No-Fault Case Law

The relevant facts considered by the court were that the defendant in the case had moved to vacate a default judgment and compel the plaintiff to accept a late answer in an action to recover assigned first-party no-fault benefits. The main issue decided by the court was whether the defendant had demonstrated a reasonable excuse for its default and a meritorious defense to the action. The holding of the court was that the defendant failed to establish a reasonable excuse for its default, and therefore, the lower court had improvidently exercised its discretion in granting the defendant's motion to vacate the default judgment and to compel the plaintiff to accept a late answer. Therefore, the order was reversed, and the defendant's motion was denied.

The main facts of this case involve a medical provider, Midborough Acupuncture, P.C., seeking to recover assigned first-party no-fault benefits from State Farm Insurance Company. The suit involved a dispute as to whether Midborough Acupuncture was eligible to receive the benefits due to being fraudulently incorporated. The main issue was whether or not the discovery demands concerning the license of the owner of Midborough Acupuncture and its corporate structure were proper. The court decided that the demands were proper and ruled in favor of State Farm Insurance Company. The appellate term court affirmed the decision to grant the branches of State Farm's motion seeking to compel Midborough Acupuncture to produce relevant documentation for discovery and inspection within 60 days. Additionally, they ordered Midborough Acupuncture to serve the required responses to State Farm's verified written interrogatories within the same time frame.

The court considered the evidence provided by both the plaintiff and defendant in an action to recover first party no-fault benefits. The plaintiff 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 submit the IME report upon which its denials were based or any other evidentiary proof to support its defense of lack of medical necessity. The main issue decided was whether the plaintiff was entitled to partial summary judgment in the principal sum of $2,527.50, and the court held that the plaintiff's motion for partial summary judgment should be granted. The court reversed the previous order and directed the clerk to enter judgment accordingly, as the defendant failed to raise a triable issue and the plaintiff made a prima facie showing of entitlement to partial judgment.

The court considered the plaintiff's motion for summary judgment in a case involving the recovery of first party no-fault benefits from the defendant insurance company. The main issue decided was whether the defendant had timely denied the claim forms within the prescribed 30-day period, which would affect their ability to assert statutory exclusion defenses such as excessive fees and lack of medical necessity. The holding of the court was that the plaintiff's motion for summary judgment in the principal sum of $2,420 was granted, and the defendant was found to be precluded from asserting the statutory exclusion defenses due to the lack of competent proof of timely denial of claim forms. Thus, the court reversed the previous denial of the plaintiff's motion and ordered the Clerk to enter judgment accordingly.

The court considered the plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits, which was denied by the lower court. The main issue decided was whether the defendant had raised triable issues of fact as to the denial of the claim and as to whether the plaintiff timely mailed the bills to the defendant. The holding of the case was that the defendant failed to present evidence that it timely denied the plaintiff's claim within the prescribed period, and therefore, the plaintiff's motion for summary judgment was granted. The matter was remanded to the lower court for a calculation of statutory interest and an assessment of attorney's fees.

The relevant facts considered by the court included a motion by a provider to recover assigned first-party no-fault benefits, opposition by the defendant, denial of claim forms, and peer review reports submitted by both parties. The main issues decided were whether the provider made a prima facie showing and the admissibility of the defendant's peer review reports. The holding of the case was that the provider made a prima facie showing of the validity of the assignment, and the defendant's peer review reports were deemed inadmissible due to noncompliance with CPLR 2106, resulting in the affirmation of the judgment in favor of the provider.

The main issue in this case was the payment of no-fault first-party benefits for medical services provided by Lenox Hill Radiology, as the assignee of Mr. Almadovar, which were allegedly unpaid by New York Central Mutual Fire Insurance Company. The court considered the plaintiff's performance of MRIs on the assignor and the bill submitted to the defendant for the services. The defendant had made a partial payment and denied the balance of the plaintiff's claim on the basis that the fees charged for the MRIs were in excess of the workers' compensation fee schedule. The main issue decided was that the defendant's motion for summary judgment was denied, while the plaintiff's cross motion for summary judgment was also denied. The court also granted dismissal of the defendant's second and third affirmative defenses, but denied the plaintiff's motion for sanctions against the defendant for alleged frivolous conduct. The holding of the case was that the defendant's motion for summary judgment was denied and the plaintiff's cross motion was also denied, while certain affirmative defenses were dismissed.

The court considered a case in which Alpha Chiropractic, P.C. sought to recover first-party no-fault benefits from State Farm Mutual Auto Insurance Company for medical services provided to various individuals. The main issue decided by the court was whether the attorney's fees awarded to the plaintiff should be based on each of the eight claims submitted for medical services or on the aggregate sum of the eight claims. The court held that the judgment of the Civil Court of the City of New York, Queens County, awarding plaintiff the principal sum of $1,200.53, plus interest and attorney's fees, was affirmed without costs. The court based its decision on a similar case, Fortune Med., P.C. v New York Cent. Mut. Fire Ins. Co., and concluded that the attorney's fees should be awarded upon each of the claims submitted for medical services provided to the assignor.

The court considered the fact that the defendant's documentary submissions were sufficient to give rise to a presumption that the defendant's verification requests were timely mailed and received by the plaintiff. The main issue decided was whether the plaintiff's claim for payment was premature, as the plaintiff did not respond to the defendant's verification requests, and an insurer is not required to pay or deny a claim until it receives verification of all relevant requested information. The holding of the case was that the defendant was entitled to summary judgment dismissing the action, as there was no triable issue as to whether the plaintiff provided the defendant with the requested information.

The court considered a lawsuit brought by One Beacon Insurance Group, LLC against various individual and professional entities, alleging a systematic scheme to defraud the insurance company. The plaintiff contended that the defendants were fraudulently incorporating medical corporations in order to obtain benefits from the plaintiff, and sought injunctive relief to stay all current and future proceedings against the defendants. The defendants, including the Halima et al. defendants and the Minick defendants, opposed the requested relief and sought dismissal and a change of venue. The court ultimately granted injunctive relief for the defaulting defendants and required documentation from appearing defendants to prove ownership by a licensed physician, denied the motions for dismissal by the Minick defendants, and denied the motion to change venue by Mark Slamowitz. The main issues decided in this case were the entitlement to injunctive relief, the sufficiency of the complaint to state a cause of action, and the appropriateness of the venue for the lawsuit. The holding of the court was to grant injunctive relief in favor of the plaintiff, deny the motions for dismissal, and deny the motion to change venue. The court also directed the defendants to provide documentation of ownership by a licensed physician for the professional corporations seeking no-fault benefits.