failed to comply with the defendant's verification requests. As a result, the court dismissed the complaint. This was the decision and order of the court, dated February 26, 2009.

The relevant facts considered by the court were that plaintiff's subrogor was injured in a car accident and received no-fault benefits from the plaintiff in the sum of $14,511.93. A default judgment had been entered against the defendants in 2001. Defendant George German had moved multiple times to vacate the default judgment against him, and the judgment was reinstated when he failed to appear for trial. The main issue decided was whether the defendant had a reasonable excuse for the default and a meritorious defense to the action, as required to vacate the judgment. The holding of the case was that the court reversed the lower court's decision, denied the defendant's motion to vacate the default judgment, and reinstated the default judgment against the defendant. The court found that the defendant's consistent and repeated defaults demonstrated a pattern of neglect, and the default should not be excused. Therefore, it was an improvident exercise of discretion for the lower court to have granted the defendant's motion to vacate the default judgment.

The main issue in this case was whether the defendant had raised triable issues of fact in opposition to the plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits. The court considered the submission of a statutory claim form and the payment of no-fault benefits to be overdue as evidence of the plaintiff's entitlement to summary judgment. However, the defendant opposed the motion on the grounds of lack of coverage, failure by plaintiffs' assignors to appear for independent medical examinations, and lack of medical necessity. In support of their defense, the defendant submitted various evidence including the affidavit of its litigation examiner, the police report, the affidavit of its investigator, and transcripts of statements made by the assignors and the insured. The court ultimately affirmed the denial of the plaintiff's motion for summary judgment, albeit on other grounds. Holding: The denial of the plaintiff's motion for summary judgment was affirmed due to the triable issues of fact raised by the defendant.

The relevant facts the court considered were that the defendant argued it timely denied the plaintiff's claims based on the owner's failure to appear for scheduled examinations under oath (EUOs). The main issues decided were whether the defendant complied with the EUO scheduling regulations and whether the initial EUO was scheduled within 30 days of receiving the plaintiff's claims. The holding of the court was that the defendant did not comply with the EUO scheduling regulations and that the initial EUO was not scheduled within 30 days of receiving the plaintiff's claims. Therefore, the judgment was reversed, the order entered on November 15, 2007 was vacated, plaintiff's cross-motion for summary judgment was denied, defendant's motion for summary judgment was granted, and the complaint was dismissed.

The main issues considered in this case involve the recent amendment to CPLR 2001 and its application to an action that has been commenced by service of process, and how commencement errors should be dealt with. The court considered the effect of the stipulation of discontinuance and whether the plaintiff's recommencement of the action was valid without purchasing a new index number. The main legal issue decided was the interpretation of CPLR 2001, the effect of commencement infirmities, and the effect of the defendant's failure to timely object to the plaintiff's commencement errors. The holding of the court was that technical, nonprejudicial procedural defects in the commencement of the action should be excused and can be disregarded, whether by application of the 2007 revision of CPLR 2001 or by following the former CPLR 2001. The court also held that defendant waived objections to commencement infirmities by failing to move to dismiss the case based on those grounds within 60 days after serving its answer. In conclusion, the court denied the defendant's motion for discontinuance or dismissal of the case based on commencement errors.