No-Fault Case Law

The court considered the plaintiff’s claim to recover no-fault benefits for medical services rendered to the insured, Jose Rodriguez, after a motor vehicle accident, which the defendant insurance company denied coverage for, alleging it was a staged, intentional collision. The main issue was whether the accident was a covered event under no-fault insurance, and the holding was that the defendant failed to meet its burden of proof in rebutting the plaintiff’s prima facie case of providing medical services. The court also emphasized that under the Fair Price decision, the extent to which the medical services billed for were actually rendered was not the ultimate issue for the court to decide, and regretfully awarded judgment to the plaintiff based on the lack of coverage defense raised by the defendant. The court expressed regret in having to make an award in the event there was provider fraud, but was constrained by higher authority.

The relevant facts of the case involved a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company moved to dismiss the complaint based on the pendency of a prior action in Queens County Civil Court for the same cause of action. The court granted the insurance company's motion only to the extent of deeming the prior action in Queens County Civil Court discontinued, and denied the motion seeking the imposition of costs pursuant to part 130 of the Rules of the Chief Administrator. The main issue decided by the court was whether the instant complaint should be dismissed based on the pendency of a prior action for the same cause of action. The court held that both lawsuits were predicated on the same cause of action, and that the prior action had proceeded to discovery, so the court should properly have dismissed the instant complaint. The court also ruled that the branch of the insurance company's motion seeking costs pursuant to a specific rule was properly denied. The holding of the case was that the order was modified to provide for the dismissal of the instant complaint and affirmed without costs.

The relevant facts the court considered were that R.J. Professional Acupuncturist, P.C. filed a petition to vacate a master arbitrator's award that denied its claim for first-party no-fault benefits from Travelers Property Casualty Insurance Company. The insurer opposed the petition, arguing that R.J. failed to provide documentation to support the bills for the services it rendered. The main issue decided was whether the master arbitrator's and arbitrator's awards were irrational and contrary to settled law. The holding of the case was that the court reversed the denial of the petition to vacate the master arbitrator's award, vacated the awards of the master arbitrator and arbitrator, and remitted the matter for a rehearing before a different arbitrator. The court ruled that R.J. was entitled to a new hearing before a different arbitrator, as the previous decisions were contrary to settled law.

The court considered the facts that Metropolitan Radiological Imaging, P.C. sought to vacate a master arbitrator's award which upheld the denial of its claim for assigned first-party no-fault benefits, and the insurer opposed the petition. The main issues decided were whether the master arbitrator's award was irrational and contrary to settled law, and whether Metropolitan failed to make a prima facie showing of the medical necessity of the services rendered. The holding was that the court affirmed the judgment, finding that the master arbitrator's award was irrational and contrary to settled law, and that Metropolitan did make a prima facie showing, thus properly granting the petition and vacating the master arbitrator's award. The dissenting judge expressed concerns about the standard of review and the distinction between compulsory and voluntary arbitration for claimant-providers seeking judicial review of no-fault arbitrator's awards.

The court considered a motion for summary judgment from the defendant to dismiss the complaint on the grounds that the action was premature due to the plaintiff's failure to adequately respond to verification requests. The plaintiff also cross-moved for summary judgment. The court denied both the defendant's motion and the plaintiff's cross motion. The main issues decided were whether the defendant's motion for summary judgment should be granted and whether the appeal should be dismissed. The court held that the defendant's motion for summary judgment was granted upon reargument and the appeal was dismissed as moot due to the order granting the motion for summary judgment.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff was entitled to summary judgment in the case, and whether the defendant's cross motion for summary judgment should have been granted. The holding of the court was that the plaintiff's motion for summary judgment was properly denied because they failed to make a prima facie showing of their entitlement to summary judgment. Additionally, the court held that the defendant's cross motion for summary judgment was properly granted, as the evidence submitted by the defendant established prima facie that there was no medical necessity for the MRIs performed by the plaintiff, and this evidence was unrebutted.

The court considered the motion for summary judgment by the plaintiff and the cross motion for summary judgment by the defendant in an action to recover assigned first-party no-fault benefits. The issue decided was whether the supplies provided by the plaintiff were medically necessary, as the defendant had timely denied the claim on that ground based on a peer review report. The holding of the court was that the defendant established a lack of medical necessity and that the denial of claim form interposing said defense was timely. As a result, the court affirmed the denial of plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. The court did not pass on the issue of plaintiff's establishment of its prima facie case, as the defendant did not raise any issue in that regard.

The relevant facts the court considered in this case were that Eagle Chiropractic and Liberty Neurodiagnostic were seeking to recover first-party no-fault benefits for services rendered. The insurance company, Chubb Indemnity, argued that the claims submitted were beyond the 45-day deadline set forth in the automobile insurance policy's Mandatory Personal Injury Protection Endorsement. The main issue decided in this case was whether the claims submitted were subject to the 45-day deadline in the insurance policy. The holding of the case was that the appellate court reversed the lower court's decision and granted the insurance company's motion for partial summary judgment, stating that the claims were submitted beyond the 45-day deadline and the providers failed to provide admissible evidence demonstrating a reasonable justification for the untimely submission of the claims.

The relevant facts of the case were that Vista Surgical Supplies, Inc. was seeking to recover assigned first-party no-fault benefits from Utica Mutual Insurance Company. The court denied Vista Surgical's motion for summary judgment, finding that Utica Mutual had raised an issue of fact by demonstrating that its time to pay or deny the claim was tolled due to timely verification requests. On appeal, Utica Mutual asserted that the affidavit by Vista Surgical's corporate officer failed to lay a proper foundation for the documents submitted with their motion, and therefore failed to establish a prima facie case. The court agreed that the affidavit was insufficient to establish the officer's personal knowledge of Vista Surgical's practices and procedures, and as a result, Vista Surgical failed to make a prima facie showing of entitlement to summary judgment. The court affirmed the order denying Vista Surgical's motion for summary judgment, albeit on different grounds. In this case, the main issue decided was whether Vista Surgical Supplies, Inc. was entitled to summary judgment in their action to recover assigned first-party no-fault benefits from Utica Mutual Insurance Company. The holding of the case was that Vista Surgical failed to make a prima facie showing of entitlement to summary judgement, as their corporate officer's affidavit did not lay a proper foundation for the documents submitted with their motion. Therefore, the court affirmed the denial of summary judgment in favor of Vista Surgical, based on these grounds.

The main issue in this case was whether the plaintiff, a medical provider, was entitled to recover first-party no-fault benefits. The court considered the affidavit of the plaintiff's corporate officer, who submitted documents to support the motion for summary judgment. The court found that the affidavit failed to establish that the officer had personal knowledge of the plaintiff's practices and procedures, and therefore did not lay a proper foundation for the admission of the documents as business records. As a result, the court held that the plaintiff failed to make a prima facie showing of its entitlement to summary judgment, and reversed the order granting the motion, denying plaintiff's motion for summary judgment.