No-Fault Case Law

The court considered the fact that Nagle Medical Plaza, P.C. was seeking to recover first-party no-fault benefits, and that the defendant, Allstate Insurance Company, denied the claim on the grounds that the plaintiff was a fraudulently incorporated professional service corporation. The main issues decided were whether the plaintiff had established a prima facie case for summary judgment and whether the defendant's cross motion for summary judgment should be granted. The holding of the case was that the court reversed the judgment, vacated the order granting plaintiff's motion for summary judgment, denied plaintiff's motion for summary judgment, and remanded the matter to the court for further proceedings. The court found that the affidavit submitted by the plaintiff's president did not establish a proper foundation for the admission of the documents annexed to the moving papers, and that the defendant's argument regarding the plaintiff's eligibility for reimbursement of no-fault benefits was not supported by the evidence.

The relevant facts the court considered in this case involved a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the affidavit submitted by the plaintiff's corporate officer laid a proper foundation for the admission of documents annexed to the plaintiff's moving papers, and whether the insurance company demonstrated that it timely mailed the denial of claim forms and that there was no medical necessity for the equipment provided by the plaintiff. The holding of the court was that the affidavit submitted by the plaintiff's corporate officer was insufficient to establish a foundation for the admission of the documents, and that the insurance company demonstrated that it timely mailed the denial of claim forms and provided prima facie evidence of no medical necessity for the equipment. As a result, the court reversed the order, denied the plaintiff's motion for summary judgment, and granted the defendant's cross-motion for summary judgment dismissing the complaint.

The court considered the case of Mary Immaculate Hospital Caritas Health Care, which provided first-party no-fault benefits to persons covered by policies of insurance issued by the defendant, Government Employees Insurance Company. The main issue decided was whether the defendant had a valid defense for not paying the claim within the required 30-day period and whether the treatment provided by the plaintiff was the result of an intentional act. The court held that the defendant failed to demonstrate the existence of triable issues of fact and had not come forward with competent evidence to support its contention, thus granting summary judgment in favor of the plaintiff for legal fees and interest on the Second Cause of Action and in favor of the plaintiff on the Third Cause of Action.

The court considered the testimony and evidence presented at trial, where the plaintiff sought recovery of first party no-fault benefits for medical services rendered in connection with injuries sustained from an automobile accident. The main issue was whether EMG and NCV studies of the upper extremities were medically necessary, as the defendant insurance carrier denied payment for these services. The court found that the burden was on the defendant to establish lack of medical necessity, and both medical experts presented by the defendant testified that the tests were not medically necessary based on the information in the patient's medical records. The court concluded that the defendant had met its burden of proof, and since the plaintiff failed to produce any witnesses at trial to rebut the defendant's evidence, the plaintiff's complaint was dismissed. Therefore, the holding of the case was that the defendant insurance carrier was not obligated to pay for the services rendered, as the plaintiff did not meet its burden to establish medical necessity.

The relevant facts of the case were that the plaintiff, a medical provider, sought reimbursement for services rendered to an assignor who was injured in an automobile accident. The defendant insurance company denied the claim, stating that the assignor was a taxicab driver who was injured while driving and therefore may be eligible for Worker's Compensation benefits. The main issue decided by the court was whether the defendant had submitted sufficient evidence to show that the assignor was employed at the time of the accident. The court held that the information contained in the NF-2 form, which stated that the assignor was employed at the time of the accident, and the police accident report stating that the vehicle involved was a taxicab, were sufficient for the defendant to meet its burden. As a result, the court granted the defendant's motion for summary judgment, dismissing the complaint without prejudice, and denied the plaintiff's cross-motion for summary judgment as moot.

