No-Fault Case Law

The relevant facts of the case include that A.M. Medical Services, P.C. sought to recover assigned first-party no-fault benefits from Progressive Casualty Insurance Co. in the Civil Court of the City of New York, Queens County. Progressive Casualty Insurance Co. moved for a protective order striking A.M. Medical Services, P.C.'s notice to admit, and the court granted the motion in its entirety. A.M. Medical Services, P.C. appealed the decision. The main issue in the case was whether it was an improvident exercise of the lower court's discretion to grant Progressive Casualty Insurance Co.'s motion for a protective order striking A.M. Medical Services, P.C.'s notice to admit. The holding of the case was that the court modified the order by providing that Progressive Casualty Insurance Co.'s motion for a protective order was granted only to the extent of striking items 4, 7, and 8 of A.M. Medical Services, P.C.'s notice to admit. The court affirmed the decision without costs and directed Progressive Casualty Insurance Co. to respond to items 1, 2, 3, 5, and 6 of the notice to admit within 20 days.

The case involved an action by a provider to recover assigned first-party no-fault benefits. The defendant had moved for an order compelling examinations before trial of the plaintiff, the plaintiff's assignor, and the plaintiff's assignor's treating physician, while the plaintiff had cross-moved for a protective order. The court granted the defendant's motion to the extent of ordering the plaintiff to produce the assignor's treating physician for an examination before trial and denied the plaintiff's cross-motion for a protective order. The main issue was whether the court had appropriately exercised its discretion in granting the defendant's motion and denying the plaintiff's cross-motion. The holding was that the court had not improvidently exercised its discretion in compelling the plaintiff to produce the assignor's treating physician for an examination before trial and denying the plaintiff's cross-motion for a protective order.

The relevant facts considered by the court were that the plaintiff, Med-Tech Product, Inc., was seeking to recover first-party no-fault benefits from the defendant, Liberty Mutual Ins. Co. The plaintiff submitted a claim form, but the defendant had timely denied the claim on the basis of lack of medical necessity. The main issue decided by the court was whether the plaintiff had established its entitlement to summary judgment, and whether the defendant had shown a triable issue of fact. The holding of the case was that the plaintiff's motion for summary judgment was properly denied, as the defendant had established a sufficient factual basis and medical rationale to demonstrate the existence of an issue of fact as to medical necessity. The order of the Civil Court denying the plaintiff's motion for summary judgment was affirmed without costs.

The court considered the appeal from an order of the District Court of Nassau County, where the order denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issues decided were whether the plaintiff had made a sufficient showing of entitlement to summary judgment and whether the defendant's denial of claim form was timely. The court held that the plaintiff failed to make a prima facie showing of its entitlement to summary judgment because the affidavit submitted by the plaintiff's owner was insufficiently specific. However, the court also held that the defendant's cross motion for summary judgment dismissing the complaint was denied because there was an issue of fact as to whether the defendant's denial of claim form was timely. Therefore, the order was modified to deny the defendant's cross motion for summary judgment dismissing the complaint.

The court considered an action to recover no-fault medical payments, and the plaintiff's motion for summary judgment on the complaint was denied, resulting in the appeal. The main issue decided was whether the plaintiff had established its entitlement to judgment as a matter of law, and whether the defendant had submitted admissible evidence in opposition to the plaintiff's motion. The holding of the case was that the defendant raised a triable issue of fact as to whether it issued a proper denial of claim form, and the excerpts of the insured's medical records submitted by the defendant in opposition to its motion constituted admissible evidence sufficient to raise a triable issue of fact as to whether the defendant was entitled to deny the claim. Therefore, the order was affirmed insofar as appealed from.

The court considered the fact that the plaintiff, a provider, had filed a motion for summary judgment to recover first-party no-fault benefits, but the defendant had timely denied the claim based on a peer review report stating that the services provided were not medically necessary. The main issue decided was whether the denial of the claim form was timely mailed according to the defendant's standard office practice and procedure, and whether the peer review report submitted by the defendant was sufficient to demonstrate an issue of fact with respect to the defense of lack of medical necessity. The holding of the case was that the denial of claim form was found to have been timely mailed, and the peer review report submitted by the defendant was deemed to be enough to show the existence of an issue of fact, so the order denying the plaintiff's motion for summary judgment was affirmed.

The relevant facts considered by the court were that plaintiff, City Wide Social Work and Psychological Services, P.L.L.C., sought to recover assigned first-party no-fault benefits, and defendant, State-Wide Ins. Co., failed to submit opposition to plaintiff's motion for summary judgment, resulting in the entry of a default judgment against defendant. The main issue decided was whether defendant's motion to vacate the default judgment should be granted. The court held that the default judgment should not be vacated, as defendant failed to demonstrate a reasonable excuse for its default and a meritorious defense to the action. The court found that defendant did not show that its proffered defenses were set forth in timely denial of claim forms, as required by Insurance Department Regulations, or that defendant possessed a defense which was not subject to preclusion. Therefore, defendant's motion to vacate the default judgment was denied.

The issue in the case was whether the Supreme Court erred in denying the dismissal of the claims to recover PIP and APIP benefits. Defendant James W. Celotto contended that Supreme Court made an error in denying his cross motion seeking dismissal of the claims. However, the court found that the complaint was never amended and did not contain any such claims. Therefore, it concluded that the court properly denied the cross motion. The Appellate Division, Fourth Department affirmed the order of Supreme Court, holding that there was no error in denying the cross motion for dismissal of the claims. Therefore, the complaint containing the claims to recover PIP and APIP benefits could not be dismissed.

The court considered whether the plaintiff was entitled to summary judgment in a case to recover assigned first-party no-fault benefits. The main issue was whether the services rendered were medically necessary, and the court ultimately held that the plaintiff was entitled to summary judgment. The court found that the plaintiff had established its entitlement to summary judgment by proving the submission of a statutory claim form and that payment of no-fault benefits was overdue. The burden then shifted to the defendant to raise a triable issue of fact, but the peer review reports submitted by the defendant were found to be illegible, and therefore failed to demonstrate the existence of a triable issue of fact as to medical necessity. As a result, the plaintiff's motion for summary judgment was granted.

The relevant facts of the case include that the plaintiff, A.T. Medical, P.C., sought to recover first-party no-fault benefits as an assignee of an individual. The court granted the plaintiff's motion for summary judgment, awarding them $3,458.29. However, the defendant, State Farm Insurance Company, appealed the decision, arguing that an injunction issued by Justice Kenneth Davis barred the plaintiff from commencing suit against them to recover the benefits. The Appellate Term agreed with the defendant, finding that the injunction indeed barred the plaintiff from making the summary judgment motion. As a result, the judgment was reversed, the order granting summary judgment was vacated, and the plaintiff's motion for summary judgment was denied without prejudice. Therefore, the plaintiff's motion for summary judgment was ultimately unsuccessful due to the injunction.