No-Fault Case Law

The court considered the fact that the plaintiff, a radiological medical, sought reimbursement for medical services provided to the defendant's insured, while the defendant denied reimbursement. The main issue was whether the defendant's refusal to turn over the insured's medical records and no-fault medical examination reports, which the plaintiff had demanded, was justifiable. The court found that the plaintiff was entitled to disclosure of the information requested. However, the plaintiff was not entitled to make such discovery demands without producing an assignment of benefits from the assignor. Ultimately, the court decided that the plaintiff's motion to compel was granted upon the defendant's receipt of the assignor's valid authorization. Therefore, the holding was that the plaintiff's motion to compel disclosure was granted, with the condition that the defendant receives the assignor's valid authorization.

The court considered a case in which a provider was seeking to recover no-fault benefits for medical supplies furnished to its assignor from the insurance company. The insurance company had previously executed a stipulation of discontinuance "with prejudice" in a prior action involving the same assignor and identical claims. The main issue decided was whether this stipulation should be given res judicata effect in future litigation on the same cause of action. The court held that a stipulation of discontinuance "with prejudice" raises a presumption that it is to be given res judicata effect in future litigation on the same cause of action. Since the cause of action in the discontinued case was identical to the cause of action in the instant case and the stipulation did not contain any exceptions permitting the instant action to continue, the court affirmed the judgment dismissing the complaint.

The relevant facts of the case involve plaintiffs seeking to recover first-party no-fault benefits in an action commenced in April 2004. After plaintiffs moved for summary judgment, defendant opposed the motion and cross-moved for summary judgment dismissing the complaint. In July 2005, the court granted plaintiffs' motion and denied the defendant's cross motion, resulting in a judgment entered in favor of plaintiffs. The main issue decided in the case was whether the judgment and order awarding judgment to plaintiffs should be vacated, and whether plaintiffs failed to establish their entitlement to summary judgment. The holding of the case was that the court affirmed the order granting plaintiffs' motion to lift the stay and denied the defendant's cross motion seeking to either vacate the judgment or toll the time during which interest accrued on the judgment. The court found that the defendant's contentions had no merit and that the order was affirmed.

The relevant facts considered by the court were that Valentin Avanessov, Physician, P.C. had commenced a proceeding to vacate a master arbitrator's award which upheld the denial of its claim for assigned first-party no-fault benefits. The court found that the papers submitted by the petitioner were insufficient to warrant the granting of any relief. The main issue decided was whether the document submitted by the petitioner was sufficient as an affirmation to support the petition to vacate the master arbitrator's award. The holding of the court was that the order granting the petition to vacate the master arbitrator's award was reversed, the petition was denied, and the matter was remanded to the court below for the entry of a judgment confirming the master arbitrator's award.

The main issue in this case was whether personal jurisdiction had been properly obtained in the proceeding to confirm an arbitration award. The respondent, Republic Western Insurance Co., argued that personal jurisdiction had not been obtained and that the award was invalid. The court considered the fact that the petition in the proceeding was served on Republic Western and its attorney by regular mail, which was not an acceptable form of service according to CPLR 308. As a result, the court concluded that proper service had not been made and therefore dismissed the petition. The holding of the case was that the respondent's motion to dismiss the petition pursuant to CPLR 3211(a)(8) was granted and the petition was dismissed. The court determined that because the petition was not served properly, the court lacked jurisdiction to proceed with the case. Therefore, the decision and order of the court was to dismiss the petition.

The relevant facts the court considered in this case included Clarendon National Insurance Co. ("Clarendon") moving for summary judgment against the medical services provider, Joseph Rockman LMT a/a/o Delilah Serrano, on the grounds that the provider failed to timely submit written proof of claim within 180 days of the date medical services were rendered. The defendant alleged that the bills were for services rendered in October - November 2002, but were dated some four and a half years after the services were rendered. The main issue decided was whether the medical services provider timely submitted the proof of claim, as required by insurance regulations. The court held that the defendant, Clarendon, was entitled to summary judgment because the plaintiff, Rockman, failed to present evidentiary facts to controvert the defendant's denial based on the untimely submission of the bills. In summary, the main issues considered were the timely submission of written proof of claim by the medical services provider, and the court's holding was that the defendant was entitled to summary judgment because the plaintiff failed to present evidence to controvert the defendant's denial based on untimely submission.

The main issue in Art of Healing Medicine, P.C. v. Travelers Home and Marine Insurance Company was an action to recover assigned first-party no-fault benefits under an insurance contract. The plaintiffs appealed from a denial of their motion for partial summary judgment by the Civil Court of the City of New York, Kings County. The Appellate Term of the Supreme Court for the Second and Eleventh Judicial Districts affirmed the lower court's order, holding that the plaintiffs had failed to establish their entitlement to judgment as a matter of law. The court found that the medical service providers failed to demonstrate the admissibility of their billing records under the business records exception to the hearsay rule. Therefore, the plaintiffs' motion was properly denied, regardless of the sufficiency of the opposing papers. The court did not address the defendant's cross motion for summary judgment dismissing the complaint, as it remained pending and undecided.

The primary issue in this case was whether the 90-day statute of limitations began on the date that the arbitrator's decision was mailed to the petitioner or the date on which it was received. The court held that the relevant date is the date on which the decision was received by the petitioner or their agent. The case involved a situation where the petitioner had pursued no-fault arbitration to recover personal injury protection benefits for injuries sustained in a motor vehicle accident. The master arbitration award was mailed to the parties and received by the petitioner's attorney. The court concluded that the proceeding was timely commenced because it fell within the 90-day period from receipt of the award, rather than the date of mailing. This interpretation of "delivery" as the date of receipt rather than mailing was supported by previous case law.

The main issue in this case was whether the plaintiff was entitled to summary judgment to recover assigned first-party no-fault benefits. The court considered the affidavit of plaintiff's employee and various documents annexed thereto, as well as the argument by the defendant that the affidavit failed to lay a proper foundation for admission of the attached documents as business records. The holding of the court was that the plaintiff failed to make a prima facie showing of its entitlement to summary judgment because the affidavit of plaintiff's employee did not refer to the documents attached to the moving papers and did not assert that they were plaintiff's business records, as required by CPLR 4518(a). Therefore, the court reversed the order granting summary judgment to the plaintiff and denied plaintiff's motion for summary judgment. No other issues were considered in light of this decision.

The main issues in this case were whether the affidavits submitted in support of the plaintiff's cross motion for summary judgment laid a proper foundation for the documents annexed to the moving papers, as well as whether the defendant's motion seeking summary judgment dismissing the complaint as premature should have been granted. The court considered the fact that an insurer must accept a completed hospital facility form submitted on behalf of a provider of health services in lieu of a prescribed application for motor vehicle no-fault benefits, and that the insurer is entitled to receive verification of all relevant information requested. The court held that the defendant was entitled to summary judgment dismissing the plaintiff's second cause of action, but that the plaintiff's cross motion for summary judgment was granted with respect to the first cause of action.