The relevant facts in this case involved a medical supply company seeking to recover no-fault benefits from an insurance company. The insurance company denied the claim for certain medical supplies, stating that they were not medically necessary. The main issue considered by the court was whether the medical supply company had proven its entitlement to recover the benefits and whether the insurance company's denial was valid. The decision of the court was to reverse the judgment, vacate the order granting the medical supply company's motion for summary judgment, and grant the insurance company's cross motion for summary judgment to dismiss the second cause of action. The court found that the medical supply company had not provided sufficient evidence to rebut the insurance company's denial of the claim for certain supplies, which was based on a peer review that found the supplies were not medically necessary. The court remanded the case for the calculation of interest and attorney's fees on the remaining sum awarded to the medical supply company.

In this case, Infinity Health Products, Ltd. sought to recover assigned first-party no-fault benefits from Progressive Insurance Company. The lower court granted Infinity's motion for summary judgment and denied Progressive's cross motion for summary judgment, resulting in a judgment in favor of Infinity. The main issue on appeal was whether Infinity had established a prima facie case to be entitled to summary judgment. The court found that the affidavit submitted by Infinity's billing manager did not lay a proper foundation for the admission of the documents annexed to Infinity's moving papers, and therefore, Infinity failed to make a prima facie showing of its entitlement to summary judgment. Additionally, the court found that Progressive's cross motion for summary judgment was properly denied. As a result, the court reversed the judgment, vacated the order granting Infinity's motion for summary judgment, denied Infinity's motion for summary judgment, and remanded the matter to the lower court for further proceedings. Therefore, the holding of the case was in favor of Progressive, and the judgment in favor of Infinity was reversed.

The main fact considered by the court was the motion for summary judgment by the plaintiff, East Coast Acupuncture, P.C., to recover assigned first-party no-fault benefits. The court also considered the submission of NF-3 forms regarding specific claims. The main issue decided by the court was whether the plaintiff was entitled to recover direct payment of assigned no-fault benefits from the insurer, and whether the insurer's defense raised a triable issue of fact. The holding of the court was that the judgment granting plaintiff's motion for summary judgment was reversed, and the matter was remanded to the court below for further proceedings on the remaining claims. The court also granted the plaintiff partial summary judgment on one claim and ordered a calculation of statutory interest and attorney's fees on that claim.

The relevant facts in the case were that Lenox Hill Radiology MIA, P.C. was seeking first-party no-fault benefits under an automobile insurance policy from American Transit Insurance Company. Defendant claimed that the lawsuit was premature because the plaintiff did not comply with demands for verification and proof of claim had not been submitted to the carrier. Plaintiff had commenced the action in April 2007, alleging that the insurer had not paid or denied its claim within the allotted 30 days and was seeking the amount of the claim, as well as interest and attorney's fees. The main issue decided by the court was whether the insurer was entitled to receive verification of a claim even if the request for verification was untimely, and whether the case for breach of contract was premature because the plaintiff did not comply with verification demands. The court held that the time frames specified in the statute should not be rendered meaningless, and declined to adopt the interpretation of the regulations proposed by the defendant, ruling that an insurer must, within 30 calendar days of receiving the initial proof of claim, either pay the claim, deny the claim, or make a timely request for verification. Therefore, the plaintiff's cross motion for summary judgment was granted, and the defendant's motion for summary judgment was denied.

The court considered the facts of an automobile accident on April 30, 2005, in which the plaintiff filed a claim for no-fault insurance benefits with the defendant, Encompass Insurance Company. The defendant denied the plaintiff's claim, citing a regulation requiring the claim to be filed within 30 days of the accident. However, the plaintiff's claim was filed 32 days after the accident, with justification for the two-day delay due to a backlog of work. The main issue decided by the court was whether the plaintiff's claim for no-fault insurance benefits was reasonable under the circumstances, and whether the defendant's notice fulfilled the regulatory mandate. The court held that the plaintiff's claim and excuse for the brief delay in filing the claim were not unreasonable. Additionally, the court found that the defendant's notice failed to fulfill its regulatory mandate, and therefore denied the defendant's motion for summary judgment.