No-Fault Case Law

The main issues decided in this case were whether the trial court properly vacated the notice of trial and directed the plaintiff to respond to the defendant's discovery demands and appear for an examination before trial with respect to the defense based on the plaintiff's alleged fraudulent incorporation. The court considered the fact that the plaintiff had represented that discovery was complete, but the defendant argued that it was not. The court also considered whether the defendant was entitled to conduct an examination before trial of the plaintiff. The holding of the case was that the trial court's decision to vacate the notice of trial and certificate of readiness and direct the plaintiff to respond to the defendant's discovery demands and appear for an examination before trial was affirmed, and the defendant was entitled to conduct the examination before trial.

The court considered the case of Post Traumatic Medical Care, P.C. v Progressive Casualty Insurance Company, which involved a provider seeking to recover first-party no-fault benefits. The main issue decided was whether the plaintiff was entitled to summary judgment, as the defendant argued that the assignors breached the cooperation clause of the insurance policy by failing to attend scheduled independent medical examinations (IMEs). The court found that the defendant failed to create a triable issue of fact by competent proof that the assignors failed to attend the IMEs, as they did not submit evidence in admissible form from anyone with personal knowledge of the nonappearances. Therefore, the order was reversed, and plaintiff's motion for summary judgment was granted, with the matter remanded for the calculation of statutory interest and attorney's fees.

The court considered a case in which A Plus Medical, acting as the assignee of Sheresse O'Neill, sued Government Employees Insurance Co. for no-fault benefits in the amount of $878.67 for medical services provided. Plaintiff and defendant agreed that the only issue for trial was the medical necessity of the services, based on a peer review. The burden was on the defendant to prove lack of medical necessity, and they called a witness, Dr. Drew Stein, to testify that an MRI of the right shoulder was not medically necessary. However, the court found that Dr. Stein's testimony was insufficient to establish a defense based on the lack of medical necessity. The court held that the evidence was insufficient to sustain the defendant's burden and ruled in favor of the plaintiff for the amount of $878.67, plus statutory interest and attorneys' fees.

The relevant facts considered by the court in the case of Bronx Multi Med. Care, P.C. v Kemper Cas. Ins. Co. included the plaintiff's motion for summary judgment to recover first party no-fault benefits, which was denied by the Civil Court of the City of New York. The main issue decided was whether the plaintiff made a prima facie showing of entitlement to summary judgment, and whether the defendant raised triable issues of fact in opposition. The holding of the court was that the order denying the plaintiff's motion for summary judgment was reversed, and the plaintiff's motion was granted in the principal sum of $8,054.90. The court found that the plaintiff had submitted evidentiary proof that the prescribed statutory billing forms had been mailed and received, and that payment of no-fault benefits was overdue, while the defendant failed to raise triable issues of fact in opposition. Consequently, the plaintiff was entitled to summary judgment.

The main issues in this case were whether the defendant, State Farm Mutual Inc. Co., had the right to dismiss the plaintiff, Bay Plaza Chiropractic's complaint due to the plaintiff's failure to appear for an examination before trial or provide verified, complete, and meaningful responses to the defendant's discovery demands. The court also had to consider whether there was evidence to support the defendant's claim that the plaintiff was a fraudulently incorporated facility and therefore ineligible to collect non-fault benefits. The court ultimately held that the defendant had a "founded belief" that the plaintiff was actually controlled by a non-licensed professional, and therefore had made allegations sufficient to raise an issue of fact as to whether the plaintiff was fraudulently incorporated. As a result, the court directed the plaintiff to produce their purported owner, Dr. Geraldine McGowan, for an exam before trial within 30 days and comply with all discovery requests related to corporate structure and fraudulent incorporation. The court also ordered the plaintiff to respond to the applicable defendant's discovery requests within 45 days and to renotice Dr. McGowan for an EBT within 30 days after receiving plaintiff's responses. However, the court declined to dismiss the plaintiff's complaint, as they had responded to some of the discovery requests and had not engaged in willful, contumacious, or bad faith conduct.

The court considered the timing of interest accruing on first-party benefits and the validity of section 65-3.9 (c) of the Insurance Law. The main issue decided was whether section 65-3.9 (c) was contrary to Insurance Law § 5106 (a). The holding was that the regulation was not contrary to the statute's clear language and was a valid regulation within the scope of the superintendent's authority. The court concluded that the regulation was not unreasonable or contrary to the statute under which it was promulgated, and that it had a rational basis for providing a penalty against insurers who do not comply with the time frames of the No-Fault Law. Therefore, the petition was denied, and the cross-petition to confirm the arbitration award was granted.

The court considered the fact that the plaintiff, a health care service provider, sought to recover no-fault benefits for supplies furnished to its assignor, while the defendant argued that the claim was premature because the plaintiff failed to comply with an additional verification request. The main issue decided was whether the defendant was obligated to notify the plaintiff that its response to their additional verification request was insufficient and/or incomplete. The court held that once the plaintiff submitted its response to the defendant's additional verification request, it was then incumbent on the defendant to inform the plaintiff that said response was insufficient and/or incomplete. Therefore, the court granted the plaintiff's motion, awarding judgment in favor of the plaintiff for $2,118.33 plus interest, attorney's fee, costs, and disbursements.

The main issue in this case was whether the Civil Court of the City of New York, Kings County, erred in denying plaintiff's motion to compel the deposition of the defendant in an action to recover assigned first-party no-fault benefits. The court held that under CPLR 3101 (a), parties to an action are entitled to reasonable discovery of any facts bearing on the controversy which will assist preparation for trial. The relevant facts considered by the court were the plaintiff's motion to compel the deposition of the defendant and the defendant's opposition to the motion. The holding of the court was that the order denying plaintiff's motion was reversed without costs and the motion was granted to the extent that the defendant was ordered to appear for a deposition within 30 days of the order entered.

The relevant facts of the case involved Bath Medical Supply, Inc. seeking to recover assigned first-party no-fault benefits and moving to compel the deposition of defendant American Transit Insurance Co. Defendant failed to oppose the motion. The main issue decided was whether the court should grant plaintiff's motion to compel defendant to appear for a deposition. The holding of the case was that the order denying plaintiff's motion was reversed without costs and plaintiff's motion was granted to the extent that defendant was ordered to appear for a deposition within 30 days of the order.

The relevant facts of the case involve a provider, Bath Medical Supply, Inc., seeking to recover first-party no-fault benefits, and filing a motion to compel the deposition of the defendant, American Transit Insurance Co. The defendant did not oppose the motion, and the court denied the plaintiff's motion, which included a request for a conditional order striking the defendant's answer or precluding the defendant from testifying if they did not comply. The main issue decided was whether the court should have granted the plaintiff's motion to compel the defendant to appear for a deposition, and the holding of the case was that the order was reversed, and the plaintiff's motion was granted to the extent that the defendant was ordered to appear for a deposition within 30 days of the order. The decision was made by Pesce, P.J., Rios and Steinhardt, JJ., and was published by the New York State Law Reporting Bureau.