No-Fault Case Law

The relevant facts considered by the court in this case were that the plaintiff, Eastern Medical, P.C., moved to reargue and renew the prior order of the court, which granted the defendant, Allstate Insurance Company, the relief requested. The main issues decided were whether the defendant's motion to strike the notice of trial was supported by the requisite affidavit detailing the need for additional discovery, and whether the consolidation of all pending no-fault cases involving the same parties was proper. The court held that the defendant's motion was justified due to outstanding demands for documents, and that the consolidation of the pending cases was proper for the purpose of entertaining the Mallela defense, which served judicial economy and efficiency. Additionally, the court held that the Appellate Division's recent decision in Fair Price Med. Supply Corp. v Travelers Indem. Co. did not change the prior determination, as a Mallela defense is not waived by the failure to assert it in a denial of claim form, nor is it precluded as a result of an untimely denial. Therefore, upon review, the court adhered to its original determination.

The main issue in this case was whether the defendant, Liberty Mutual Insurance Company, was entitled to summary judgment dismissing the action for no-fault first party benefits on the ground that the medical services were performed by an independent contractor. The court considered the fact that the plaintiff provider submitted the treating physician's affidavit stating that he is the plaintiff's president and sole shareholder, not an independent contractor, and that the box for "Independent Contractor" on the NF-3 claim form had been marked erroneously. The court held that in these circumstances, the record presented issues of fact as to whether the services were performed by the plaintiff through its officer rather than an independent contractor. Therefore, the court affirmed the order of the Civil Court denying the defendant's motion for summary judgment.

The relevant facts considered by the court include the defendant's motion to dismiss the plaintiff's complaint for failure to comply with discovery requests, specifically the demand for a verified bill of particulars and combined demand request. The defendant alleged that the plaintiff's failure to respond to the requests would prejudice them at trial. The main issues decided were whether the plaintiff's response to discovery was proper, whether the defendant was entitled to further discovery, and whether the defendant's request for Mallela type documents was justified. The holding of the court was that the defendant's motion to dismiss and for summary judgment was denied, and the court issued a protective order limiting discovery to specific items. The court also found that the plaintiff did not need to further respond to the verification requests.

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.