No-Fault Case Law

The relevant facts considered by the court in this legal case involved a motor vehicle accident in which Michael Chesebro was injured in a collision with a vehicle operated by Deborah Redden. Following the accident, the New York State Insurance Fund sought reimbursement from Progressive Northeastern Insurance Company for workers' compensation benefits it had paid in connection with the accident. The issue before the court was whether the vehicle operated by Redden, which was insured by Progressive Northeastern Insurance, was used primarily for the transportation of persons or property for hire, as required by Insurance Law § 5105 (a). The court held that as the applicant seeking reimbursement, the burden was on the New York State Insurance Fund to show entitlement to recover benefits paid, and that the evidence submitted by the Fund was insufficient to establish that the insured vehicle was used primarily for hire in accordance with the above-mentioned law. The court also noted that the Fund had not made use of available avenues for discovery to procure additional evidence for the arbitration, and ruled that the arbitration award should be vacated.

The court considered the fact that the plaintiff, a former medical services provider, sought to recover no-fault benefits from the defendant after an automobile accident in 2006. The plaintiff sought summary judgment for several claims, but the defendant had partially paid and partially denied the claims. The main issue decided was whether the defendant was entitled to summary judgment based on the plaintiff's failure to cooperate in good faith with the insurer in the investigation of its claim. The court held that the plaintiff's motion for summary judgment was denied for the first six claims, as there was a question of fact as to the proper fee to be charged and paid. The court also granted the defendant summary judgment for the last six claims since the plaintiff failed to cooperate in good faith with the insurer. The court dismissed the fifth and last six claims and denied summary judgment for the first, second, third, fourth, and sixth claims.

The relevant facts of the case involved Utica National Insurance Group seeking recoupment of payments made to defendant Arthur Luban and the defendant professional corporations owned by Luban for medical services provided to automobile accident victims. Utica claimed that the defendants did not meet the New York State licensing requirements of owning and controlling a medical professional corporation, as required by the New York Business Corporation Law. Utica moved for partial summary judgment to recover the payments made to the defendant entities, and the defendants opposed this motion. The main issue decided by the court was whether the defendant entities were entitled to reimbursement for the medical services rendered, and the court held that the defendants Providian Medical P.C., Harbor Medical Diagnostic P.C., Valiant Medical Services, Vital Medical Care, and Bay Medical Services were not entitled to reimbursement and were obligated to repay Utica for the amounts paid to them. The court also dismissed the first, second, third, fifth, sixth, seventh, eighth, ninth, and tenth causes of action against other defendant entities and granted the cross-motion for discovery to proceed regarding the remaining causes of action.

The relevant facts the court considered were that the plaintiff sought to recover uninsured and basic no-fault benefits for an individual who was injured in a motor vehicle accident. The defendant, Musa-Obregon, was awarded a default judgment but then moved to vacate it on the grounds that he was not properly served. After a so-ordered stipulation and another default by the defendant, an inquest was held and the default judgment was reinstated against him. The main issue decided was whether the defendant had a reasonable excuse for his default and a meritorious defense to the action, as required by CPLR 5015 (a) in order to vacate a default judgment. The holding was that the defendant failed to establish a reasonable excuse for his default, and therefore, his motion to vacate the default judgment was denied, and the default judgment against him was reinstated.

The court considered a case in which the appellant, Harold R. Hammond, was involved in an accident where he suffered severe burns while trying to light a cigarette after spilling gasoline on himself. He sought to recover no-fault insurance benefits from GMAC Insurance Group, the respondent. The main issue decided was whether the injuries sustained by Hammond arose out of the use or operation of a motor vehicle, as required for the payment of no-fault insurance benefits. The court held that the injuries did not arise out of the use of the vehicle, as they would have occurred even if Hammond had never reentered the vehicle and his friend had driven away. Therefore, the court affirmed the lower court's decision to deny plaintiff's motion for summary judgment.

The relevant facts of the case involved a provider who sought to recover assigned first-party no-fault benefits. The provider alleged that the insurance company failed to timely deny the claim. The main issue decided by the court was whether the insurance company's request for follow-up verification was premature, and if the statutory time period to pay or deny the claim was tolled due to the assignor's delay in appearing for an examination under oath. The court held that the insurance company's request for verification was not proper, and therefore the 30-day claim determination period was not tolled. As a result, the insurance company's denial of the claim form was untimely, and it was precluded from raising certain defenses. The judgment of the lower court granting the provider's motion for summary judgment was affirmed.

The court considered an appeal of an order by a Civil Court in a case where a medical provider was seeking first-party no-fault benefits from an insurance company. The insurance company had served the medical provider with a demand for discovery and inspection, as well as a notice of examination before trial. The main issue was whether the medical provider was obligated to comply with the outstanding discovery demands and appear for an examination before trial. The court held that the medical provider was obligated to produce the information sought in the demand for discovery and inspection, as they had failed to challenge the propriety of the demand within the prescribed time. The court also held that the insurance company was entitled to an examination before trial, as its defense was based on the medical provider's alleged ineligibility to recover reimbursement of assigned no-fault benefits.

The court considered the fact that an insurer rejected a completed hospital facility form submitted by a healthcare provider in lieu of a prescribed application for motor vehicle no-fault benefits. The main issue decided was whether an insurer is required to accept a completed hospital facility form in place of a prescribed application for motor vehicle no-fault benefits. The holding of the court was that an insurer must accept a completed hospital facility form submitted by a provider of health services in lieu of a prescribed application for motor vehicle no-fault benefits, and since the insurer failed to raise a triable issue of fact in opposition to the provider's motion for summary judgment, the court properly granted the provider's motion and denied the insurer's cross motion.

The court in this case considered the defendant's motion for summary judgment, in which they sought to dismiss the plaintiff's complaint to recover first-party no-fault benefits, interest, and attorney's fees. The main issue decided was whether the insured party's failure to appear for independent medical exams (IMEs) and examinations under oath (EUOs) represented a violation of the insurance policy's conditions. The court ultimately held in favor of the defendant, granting their motion for summary judgment and dismissing the plaintiff's complaint. The evidence submitted by the defendant was deemed sufficient to establish that initial IME requests, follow-up IME requests, and the denial of the plaintiff's claims were mailed in accordance with standard office practice and procedure, and that the insured party failed to appear for the IMEs. As a result, the court did not need to address the plaintiff's arguments concerning the sufficiency of the defendant's EUO requests.

The court considered the facts of a case where Avenue N Medical, P.C. sought to recover assigned first-party no-fault benefits from Travelers Property Casualty Ins. Co. The key issue was whether Avenue N Medical, P.C. had established its entitlement to summary judgment, including proof of the submission of the claim forms and the amount of loss sustained. The court held that any deficiency in the plaintiff's moving papers regarding proof of mailing of the claim forms was cured by defendant's claim denial forms and the affidavit of defendant's claims representative, which conceded receipt of the claims in question. The court also found that the defendant established that the plaintiff's claims were properly and timely denied based on the lack of medical necessity. As a result, the order denying plaintiff's motion for summary judgment was affirmed.