No-Fault Case Law

The court considered the argument of Eveready Insurance that their request was premature as it was sent before the expiration of the 30-day period for providing the requested verification, which ultimately resulted in granting Infinity Health Product's motion for summary judgment and denying Eveready's cross motion for summary judgment. The main issue decided was that Eveready failed to establish that its time to pay or deny plaintiff's claims was tolled since its follow-up verification request was sent to plaintiff prior to the expiration of the 30-day period within which the verification was to be provided. Infinity Health Products was granted summary judgment and Eveready's defensive argument of excessive fees was precluded by an untimely denial. Eveready further argued that Infinity Health Products was only entitled to recover interest that accrued since the commencement of the action, but the court found that it lacked merit. Ultimately, the court held in favor of Infinity Health Products.

The relevant facts considered by the court were that the plaintiff, Vista Surgical Supplies, Inc., sought to recover no-fault benefits from the defendant, Autoone Insurance Company, on claims for $350 and $766.57. The defendant cross-moved for summary judgment dismissing the complaint, arguing that the plaintiff failed to provide the verification requested. The court found that the letters requesting verification and scheduling independent medical examinations (IMEs) were timely sent, but the plaintiff did not provide the verification requested by the defendant for the $350 claim, so the court granted summary judgment dismissing that claim as premature. However, the court found that the defendant was not entitled to summary judgment dismissing the $766.57 claim because they failed to prove the plaintiff's assignor's failure to appear for the IMEs. The holding of the case was that the plaintiff's claim for $350 was dismissed, but their claim for $766.57 was not dismissed.

The court considered the fact that Midwood Medical Equipment & Supply, Inc. was seeking to recover assigned first-party no-fault benefits from Auto One Insurance Company. The main issue was whether the plaintiff was required to plead and identify its license in its complaint as required by CPLR 3015 (e). The court held that the defendant's contention that the plaintiff was not licensed was purely conclusory and not based on any factual evidence in the record. Furthermore, the court determined that CPLR 3015 (e) is only applicable to actions against a consumer, and in this case, the defendant was an insurance company from which the plaintiff was seeking to recover benefits. Therefore, the court reversed the decision of the lower court and denied the defendant's cross motion for summary judgment.

The court considered a motion by defendant to consolidate an action with 11 other pending actions commenced by the same provider, and for summary judgment dismissing the action. The defendant argued that the provider is ineligible for reimbursement of no-fault benefits because it was a fraudulently incorporated professional service corporation at the time the services were rendered. The court denied the defendant's motion, stating that the actions did not have common questions of law or fact for consolidation. The court also denied the motion for summary judgment, as the defendant failed to present sufficient evidence to show an absence of a triable issue of fact on the matter of the provider's eligibility for reimbursement. Finally, the court also denied the defendant's motion for an order compelling plaintiff to provide discovery, as the defendant failed to submit an affidavit specifying any facts entitling it to pretrial proceedings almost a year after the notice of trial was filed. The main issue decided was whether the defendant was entitled to consolidation of the action and summary judgment dismissing the provider's complaint on the ground of ineligibility for reimbursement of no-fault benefits. The court held that the consolidation was properly denied and that the defendant failed to establish its entitlement to summary judgment or compelling plaintiff to provide discovery.

The court considered a motion for summary judgment by the plaintiff, Freeport Medical, P.C., and a cross-motion for summary judgment by the defendant, Utica National Insurance Company of Texas. The main issue in the case was whether the injuries of the plaintiff's assignor arose out of an insured incident, as the defendant claimed that the underling loss was the result of an intentional act. The court found that the affidavit submitted by the plaintiff established their entitlement to summary judgment, shifting the burden to the defendant to raise a triable issue of fact. The defendant failed to establish their defense of lack of coverage based on the belief that the alleged injury did not arise out of an insured incident. Ultimately, the court affirmed the order without costs, holding that the plaintiff was entitled to summary judgment and the defendant's cross-motion was denied.

The court in this case was presented with a dispute between a medical provider and an insurance company regarding the recovery of no-fault benefits. Defendants moved for summary judgment, claiming that they timely denied the plaintiff's claims, while the plaintiff cross-moved for summary judgment, arguing that the denial was not properly mailed. The court found that defendants failed to establish that they timely denied the claims, as they did not show that the verification requests and denial of claim forms were mailed in accordance with standard office practice and procedure. The court denied defendants' motion for summary judgment and granted plaintiff's cross motion, but was later modified, with the decision being affirmed without costs. The court also noted that an affidavit submitted by plaintiff's counsel's employee was insufficient to establish a proper foundation for the admission of documents annexed to plaintiff's moving papers as business records.

The court considered the fact that plaintiff was seeking to recover assigned first-party no-fault benefits and that the defendant opposed the motion by submitting two peer review reports claiming that the medical services provided were not medically necessary. Plaintiff contended that the peer review reports did not constitute evidence in admissible form since they were not properly affirmed. The main issue decided was whether the peer review report upon which the defendant relied was in admissible form pursuant to CPLR 2106. The holding of the case was that defendant failed to raise a triable issue of fact with respect to the claim at issue, as there was nothing in the record to indicate that the facsimile signature was placed on the report by the doctor who performed the peer review or at his direction. Therefore, the judgment was affirmed.

The relevant facts considered by the court in this case were that the plaintiff sought to recover $958.32 for psychiatric evaluation and testing performed on the assignee relating to injuries sustained in 2003. The main issue decided by the court was whether the services provided by the plaintiff were medically necessary, as the defendant had issued a denial of the claim based on lack of medical necessity. The court held that the burden of proof for the defendant's defense of lack of medical necessity rested with the defendant, and the defendant's expert testimony was deemed sufficient to establish that the services provided deviated from generally accepted medical professional standards. As a result, judgment was rendered for the defendant. The court also stated that the plaintiff had failed to produce any rebuttal evidence to prove the medical necessity for the services rendered.

The court considered the denial of a claim form submitted by the defendant, which plaintiff argued was defective. The main issue decided was whether the denial of claim form was defective, and whether the defendant established its defense of lack of medical necessity. The court held that the denial of claim form was not fatally defective, as it provided specific grounds for denial, and that the defendant had established that the supplies provided by the plaintiff were not medically necessary. Therefore, the court affirmed the lower court's decision to grant the defendant's cross motion for summary judgment.

The court considered the motion for summary judgment brought by the plaintiff in a no-fault benefits case, which was supported by an affirmation from plaintiff's counsel, an employee affidavit, and various documents. The defendant cross-moved for summary judgment on the ground of lack of medical necessity, arguing that the plaintiff's evidence failed to establish a prima facie case. The court denied the plaintiff's motion and granted the defendant's cross motion, finding that the plaintiff had failed to establish its entitlement to summary judgment and that the defendant had established its defense of lack of medical necessity. The appellate court affirmed the lower court's decision, holding that the denial of claim form submitted by the defendant, which included a defense of lack of medical necessity, was not defective and that the defendant's cross motion papers established prima facie that there was no medical necessity for the supplies provided by the plaintiff. As a result, the defendant's cross motion for summary judgment was properly granted.