No-Fault Case Law

The relevant facts the court considered were that the defendant, an insurance company, sought to vacate a default judgment in a case to recover assigned first-party no-fault benefits. The defendant was required to establish both a reasonable excuse for the default and a meritorious defense. The court found that there was no support in the record for the determination that the defendant had a reasonable excuse for the default, as the only proffered excuse was set forth by the defendant's attorney, who did not allege personal knowledge of his assertions. Therefore, the court reversed the order granting the defendant's motion to vacate the default judgment and denied the motion. The holding of the case was that the court found the defendant did not have a reasonable excuse for the default and therefore the motion to vacate the default judgment was denied.

The court considered the fact that Uniondale Chiropractic Office brought a claim against State Farm Mutual Automobile Insurance Company to recover no-fault first party benefits. The action involved twenty-three bills for chiropractic services totaling $1,975.28. The main issue was whether Uniondale Chiropractic Office was entitled to summary judgment on these claims. The court held that Uniondale Chiropractic Office was entitled to summary judgment on twenty of the twenty-three claims, as the defendant admitted timely receipt of twenty of the plaintiff's claim forms. The court also held that the defendant's denial of receipt of the plaintiff's claims was insufficient to rebut the presumption of receipt upon proof of proper mailing, and therefore, the plaintiff was entitled to summary judgment on the three bills totaling $246.24 which the defendant denies receiving.

The court considered the stipulated facts that the insurance policy was issued after the effective date of a mandatory personal injury endorsement, which required that claims be submitted within 45 days of service. When the plaintiff did not submit claims within the required time, the defendant timely denied the claims. The plaintiff argued that the defendant was required to produce the policy to prove it contained the endorsement. Citing relevant case law, the court found that once the policy was issued after the effective date of the endorsement, the new regulations applied, whether or not the policy actually contained the endorsement. The court held that in this case, the defendant did not need to produce proof that the policy was issued after the endorsement was required, since the parties had stipulated to that fact. Therefore, the 45-day claim submission requirement applied, and the plaintiff's failure to meet this requirement precluded recovery.

The court considered a case regarding a provider seeking to recover no-fault benefits from an insurance company, based on seven causes of action and an eighth cause of action seeking attorney's fees. The provider moved for summary judgment, which was granted by the lower court, but the insurance company cross-moved for summary judgment to dismiss the complaint, which was denied. The main issue decided was whether the provider made a prima facie showing of its entitlement to summary judgment, and whether the insurance company was entitled to summary judgment based on timely verification requests. The holding of the court was that the provider failed to establish a prima facie case for summary judgment, and the insurance company was not entitled to summary judgment based on the timely verification requests. The judgment was reversed, the order granting the provider's motion for summary judgment was vacated, and the provider's motion for summary judgment was denied. The insurance company's cross motion for summary judgment was granted to dismiss the provider's second through seventh causes of action.

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.