No-Fault Case Law

The relevant facts of the case included a provider's motion to compel the deposition of the defendant in an action to recover assigned first-party no-fault benefits. Defendant failed to oppose the motion. The main issue decided was whether the court should grant the plaintiff's motion to compel the defendant to appear for a deposition, and for a conditional order striking the defendant's answer or precluding the defendant from testifying in the event of failure to comply. The holding of the case was that the order denying the plaintiff's motion was reversed without costs, 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. This decision was based on the failure of the defendant to oppose the motion and the legal precedent indicating that the court should have granted the plaintiff's motion to compel the defendant to appear for a deposition.

The court considered whether the provider, Infinity Health Products, Ltd., was entitled to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The main issues were whether the provider's motion for summary judgment should be granted and whether the defendant's cross motion for summary judgment dismissing the complaint should be denied. The court held that the provider failed to establish its prima facie case for summary judgment, as the affidavit submitted in support of the motion did not lay a proper foundation for the admission of the documents annexed to the moving papers. The defendant also failed to establish that its verification requests and denial of claim forms were timely mailed, so its cross motion was properly denied. Therefore, the court modified the order by providing that the provider's motion for summary judgment is denied, and affirmed the decision without costs.

The court considered the fact that the plaintiff was seeking to recover $882.39 in assigned first-party no-fault benefits for medical supplies provided to its assignor for injuries sustained in a motor vehicle accident on October 12, 2004. The defendant argued that the action was premature since they had not received claims pertaining to the accident. The main issue decided was whether the plaintiff established its entitlement to summary judgment and whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the case was that the plaintiff failed to establish its entitlement to summary judgment, as it did not submit the statutory claim forms setting forth the facts and amounts of the losses sustained. The defendant was granted summary judgment dismissing the complaint.

The relevant facts the court considered in this case include the plaintiff, Odessa Medical Supply, Inc., seeking to recover first-party no-fault benefits from Kemper Auto & Home Insurance Company, which involved a claim submitted to Unitrin Advantage Insurance Company. Unitrin had scheduled examinations under oath of the assignor's physician, but when the physician failed to appear, Unitrin issued a denial of claim form. The plaintiff then commenced an action against Kemper, with Unitrin serving and filing an answer, stating it was incorrectly sued as Kemper. The main issue decided was whether the plaintiff's motion for summary judgment against Kemper should be denied since it was served upon Unitrin and based on a claim submitted to Unitrin, and whether Unitrin's cross motion to dismiss the complaint should also be denied. The holding of the case was that the plaintiff's motion for summary judgment against Kemper was denied, as the motion papers were served upon Unitrin and the action was based on a claim submitted to Unitrin, with no showing that Kemper and Unitrin are a single entity. Additionally, since Unitrin was not a formal party to the action and sought to dismiss the complaint against a different entity, its cross motion was also denied.

The court considered an action by a medical provider to recover assigned first-party no-fault benefits. The defendant's cross-motion for summary judgment was denied by the Civil Court of the City of New York, Queens County, as they had not established that the fee charged was excessive. The defendant's affirmed peer review report established prima facie that there was no medical necessity for the supplies provided by the plaintiff. Plaintiff's contention that the peer review report was inadmissible since it contained a stamped facsimile of the doctor's signature was raised for the first time on appeal, and thus, waived any objection. The main issue decided was whether the defendant was entitled to summary judgment dismissing the balance of the claim, and whether the peer review report was admissible. The holding of the court was that the defendant was not entitled to summary judgment dismissing the balance of the claim, but was entitled to summary judgment dismissing the plaintiff's second and third causes of action. Additionally, the court held that the plaintiff waived their objection to the admissibility of the peer review report.

The court considered a motion for summary judgment in a case by a provider to recover assigned first-party no-fault benefits. The court denied the motion on the ground that the affidavit submitted by the plaintiff's officer and medical billing manager was insufficient to establish personal knowledge of plaintiff's practices and procedures, so as to lay a foundation for the admission of the documents annexed to plaintiff's moving papers as business records. As a result, the plaintiff failed to make a prima facie showing of its entitlement to summary judgment. The main issue decided was whether the plaintiff had provided sufficient evidence to establish its entitlement to summary judgment in a case to recover assigned first-party no-fault benefits. The holding of the court was that the plaintiff's affidavit was insufficient to make a prima facie showing of its entitlement to summary judgment, and therefore the order denying plaintiff's motion for summary judgment was affirmed.

The relevant facts in the case of Bronxborough Medical, P.C. v Travelers Insurance Co. involved a provider who sought to recover assigned first-party no-fault benefits from the insurance company. The issue at hand was that the provider wanted to serve a subpoena on the insurance company to produce an employee outside the City of New York, in which the lower court found that the provider did not offer a valid reason to permit service of the subpoena outside the city. The main issue decided by the court was whether the interests of justice would be served by allowing the provider to serve a subpoena outside the City of New York, and the court held that the provider's motion was properly denied because it failed to establish that the interests of justice would be served or set forth the location at which the subpoena was to be served. Additionally, the court noted that if the provider believed that the insurance company's response to its notice to admit was improper, its remedy lies in the procedure set forth in CPLR 3123 (c). The order was affirmed without costs.

The relevant issues of the case were whether the insurer scheduled an examination under oath within 30 days of receiving a no-fault claim, and if the exclusion of the phrase "examination under oath" from the Insurance Department Regulations indicated a clear intention. The appellant, Eagle Surgical Supply, Inc., contended that it was not established by the defendant's Progressive Casualty Insurance Co. that they verified the outstanding no-fault claims because the initial EUO was not scheduled within 30 days of receiving the plaintiff's claim. The defendant demonstrated that the insurance policy in effect when the EUOs were sought contained an endorsement authorizing the verification and established that the EUO scheduling letters were timely mailed, as no additional verification was required. The court held that the insurer did not employ red tape dilatory practices and that the plaintiff's claims were not overdue, and defendant was properly granted summary judgment dismissing the action as premature.

The case involved a dispute between a provider, Careplus Medical Supply, Inc., and an insurance company, New York Central Mutual Fire Insurance Company, regarding medical necessities for supplies provided. Careplus Medical moved for summary judgment to recover first-party no-fault benefits, claiming that the insurance company did not comply with their request for copies of the peer review reports that were the basis for the denial of their claim forms. The insurance company had defended its actions by stating they had timely denied the claims on the grounds that the supplies provided were not medically necessary. The Court held that an insurer's submission of a denial of claim form based on a peer review report is sufficient to raise the defense of lack of medical necessity even if the specific factual basis and medical rationale is not set out in the denial of claim form. The Appellate Division affirmed that defendant's opposition papers established a triable issue of fact based on a defense of medical necessity and therefore the lower court properly denied plaintiff's motion for summary judgment.

The case revolved around an insurance company's lawsuit against various medical service corporations and individuals, alleging fraud and unjust enrichment, and seeking a judgment declaring that they are not obligated to pay certain medical claims. The main issue was whether the radiology practice, Proscan Imaging, P.C., was fraudulently incorporated. The evidence demonstrated that Proscan may have been controlled by unlicensed individuals in violation of the Business Corporation Law. As a result, the court held that there was enough evidence to suggest fraudulent incorporation and that the defendant's motion for summary judgment was properly denied. They were also ordered to allow disclosure of financial documents relevant to the case.