No-Fault Case Law

The court considered a motion to vacate a prior disposition of the case, restore it to active status for determination on the merits, and extend the time for the plaintiff to file a note of issue. The underlying action sought payment of medical bills under no-fault coverage from an automobile accident where an infant plaintiff sustained injuries. The main issues decided were whether the defendant's motion to vacate its default and the plaintiff's motion for restoration and extension should be granted, and whether the plaintiff had met the prerequisites for the relief sought. The court held that the defendant's motion to vacate its default should have been granted, as it established that the default was not willful and demonstrated a meritorious defense. The court also held that the plaintiff did not meet the prerequisites for the relief sought, and therefore denied the motion in all respects.

The court considered the fact that the petitioner sought reimbursement of $10,300.80 for no-fault benefits paid to three claimants in compulsory arbitration proceedings. The respondent did not seek to vacate or modify the awards, but opposed the petition to confirm the awards. The main issue decided was whether the arbitration awards were supported by the evidence and if the respondent had the right to make arguments for vacating the arbitration awards in opposition to a petition to confirm the awards, even though the statutory 90-day period in which to seek vacatur of the arbitration awards had expired. The holding of the case was that the arbitration awards were supported by the evidence, and therefore the judgment to affirm the awards was upheld.

The main issue in this case was whether the affidavit submitted by the plaintiff's employee laid a proper foundation for the admission of documents annexed to the plaintiff's motion for summary judgment. The court considered whether the employee possessed personal knowledge of the plaintiff's practices and procedures in order to establish a prima facie case. The court ultimately held that the affidavit submitted was insufficient to establish the employee's personal knowledge, and therefore, plaintiff failed to make a prima facie showing of entitlement to summary judgment. As a result, the judgment was reversed, the order granting the plaintiff's motion for summary judgment was vacated, and the plaintiff's motion for summary judgment was denied.

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.