No-Fault Case Law

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.

The court considered the evidence presented by both the plaintiff and the defendant in a case involving the recovery of first-party no-fault benefits. The main issue decided was whether the defendant provided sufficient evidence in support of its cross motion for summary judgment to dismiss the plaintiff's complaint on the grounds that the injuries sustained did not arise from an insured incident. The court held that while the defendant demonstrated a "founded belief" that the injuries did not arise from an insured incident, they failed to submit enough evidence in admissible form to establish this as a matter of law. Therefore, neither the plaintiff nor the defendant were entitled to summary judgment, and the judgment was reversed, with the plaintiff's motion for summary judgment denied.

The relevant facts the court considered were that Mani Medical, P.C. sought to recover first-party no-fault benefits which were allegedly overdue from NY Central Mutual Insurance Company. Mani Medical, P.C. moved for summary judgment but was denied. The main issue decided was whether there was a triable issue of fact regarding the causation of the injuries. The holding of the court was that while Mani Medical, P.C. had established a prima facie entitlement to summary judgment, NY Central Mutual Insurance Company had raised a triable issue of fact. Therefore, the lower court's decision to deny plaintiff's motion for summary judgment was affirmed.

The court considered the medical records and testimony of the treating physician and the defendant's expert witness, Dr. Joseph C. Cole, to determine whether an electromyography (EMG) and nerve conduction velocity (NCV) test were medically necessary. The main issue decided was whether the EMG/NCV conducted on October 5, 2006, following an automobile accident, was necessary. The court held that the defendant failed to demonstrate the lack of medical necessity for the treatment in question. The court emphasized that the defendant's expert witness's testimony did not provide a factual basis and medical rationale for the lack of medical necessity and that the plaintiff's treating physician initially recommended conservative management and only ordered the test after the patient's condition did not improve over a span of over a month. Therefore, the court ruled in favor of the plaintiff.

The case involved a dispute between Impulse Chiropractic, P.C. and New York Central Mutual Fire Insurance Company. Plaintiff's motion for summary judgment was granted in an action to recover first-party no-fault benefits. The issue on appeal was whether there was enough evidence to raise a triable issue of fact about whether the injuries sustained by the plaintiff's assignor arose from an insured incident. Defendant submitted an accident analysis report and an affidavit of a technical consultant to demonstrate this, but the affidavit did not comply with CPLR 2309 (c) because it was not accompanied by a certificate of conformity. Therefore, defendant failed to introduce competent evidence in admissible form to establish that there was a founded belief that the injuries did not arise out of an insured incident. The court held that plaintiff's motion for summary judgment was properly granted and affirmed the judgment. The constitutional challenge to CPLR 2309 (c) was unpreserved for appellate review, and defendant failed to give the requisite statutory notice to the Attorney General.

The case involved an action by a health care provider to recover no-fault benefits from an insurance company for medical treatment provided to two individuals involved in automobile accidents. The insurance company, Progressive Casualty Insurance Company, cross-moved for summary judgment denying one of the claims and granting it for the other. The court decided to grant the cross-motion for summary judgment as to the claim for medical treatment of Gary Donecker but was denied as to the claim for treatment of Ernest Cretara. The main issues the court considered were whether the insurance company, Progressive, had received sufficient verification for both claims, whether Cretara was operating a motor vehicle while intoxicated, and whether Donecker's injuries were related to a motor vehicle accident. Progressive sent various verification request forms and letters requesting documents and information related to the accidents and injuries. However, they had not received all the necessary information to verify the claims. The holding of the court was that due to insufficient verification and the lack of available information concerning Cretara's condition and Donecker's injuries, the insurance company was not required to pay or deny the claims. The court denied the motion for summary judgment as to Cretara's claim but granted it for Donecker's claim, dismissing the no-fault claim for his treatment.

The court considered an action by two medical providers to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance company proffered sufficient evidence to demonstrate that there was an issue of fact as to whether the injuries sustained by the providers' assignor arose from an insured incident. The court found that the insurance company failed to provide enough evidence to show that it possessed a "founded belief that the alleged injuries did not arise out of an insured incident". Therefore, the court granted the providers' motion for summary judgment and remanded the case for a calculation of statutory interest and an assessment of attorney's fees pursuant to Insurance Law § 5106 (a). The holding of the case was in favor of the medical providers, granting their motion for summary judgment and remanding for further proceedings.

The main issue in the case was whether the plaintiff, Colonia Medical, P.C., had made a prima facie showing of its entitlement to summary judgment in a case to recover assigned first-party no-fault benefits. The court considered the affidavit from the plaintiff's corporate officer, which stated that the documents annexed to the motion papers were plaintiff's business records. The court found that this affidavit was insufficient to establish that the officer possessed personal knowledge of the plaintiff's practices and procedures, and therefore, the plaintiff failed to make a prima facie showing of its entitlement to summary judgment. The main decision of the court was to reverse the judgment, vacate the order granting plaintiff's motion for summary judgment, deny plaintiff's motion for summary judgment, and remand the matter to the lower court for determination of the defendant's cross motion to compel depositions.