No-Fault Case Law

The main issue decided in this case was whether the defendant, Lancer Insurance Co., timely mailed the examination under oath (EUO) scheduling letters and the denial of claim forms to the plaintiff, JCC Medical, P.C., in a first-party no-fault benefits claim. The court found that defendant established that the EUO scheduling letters were timely mailed to the plaintiff by first class mail, and despite not being mailed by certified mail, return receipt requested, their timeliness was established. Additionally, the testimony of the defendant's no-fault claims examiner was deemed sufficient to establish that the denial of claim forms were also timely mailed to the plaintiff. Based on these findings, the court reversed the judgment and remitted the matter to the Civil Court to enter a judgment in favor of the defendant dismissing the complaint.

The relevant facts considered by the court were that the plaintiff, Wellmax Products Corp, was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co as an assignee of Stephanie Crespo. The main issue decided was whether the verification requested by the defendant remained outstanding. The court held that after a nonjury trial, in which the testimony proffered by the defendant's witness was found to be credible, the Civil Court dismissed the complaint. The Appellate Term, Second Department affirmed the judgment, stating that the determination of a trier of fact as to issues of credibility is given substantial deference, and as the record supported the Civil Court's determination based on the assessment of the credibility of the witness, there was no basis to disturb the finding.

The relevant facts considered by the court in this case were that the plaintiff, Madison Products of USA, Inc., as the assignee of Barnes, Omari, filed a complaint to recover assigned first-party no-fault benefits from the defendant, 21st Century Insurance Company. The main issue decided was whether the defendant's motion for summary judgment to dismiss the complaint and denying the plaintiff's cross motion for summary judgment was appropriate. The holding of the court was that the order granting defendant's motion for summary judgment dismissing the complaint and denying plaintiff's cross motion for summary judgment was affirmed, with $25 costs. The court found that the defendant had established that the examination under oath scheduling letters had been timely mailed, therefore, the order to dismiss the complaint was affirmed.

The court considered the plaintiff's motion to compel discovery and the defendant's cross motion for summary judgment in a case where a provider sought to recover assigned first-party no-fault benefits. The issues decided included the failure of the plaintiff's assignor to appear for duly scheduled independent medical examinations, the claim forms and denial of claim forms being timely mailed, and the submission of a claim that the defendant never received. The holding of the case was that the branches of the defendant's cross-motion seeking summary judgment dismissing claims seeking to recover sums for specific amounts were granted, and the order was modified to reflect this decision. Additionally, the defendant's defense that the fees charged exceeded the amounts set forth in the workers' compensation fee schedule was not conclusively established, and the court ordered the defendant to respond to the plaintiff's discovery demands pertaining to the unpaid portion of a specific claim.

The main issue in the case of BSS Medical, P.C. v Travelers Insurance was whether the defendant's motion to vacate a notice of trial and certificate of readiness should have been granted. In this action to recover assigned first-party no-fault benefits, the defendant argued that discovery was not complete despite the plaintiff's representation that it was. The Civil Court had previously denied the defendant's motion, but the Appellate Term, Second Department reversed that decision. The Appellate Court held that the notice of trial and certificate of readiness should have been vacated, as it was undisputed that the plaintiff had not served responses to the defendant's demand for written interrogatories, despite being served with a demand for the same. Therefore, the Appellate Court granted the defendant's motion to vacate the notice of trial and certificate of readiness. In summary, the court considered the lack of completion of discovery, the defendant's motion to vacate the notice of trial and certificate of readiness, and the plaintiff's failure to serve responses to the defendant's discovery demand. The main issue decided was whether the defendant's motion to vacate should have been granted, and the holding of the case was that the notice of trial and certificate of readiness should have been vacated, and the defendant's motion was granted.

The court considered whether the defendant had sufficiently demonstrated that independent medical examinations (IMEs) were properly scheduled, and whether the plaintiff had established that the claim at issue had not been timely denied. The main issue was whether the defendant's affidavit in support of its cross motion for summary judgment sufficiently set forth a standard office practice or procedure that would ensure that the IMEs were properly addressed and mailed. The holding of the court was that while the defendant failed to demonstrate that the IMEs were properly scheduled, the plaintiff also failed to establish its entitlement to summary judgment. Therefore, the court modified the order to provide that the defendant's cross motion for summary judgment dismissing the complaint was denied, and affirmed the order as modified.

The court considered whether the defendant had received the claim at issue in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had received the claim form, as the affidavit of defendant's personal injury protection unit supervisor established that defendant had never received the claim in question from the plaintiff. However, the affidavit of plaintiff's billing clerk, submitted in opposition to the defendant's motion, was sufficient to give rise to a presumption that the claim form had been mailed to and received by defendant, raising a triable issue of fact. The holding of the case was that the defendant did not demonstrate, as a matter of law, that the address to which the plaintiff mailed the claim form was not the defendant's address, and as a result, the defendant's motion for summary judgment dismissing the complaint was properly denied. Therefore, the order was affirmed.

The main issue in this case was whether the denial of claim forms had been timely mailed, and whether the plaintiff's assignor had failed to appear for duly scheduled examinations under oath (EUOs). The court considered the affidavit submitted by the defendant, which established that the denial of claim forms had been timely mailed in accordance with standard office practices and procedures. Additionally, the affirmation submitted by defendant's attorney was sufficient to establish that the EUO scheduling letters had been timely mailed, and that plaintiff's assignor had failed to appear on the scheduled dates. The court held that the defendant had demonstrated its prima facie entitlement to summary judgment dismissing the complaint, and that the plaintiff had failed to raise a triable issue of fact in opposition to the defendant's motion. As a result, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the plaintiff, Quest Supply, Inc., as assignee of Valerio Marck, was entitled to recover assigned first-party no-fault benefits from the defendant, Praetorian Ins. Co. The court granted the defendant's cross motion for summary judgment, as they had shown that the plaintiff's assignor failed to appear for duly scheduled independent medical examinations (IMEs). The court held that the defendant's proof sufficiently established that the assignor had failed to appear for the scheduled IMEs, and therefore affirmed the order of the Civil Court granting summary judgment dismissing the complaint. The Appellate Term, Second Department, affirmed the order, with each judge concurring. The decision was entered on May 14, 2021.

The court considered an appeal from an order of the Civil Court denying the defendant's motion for summary judgment to dismiss a complaint by a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff's assignor had failed to appear for scheduled examinations under oath, which was the grounds for the defendant's motion for summary judgment. The court ultimately held that the order denying the defendant's motion was reversed, and the defendant's motion for summary judgment dismissing the complaint was granted, citing a previously decided case for the reasons for the decision.