No-Fault Case Law

The relevant facts the court considered include the circumstances surrounding an accident at a construction site which led to a personal injury action. Plaintiff Alcon Builders Group sought a declaration that U.S. Underwriters Insurance Company and National Union Fire Insurance Company of Pittsburgh, PA must defend and indemnify it in the personal injury action. Underwriters moved for summary judgment declaring that it does not have a duty to defend or indemnify Alcon in connection with the personal injury action. The main issue decided was whether Underwriters had a duty to defend or indemnify Alcon in the personal injury action. The holding was that Underwriters had no obligation to defend or indemnify Alcon, and plaintiff's and National Union's cross motions for summary judgment on the Umbrella Policy were denied without prejudice.

The main issue in Westchester Medical Center v Allstate Insurance Company was whether the plaintiff was entitled to summary judgment on the first cause of action to recover no fault benefits on behalf of its assignor. The court considered whether the plaintiff had complied with the defendant's timely and properly sent verification requests seeking information regarding the assignor's toxicology report. The court held that the plaintiff had made a prima facie showing of entitlement to summary judgment, but the defendant raised a triable issue of fact as to whether the plaintiff complied with the verification requests. Therefore, the plaintiff was not entitled to summary judgment on the first cause of action. The order of the Supreme Court granting the plaintiff's motion for summary judgment was reversed and denied on the first cause of action.

The court considered a motion for summary judgment in a case where the plaintiffs were seeking to recover fees for medical treatments provided under the no-fault law to their assignor, Robert Aronov. The defendant opposed the motion, arguing that the claims were denied due to the assignor's failure to appear at an independent medical examination and that some of the claims were late. The main issue decided by the court was whether the plaintiffs had established a prima facie case for summary judgment by showing that the claim forms were timely and properly submitted and that the defendant had either failed to pay or properly deny the claim within the statutory time frame. The court held that the affidavit submitted by the plaintiffs' biller failed to satisfy the business record exception to the hearsay rule and did not lay a sufficient evidentiary foundation for the admission of the documents annexed to the plaintiffs' moving papers. As a result, the plaintiffs failed to establish a prima facie showing of their entitlement to summary judgment and their motion was denied.

The court considered whether the defendant's failure to issue the denial of claim form "in duplicate" was a fatal error, which precluded them from asserting a defense that would result in the granting of summary judgment to the plaintiff. Article 51 of the Insurance Law, commonly known as New York's No-Fault Insurance Law, provides a plan for compensation for motor vehicle accident victims without considering fault or negligence. The court eventually decided that the defendant's failure to issue the denial of claim form in duplicate was not a fatal error that precluded them from asserting a defense, thus not granting summary judgment to the plaintiff.

The relevant facts of this case are that the Plaintiff was seeking to recover no-fault first party benefits for medical services provided to its assignor between February 1, 2002 and April 18, 2002, in the total sum of $200.00 from the Defendant. The Defendant moved for summary judgment, claiming that the accident in question was an intentional fraudulent act and therefore an uncovered event. The Defendant alleged that this issue had already been decided in two prior actions and that the Plaintiff was collaterally estopped from contesting this defense. The court found that the Plaintiff was not in privity with the assignor in the prior proceedings, and therefore, the prior determinations did not bar the Plaintiff from re-litigating the issue of a staged accident in the matter before the court. Additionally, the court found that the Defendant had not provided sufficient evidence to show that the alleged accident was staged as a matter of law and that there were factual issues that needed to be reserved for the trier of facts. Ultimately, the Defendant's motion for summary judgment was denied.

The relevant facts considered by the court include a previous determination that the plaintiff had made out its prima facie case, that defendant's denial was based on a peer review, and that the only triable issue was the medical necessity of the items furnished to the assignor. The defendant insurer based its argument on the testimony of a doctor who stated there was no medical necessity for the supplies. The main issue was whether the testimony of the doctor was admissible, as it relied on medical records that were not introduced into evidence. The court held that the out-of-court material relied upon by the doctor was of a type generally accepted in the profession as reliable, and therefore the defendant presented sufficient evidence to establish a defense based upon lack of medical necessity. As a result, the judgment was rendered in favor of the defendant and plaintiff's complaint was dismissed.

The court considered the facts of a case involving Alur Medical Supply, Inc. seeking to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff was entitled to summary judgment in their favor, or if the defendant was entitled to summary judgment. The court held that the affidavit submitted by the plaintiff's billing manager was insufficient to establish that she possessed personal knowledge of the plaintiff's practices and procedures, so the plaintiff failed to establish a prima facie case. Additionally, the IME report submitted by the defendant did not address the necessity for medical supplies, so the defendant was also not entitled to summary judgment. Ultimately, the judgment in favor of the plaintiff was reversed and the motion for summary judgment was denied.

The court considered whether to grant a petition to vacate a master arbitrator's award which upheld the denial of a claim for reimbursement of first-party no-fault benefits. The main issue was whether the papers submitted by the petitioner were sufficient to warrant granting any relief. The court found that the petition was granted on the basis of insufficient evidence, as the affirmation submitted by the attorney for the petitioner was not in admissible form. The holding of the case was that the amended order to vacate the master arbitrator's award was reversed and the petition to vacate the award was denied due to the insufficient evidence provided by the petitioner.

The court considered the dispute between Vista Surgical Supplies, Inc. and American Protection Insurance Company over assigned first-party no-fault benefits for medical supplies furnished to plaintiff's assignor. After the parties entered into a stipulation which provided that plaintiff would be precluded from presenting evidence at trial as to medical necessity if plaintiff failed to appear for depositions, plaintiff failed to appear, and defendant cross-moved for summary judgment. The court held that defendant's affirmed peer review report established that the supplies furnished by plaintiff were not medically necessary and that plaintiff was precluded from presenting rebuttal evidence as to medical necessity. Plaintiff's corporate officer's affidavit failed to establish that said officer possessed 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. Defendant's cross motion for summary judgment was properly granted since the peer review report submitted by defendant established prima facie that the supplies furnished by plaintiff were not medically necessary.

The court considered whether American Transit Insurance Company was required to pay for medical services rendered to its assignor, Maria Acosta, under the No-Fault Law after she was injured in a car accident. The main issue decided was whether the Workers Compensation Board had primary jurisdiction over determining if Acosta was acting within the scope of her employment at the time of the accident. The court found that the police accident report, which identified the car Acosta was driving as a taxi, constituted admissible evidence. Defendant failed to show potential merit to its claim that Acosta was employed at the time of the accident, so the court denied the motion to dismiss the complaint. Defendant's motion to amend its answer to include an affirmative defense based on the court's lack of jurisdiction was granted, and the court reserved a decision on whether plaintiff had proven its prima facie case until trial.