No-Fault Case Law

The civil court case of All-Boro Med. Supplies, Inc. v Progressive Northeastern Ins. Co. involved a dispute over the denial of a claim of first-party no-fault benefits in the amount of $442.50 by plaintiff All-Boro Medical Supplies, Inc., as an assignee of Tony Stringer, due to the failure of Mr. Stringer to appear for an examination under oath (EUO) on multiple occasions. The court considered whether the failure to appear for the EUO constituted a valid basis for denial of the claim. The main issue decided by the court was whether the insurer had the right to schedule an EUO of Mr. Stringer before it had received the claim, and whether the defendant was required to adhere to the statutory and regulatory scheme for the processing of no-fault claims. The holding of the court was that the failure to appear for the EUO was not a valid basis for denial of the claim. It was decided that the plaintiff was entitled to judgment as a matter of law in the amount of $442.50, together with interest and attorneys fees pursuant to Insurance Law § 5106 and regulations promulgated thereunder, plus costs and disbursements.

The case involved Westchester Medical Center suing Progressive Casualty Insurance Company to recover no-fault medical payments. The plaintiff alleged that the defendant failed to either pay or deny its claim within 30 days as required by Insurance Law. The defendant argued that the 30-day period in which to pay or deny the claim was not triggered until it received requested medical records and also claimed Forthmuller was driving while intoxicated at the time of the accident. The court found that the plaintiff made a prima facie showing of its entitlement to judgment but the defendant raised a triable issue of fact regarding the timely denial of the claim and Forthmuller's alleged intoxication and its role in the accident. The court modified the lower court order and denied the defendant's cross motion for summary judgment dismissing the first cause of action, affirming the judgment of the Supreme Court.

The case involved a dispute over no-fault medical benefits under an insurance contract after a woman was injured in an accident and treated at a hospital. The insurance company requested information about the woman's blood alcohol level at the time of the accident, but did not receive a response. The insurance company later denied the claim on the grounds that the woman was driving while intoxicated, which prompted the hospital to file a lawsuit to recover the no-fault benefits. The main issue was whether the insurance company was entitled to all available information relating to the woman's condition at the time of the accident, and whether the woman's intoxication was the cause of her accident and injuries. The court held that the insurance company's verification requests were not untimely or improper and that the woman's intoxication was not proven to be the cause of her accident, so the denial of the claim was upheld and the hospital's motion for summary judgment was denied.

The relevant facts in this case include Lenox Hill Radiology and MIA P.C.'s attempt to recover first-party no-fault benefits in the amount of $2,670.39 from Global Liberty Insurance for three MRI studies it allegedly conducted for its assignor, Nila Sokol. The bills were sent to Global Liberty Insurance along with a cover letter from the plaintiff's attorneys, requesting that the insurance company deal directly with the attorneys for all future correspondence. Global Liberty's claims examiner sent verification requests for the bills to plaintiff's attorneys, but received responses that did not address the requests. The insurance company filed a motion for summary judgment, which was granted and the complaint was dismissed, as the court found that the plaintiff failed to respond to valid and proper verification requests, so the claim for no-fault benefits was not overdue and the action was dismissed. The court also found no merit in the plaintiff's claims that additional notifications should have been sent to the plaintiff's attorneys and their client regarding the verification requests.

The court considered the facts surrounding an arbitration award between Progressive Northern Insurance Company and Sentry Insurance A Mutual Company. Progressive sought reimbursement of first-party benefits paid to an insured after an automobile accident with Sentry's insured. They had made a priority-of-payment claim, which was denied. Progressive then commenced a second arbitration proceeding seeking the same reimbursement through a loss-transfer claim. Sentry raised the affirmative defense of res judicata and the arbitrator denied the instant claim on that ground. The holding of the case was that the arbitrator did not exceed its authority, and the decision to bar the instant arbitration was neither arbitrary nor capricious. Therefore, the instant award was not subject to vacatur under CPLR 7511 (b) (1).

The facts of the case involved a medical provider seeking to recover assigned first-party no-fault benefits from an insurance company. This was done through the submission of a no-fault claim form, which was denied by the insurer. The main issue was whether the testimony provided by the president of the medical provider's billing company was sufficient to establish the admissibility of the underlying no-fault claim form, which incorporated information from medical records that were not admitted into evidence and not shown to be admissible under any hearsay exception. The decision of the court was that the plaintiff failed to present the required evidence in admissible form to establish the facts asserted in the no-fault claim form, therefore sustaining the insurer's objection and denying recovery of the benefits.

The main issue in this case was whether the master arbitrator's denial of the petitioner's claim for assigned first-party no-fault benefits was properly reached and supported by the evidence. The court considered the facts that the petitioner had sought to vacate the master arbitrator's award, and that the master arbitrator upheld the original arbitrator's decision that the petitioner was without standing to seek reimbursement of no-fault benefits. The court held that the determination of the master arbitrator had a rational basis and was not arbitrary and capricious, and accordingly the petition to vacate the master arbitrator's award was properly denied. However, the court also held that upon denying the petition, it was required to confirm the award, and that the special proceeding should terminate in a judgment rather than an order. Therefore, the court affirmed the order of the Civil Court of the City of New York, with the modification of adding a provision confirming the master arbitrator's award.

The main issue in this case was whether the plaintiff made a prima facie showing of its entitlement to summary judgment in an action to recover assigned first-party no-fault benefits. The court considered the fact that the plaintiff's motion for summary judgment was supported by an affirmation from the plaintiff's counsel, an unaffirmed affidavit from the plaintiff's office services supervisor, and an unaffirmed, undated letter of medical necessity. The court also considered the defendant's argument that the plaintiff did not establish a proper foundation for the documents annexed to the motion papers. The court decided that the plaintiff failed to make a prima facie showing of its entitlement to summary judgment due to a lack of personal knowledge and failure to annex the claim forms upon which it sought to recover. The holding of the case was that the judgment was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff’s motion for summary judgment was denied.

The relevant facts of this case involve R.J. Professional Acupuncturist, P.C. appealing an order from the Civil Court of the City of New York, Kings County, which denied the petition to vacate a master arbitrator's award. The issue at hand was the denial of petitioner's claims for first-party no-fault benefits. The main holding of the case was that the determination of the master arbitrator upholding the arbitrator's award had a rational basis and was not arbitrary and capricious. The court found that until a specific decision was made, there was no settled appellate law regarding an insurer's reduction of the amount of fees charged by a licensed acupuncturist for acupuncture services rendered. Therefore, the court affirmed the denial of the petition to vacate the master arbitrator's award but modified the order to add a provision confirming the award.

The relevant facts of the case involve an action to recover first-party no-fault benefits for health care services rendered to an assignor. Defendant had moved to compel the appearance for deposition of the plaintiff's treating physician, and the trial court granted the motion to the extent that plaintiff was ordered to provide the treating physician by a specified date. However, the deposition did not occur, and defendant sought to dismiss the complaint for failure to comply with the order. In support of this motion, defendant did not provide the affidavit of a person with personal knowledge of the facts, and the affirmation by defendant's attorney was based on unsubstantiated hearsay and had no probative value. The main issue was whether or not the court properly denied defendant's motion to dismiss the complaint and awarded plaintiff $50 in costs. The holding was that the defendant's motion was properly denied because it was not supported by an affidavit with personal knowledge of the facts. Additionally, the imposition of costs upon the granting or denying of a motion was within the court's discretion and was not an improvident exercise of that discretion. Therefore, the order denying defendant's motion to dismiss the complaint and awarding plaintiff $50 in costs was affirmed.