No-Fault Case Law

The main issue in this case was whether the plaintiff was required to provide the defendant with an authorization executed by its assignor in order to obtain discovery of the defendant's no-fault file, and whether the plaintiff was responsible for the costs of reproduction of said file. The court dismissed the appeal from the order, stating that no appeal as of right lies from an order which decides a motion that was not made on notice. The court clarified that a motion is made on notice when a notice of motion or an order to show cause is served, and since no notice of motion or order to show cause was served in this case, the appeal was dismissed. The decision was made by Rudolph, P.J., McCabe and Scheinkman, JJ., and the appeal was dismissed.

The facts of the case involved a dispute between Multiquest, P.L.L.C. and Allstate Insurance Company over the reimbursement of first-party no-fault benefits for psychological services rendered in August and September 1999. The main issue decided was whether Multiquest was eligible to receive reimbursement for these services, as Allstate alleged that Multiquest was fraudulently incorporated. The court held that an Insurance Department Regulation was inapplicable to claims for services rendered prior to April 4, 2002, and in a similar case, it was held that the Regulation should be given retroactive effect. However, Allstate established that Multiquest had performed the psychological services in violation of Limited Liability Company Law, thus making them ineligible for reimbursement of no-fault benefits. The holding of the case was that Multiquest was ineligible to obtain reimbursement of the benefits and Allstate was entitled to summary judgment dismissing the complaint.

The relevant facts considered by the court in the case of Quality Health Products, Inc. v Auto One Insurance Company were that the plaintiff sought to recover first-party no-fault benefits that had been assigned to them. The main issue that was decided was whether the defendant, Auto One Insurance Company, had timely determined the plaintiff's claim for benefits. The holding of the court was that the plaintiff had established a prima facie entitlement to summary judgment, and therefore, the motion for summary judgment was granted. The court also determined that the defendant's denial of the claim was untimely, and as a result, the defendant was precluded from raising fraudulent billing as a defense in the action. The matter was remanded to the lower court for the calculation of statutory interest and an assessment of attorney's fees.

The court considered the defendant's motion to strike the plaintiff's complaint or to compel discovery, specifically seeking the production of plaintiff's certificate of incorporation, answers to written interrogatories, and an examination before trial of plaintiff's owner, Valentina Anikeyeva. Defendant had sent a good-faith letter requesting the discovery, but plaintiff rejected the demands. The court denied defendant's motion, but modified the order to compel plaintiff to produce certain requested information and to allow an examination before trial. Defendant's entitlement to discovery was based on detailed reasons to believe that plaintiff was fraudulently incorporated and ineligible for no-fault benefits. The court held that plaintiff's failure to challenge the discovery demands within the prescribed time obligated them to produce the requested information, except for matters which were palpably improper or privileged. Defendant was entitled to production of plaintiff's certificate of incorporation and certain interrogatory answers to ascertain plaintiff's eligibility for reimbursement of no-fault benefits. The court also found special circumstances that warranted the disclosure of plaintiff's corporate income tax returns. However, the defendant's motion to compel production of Anikeyeva's personal income tax returns was denied at that time, but Justice Golia dissented in part, arguing that the unique circumstances of the case justified the need for such disclosure.

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.