No-Fault Case Law

The court considered an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the affidavit by plaintiff's corporate officer, submitted in support of plaintiff's motion for summary judgment, laid a proper foundation for the documents annexed to plaintiff's moving papers, and therefore established a prima facie case. The holding was that the affidavit submitted by plaintiff's corporate officer was insufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures, therefore failing to make a prima facie showing of its entitlement to summary judgment. Additionally, the defendant failed to establish that its denial of claim forms were timely, therefore the defendant's cross motion for summary judgment was properly denied.

The court considered a motion to compel depositions by the defendant and a cross motion for summary judgment by the plaintiff. The plaintiff's cross motion for summary judgment was granted, and the defendant's motion to compel depositions was denied. The main issue decided was whether the affidavit and documents submitted by the plaintiff's corporate officer provided a proper foundation for the admission of the documents as business records, and whether the plaintiff established a prima facie case for summary judgment. The holding of the court was that the affidavit submitted by the plaintiff's corporate officer was insufficient to establish personal knowledge of plaintiff's practices and procedures, and therefore plaintiff failed to make a prima facie showing of its entitlement to summary judgment. The judgment was reversed, the order granting plaintiff's cross motion for summary judgment was vacated, and the matter was remanded to the court below for determination of defendant's motion to compel depositions.

The court considered the defendant's motion to vacate a default judgment in an action to recover assigned first-party no-fault benefits. The main issues decided were whether the defendant established a reasonable excuse for the default and a meritorious defense, as required by CPLR 5015(a) in order to vacate the default judgment. The court held that the defendant's conclusory allegations of a meritorious defense were insufficient to warrant vacatur of the default judgment, as the defendant failed to show that its defenses were set forth in timely denial of claim forms. Additionally, the court found that the defendant failed to establish a reasonable excuse for its failure to timely serve its answer, and as a result, the default judgment was reinstated.

The relevant facts in this case involved the assignor of the plaintiff, who was allegedly injured in an automobile accident and assigned the cost of her acupuncture treatment to the plaintiff. The main issue decided by the court was whether the six sessions of acupuncture treatment were medically necessary. The court held that the defendant failed to demonstrate the lack of medical necessity for the treatment and that the opinion of the defendant's expert, standing alone, was insufficient to prove lack of medical necessity. The court granted judgment in favor of the plaintiff.

The main issue decided in this case was whether GEICO's defense and counterclaim of fraud was precluded by the Insurance Law's requirement that no-fault benefits be paid within 30 days. The relevant facts that the court considered included allegations that Dr. Allen Chamberlin, a physician whose license was revoked, fraudulently billed for unnecessary procedures and surgeries, which included falsifying medical records. GEICO argued that the surgeries performed were not injuries sustained in or related to the accident, and plaintiffs contended they were entitled to be paid with interest and attorneys' fees due to GEICO's failure to pay or deny the claims within 30 days. The court ultimately held that GEICO's defense and counterclaim of fraud was not precluded by the 30-day rule, and that the matter should proceed to trial given the circumstances surrounding the alleged fraudulent claims.

The relevant facts that the court considered were that the plaintiff, Prime Psychological Services, P.C., filed a lawsuit to recover unpaid medical services provided to Anthony Montes in the amount of $1,221.04 in no-fault first party benefits. The plaintiff submitted a Notice to Admit and defendant's Responses to the Notice to Admit as evidence, but neither party presented any witnesses or other evidence. The main issue decided was whether the use solely of a Notice to Admit and/or a defendant's responses or lack thereto can establish a prima facie case in a no-fault health care provider case. The holding of the court was that the plaintiff had not established a prima facie case, the defendant's motion for a directed verdict was granted, and the plaintiff's complaint was dismissed. The court also noted an apparent split of authority between different Appellate Terms on whether a prima facie case can be established solely through the use of a Notice to Admit and/or a defendant's responses thereto.

The main issue before the court in this case was whether the defendant insurance company, American Transit Insurance Company, had timely denied three separate no-fault insurance claims for medical services provided to patients involved in automobile accidents. The court considered the evidence presented by the plaintiffs, Westchester Medical Center, The New York Hospital Medical Center of Queens, and Sound Shore Medical Center, as well as the actions taken by the defendant in response to the billing. The court found that the insurance company had failed to timely deny the claim for one of the patients, therefore, granting summary judgment in favor of the plaintiff for the outstanding hospital bill, statutory interest, and attorney's fees. However, the court found that for the other two patients, there were sufficient factual issues that prevented the court from granting summary judgment, and therefore, those matters were scheduled for a conference. The holding of the case was that the insurance company was ordered to pay the outstanding hospital bill for one of the patients, but the matters for the other two patients were placed on the court's calendar for further proceedings.

The court considered the pretrial motion to preclude defendant's denial of claim forms and directed judgment in favor of the plaintiff in the principal sum of $8,715.82 in an action to recover first-party no-fault benefits. The main issue decided was whether defendant's NF-10 forms, which stated that each claim was denied based on an independent consultant's review, sufficiently apprised the plaintiff of the factual basis for the denials, in accordance with 11 NYCRR 65-3.8 (b)(4). The holding of the court was that defendant's NF-10 forms did sufficiently apprise the plaintiff of the factual basis for the denials, and therefore the motion to preclude defendant's NF-10 denial of claim forms should have been denied. The court reversed the order, denied the motion, and remanded the matter for further proceedings.

The relevant facts of this case involved the Plaintiff, Elmont Open MRI & Diagnostic Radiology, seeking to recover no-fault first party benefits in the amount of $879.73 for medical services allegedly provided to its assignor following a motor vehicle accident. The Plaintiff moved for summary judgment, but the Defendant opposed the motion and cross-moved for summary judgment as well. The court considered the submission of admissible evidence and the timely and proper submission of claims in question. The main issues decided were whether the Plaintiff had demonstrated its timely and proper submission of claims and whether the Defendant had timely issued a proper denial of claim form. The court held that the Plaintiff failed to make a proper evidentiary foundation for the introduction of its claim forms and that the Defendant's N-F 10 form was neither timely, proper, nor approved by the Insurance Department. As a result, both the Plaintiff's motion for summary judgment and the Defendant's cross-motion for summary judgment were denied. In summary, the court decided that the Defendant's N-F 10 form was not valid, and the Plaintiff failed to meet its burden for summary judgment. As a result, neither party was granted summary judgment.

The main issue in the case was the proper method of calculating statutory attorney's fees to be awarded to the plaintiff. The defendant argued that the court should aggregate the plaintiff's fifteen cause of action/claims and award attorney's fees as 20% of the aggregate amount of the bills encompassed in the complaint, with a maximum award capped at $850. The plaintiff argued that it is entitled to separate attorney's fees for each bill submitted and overdue, on each of the fifteen separate causes of action. The court relied on Regulation 11 NYCRR §65-4.6 (e) of the Insurance Law, which governs attorney's fees in no-fault actions, and previous case law to determine that the plaintiff is entitled to attorney's fees on a per claim basis for each odd numbered cause of action, at the rate of twenty percent of the amount settled for each claim, with a maximum of $850 per claim. Therefore, the holding of the case was that the plaintiff is entitled to attorney's fees on a per claim basis for each of the fifteen separate causes of action, with a maximum of $850 per claim.