No-Fault Case Law

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.

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.