No-Fault Case Law

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.

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.