No-Fault Case Law

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.

The court considered a motion for summary judgment by the defendant to dismiss the complaint or, in the alternative, for an order compelling plaintiffs to respond to its discovery demands on Mallella issues. The plaintiffs sought to recover first-party No-Fault benefits for medical services allegedly rendered to their assignor following an automobile accident. The defendant contended that the incident was an intentionally caused loss and sought summary judgment dismissing the complaint. The court denied the defendant's motion for summary judgment, stating that cases where summary judgment could be granted to the defendant based upon a lack of coverage/staged accident defense supported by an investigator's affidavit were unavailable. The court also granted the defendant's motion to compel discovery, ordering the deposition of one of the plaintiffs' physicians, but did not find a basis to order any other depositions at that time.

The main issue in this case was whether the defendant demonstrated proper proof of mailing of denial of claim forms within the required time frame. The plaintiff had commenced the action to recover no-fault first party benefits for health care services provided to its assignor following a car accident. The defendant moved for summary judgment, claiming that the chiropractic and acupuncture services provided were not medically necessary based on a physical examination. The court held that the defendant failed to establish proper proof of mailing of the denial of claim forms within thirty days of receipt, as required by law, and therefore denied the motion for summary judgment. The court found that the defendant's affidavit did not demonstrate personal knowledge of the actual mailing, and the defendant's standard office practice and procedure did not ensure that items were properly addressed and mailed.

The court considered a provider's attempt to recover assigned first-party no-fault benefits and denied the plaintiff's motion for summary judgment, finding it premature. The court also denied the defendant's cross motion for summary judgment. However, subsequent to the court's decision, the Civil Court dismissed the action, rendering the appeal academic. As a result, the plaintiff's appeal was dismissed. The main issue decided was whether the denial of the plaintiff's motion for summary judgment was premature, and the holding was that the appeal was dismissed as academic due to the subsequent dismissal of the action.

The court considered the determination of the master arbitrator upholding the arbitrator's award, which denied the petitioner's claim for assigned first-party no-fault benefits. The main issue decided was whether the master arbitrator's decision had a rational basis and was not arbitrary and capricious. The holding of the case was that the court affirmed the order without costs, stating that upon a review of the record, they found that the master arbitrator's determination had a rational basis and was not arbitrary and capricious. Therefore, the court properly denied the petition to vacate the master arbitrator's award and granted the cross petition to confirm the award.