No-Fault Case Law

The relevant facts considered by the court were that the plaintiff, Brian Gokey, was involved in an automobile accident in March 2003 and suffered serious injuries, ultimately leading to his inability to perform his job as a house painter and the failure of his business. When he submitted a claim for lost wages and other benefits available under no-fault coverage to Blue Ridge Insurance Company, the payments ceased in mid-November 2003. The main issue decided by the court was whether the plaintiff properly submitted a claim for benefits and whether he was entitled to receive these benefits. The holding of the case was that the plaintiff had submitted a proper claim for benefits and was entitled to these benefits, and thus the court ordered Blue Ridge to pay the plaintiff the unpaid principal balance in addition to interest, as calculated from thirty days after the payments were due until the present time.

The court considered a group of seven actions, all involving claims for money damages by health care providers whose patients, insured by the defendants, had their no-fault claims denied and then assigned their claims to the providers. These providers served the summonses and complaints to the Superintendent of Insurance in Albany and New York City even though they were located in Buffalo. The main issue of the case was whether service in Albany and New York City allowed the City Court of Buffalo to obtain personal jurisdiction over the defendants. The court held that it had subject matter jurisdiction, and that service of process on the Superintendent of Insurance in Albany was valid. The court also found that the defendants had agreed to allow service upon the Superintendent of Insurance, and they were therefore subject to personal jurisdiction by the Court of Buffalo. As a result, the defendants' motions to dismiss the plaintiffs' complaints were denied in their entirety.

The relevant facts considered by the court were that a patient was injured in an automobile accident and received treatment at White Plains Hospital. The hospital billed the patient's insurance company, Allstate, for $26,979.83. Allstate did not pay the claim or issue a denial within the required 30 days. The main issue decided was whether the diagnosis and procedure codes adopted by the United States Department of Health and Human Services could be judicially noticed by the courts and used to decipher no-fault billing forms. The holding of the case was that the diagnosis and procedure codes key published by the United States Government on its HHS Web site may properly be given judicial notice, and that the codes submitted by Allstate were insufficient to raise a triable issue of fact in admissible evidentiary form sufficient to warrant denial of summary judgment in favor of White Plains Hospital. Therefore, the Supreme Court properly granted White Plains Hospital's motion for summary judgment.

The relevant facts the court considered in this case were that Justice Paitou was struck by a motor vehicle and sustained serious injuries, and Rosillo & Licata, P.C. was retained to represent him in a personal injury claim. Hereford Insurance Company sought to recover a statutory lien of $198,926.00 from the settlement proceeds obtained by Rosillo & Licata in their representation of Paitou. The main issue decided by the court was whether Hereford was entitled to enforce a statutory lien against Rosillo & Licata and Paitou under Worker's Compensation Law section 29. The court held that Hereford could not seek to enforce a lien against Rosillo & Licata based on the settlement of the claim and the payment of their attorney's fees, and therefore granted the motion to dismiss the complaint with prejudice as to both Rosillo & Licata and Justice Paitou.

The court considered the case of V.S. Medical Services, P.C. as assignee of Mohamad Nazir against Travelers Insurance Co. The main issue was whether the plaintiff had made a prima facie case to recover assigned first-party no-fault benefits. At trial, the plaintiff offered testimony from a former employee and sought to admit claim forms into evidence, but the defendant objected on the grounds of hearsay and failure to lay a foundation for their admission. The court reserved decision on the admissibility of the documents and on the defendant's motion to dismiss the complaint. After reviewing the submissions, the court dismissed the complaint, finding that the plaintiff had failed to make a prima facie case. The holding of the case was that the plaintiff failed to establish a prima facie case because their witness did not testify as to the generation of the claim forms, rendering them inadmissible as business records. As a result, the judgment was affirmed.

The main facts of the case are that Vista Surgical Supplies, Inc. was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Insurance Co. After a nonjury trial, the court dismissed the complaint. Plaintiff did not call any witnesses, but instead moved for the admission of its notice to admit and defendant's response to establish its case. However, the court held that the notice to admit was improper because it sought information going to the heart of the matter. The main issue decided was whether plaintiff had made a prima facie showing of its case. The holding of the case was that plaintiff failed to lay a sufficient foundation to establish that the claim form is admissible pursuant to the business records exception to the hearsay rule, and therefore, the court properly held that plaintiff failed to make a prima facie showing. The judgment was affirmed, and the court did not reach any other issues.

The main issue in this case was whether the defendant should have been granted leave to amend its answer to assert the affirmative defenses of res judicata and collateral estoppel. The court considered the burden of the party attempting to defeat the application of collateral estoppel to establish the absence of a full and fair opportunity to litigate. The court also examined whether the plaintiff had a full and fair opportunity to litigate the issue determined in the arbitration proceeding. The holding was in favor of the defendant, as the court found that the defendant was entitled to amend its answer to assert the affirmative defenses and that the plaintiff had failed to establish that it did not receive a full and fair opportunity to litigate in the prior arbitration proceeding. As a result, the judgment in favor of the plaintiff was reversed, and the defendant's cross motion for summary judgment was granted.

The relevant facts considered in this case include the plaintiff offering a notice to admit and an affirmation made by the defendant's attorney in order to prove its prima facie case at trial. The court found that the plaintiff failed to produce a witness and therefore failed to make its prima facie case, resulting in the dismissal of the complaint. The main issue decided was whether the plaintiff had successfully proven its case in order to recover assigned first-party no-fault benefits. The holding of the case was that the judgment was affirmed without costs, as the plaintiff failed to make its prima facie case and therefore the complaint was dismissed.

The court considered the appeal of a provider seeking to recover assigned first-party no-fault benefits, in which the lower court had granted the provider's motion for summary judgment. The main issue was whether the affidavit submitted by the provider's officer laid a proper foundation for the admission of the documents annexed to the provider's moving papers, and whether the provider had established a prima facie case. The holding of the court was that the affidavit submitted by the provider's officer was insufficient to demonstrate personal knowledge of the provider's practices and procedures, and therefore failed to lay a foundation for the admission of the documents as business records. As a result, the provider failed to make a prima facie showing of entitlement to summary judgment, and the judgment was reversed, the order granting the provider's motion for summary judgment was vacated, and the provider's motion for summary judgment was denied.

The case involved Complete Orthopedic Supplies, Inc. as an assignee of Ana Valencia, a medical provider, that was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Company. The provider moved for summary judgment, while the insurance company cross-moved for summary judgment, arguing that there was no medical necessity for the supplies provided. The Civil Court granted the provider's motion for summary judgment and denied the insurance company's cross motion. The Appellate Term, Second Department reversed this decision, ultimately holding that the insurance company's denial of claim forms, based on lack of medical necessity, were timely mailed and that there was no medical necessity for the supplies provided by the medical provider. As a result, the insurance company's cross motion for summary judgment dismissing the complaint was granted, and the provider's motion for summary judgment was denied.