No-Fault Case Law

The court considered a case in which a medical provider, Vincent Medical Services, P.C., sought to recover first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The main issues decided were whether the insurer's claim denials were timely and whether the insurer had coverage for the vehicle involved in the underlying motor vehicle accident. The court held that the insurer's proof failed to eliminate all triable issues of material fact, and therefore, the insurer's cross motion for summary judgment was denied. The insurer failed to establish prima facie that its claim denials were timely, and it also failed to allege, much less prove prima facie, that it did not insure the vehicle on the date of the loss. The court affirmed the order denying the insurer's cross motion for summary judgment.

The case involved a dispute between St. Barnabas Hospital and American Transit Insurance Company over the payment of no-fault medical benefits under insurance contracts. St. Barnabas Hospital sought summary judgment on the first cause of action, claiming that it had made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that the prescribed statutory billing forms were mailed to and received by the defendant and that payment was overdue. However, the defendant challenged this claim by arguing that the Hospital did not timely comply with the demand for verification, which raised a triable issue of fact. The court ultimately denied the defendant's cross motion for summary judgment dismissing the first cause of action and also denied the Hospital's motion for summary judgment on the first cause of action, finding that the defendant was not obligated to pay or deny the claim until all demanded verification was provided by the Hospital. Therefore, the court affirmed the order in part and modified it in part.

The relevant facts considered by the court were that the plaintiff provided first-party no-fault benefits to a person covered by a policy of insurance issued by the defendant. The plaintiff treated the insured between September 11, 2007 and October 4, 2007 and billed on November 2, 2007. The main issue decided by the court was whether the defendant had reasonable cause to believe that the accidents and later treatment by the plaintiff were the result of intoxication and thus excluded from coverage. The court held that summary judgment is denied to both the plaintiff and the defendant as to the Second and Third Causes of Action. The court also ordered all parties to appear at a Preliminary Conference at the Supreme Courthouse.

The relevant facts of the case are that A.B. Medical Services, PLLC, LVOV Acupuncture, P.C., and RW Health Plus Chiropractic, P.C. were seeking to recover first-party no-fault benefits from Country-Wide Insurance Company. The main issue decided was whether the plaintiffs were entitled to summary judgment on their claims, and the holding of the court was that A.B. Medical Services, PLLC was awarded summary judgment on several claims, LVOV Acupuncture, P.C. was awarded summary judgment on some claims, and RW Health Plus Chiropractic, P.C. was awarded summary judgment on certain claims. The matter was remanded to the court for the calculation of interest and attorney's fees, and for further proceedings on all remaining claims. The court also addressed the issue of an insurer's 30-day period to pay or deny a claim, and the evidence submitted by the defendant to support its denial of certain claims.

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.