No-Fault Case Law

The court considered a case in which plaintiff Friendly Physician, P.C. sought summary judgment to recover assigned first-party no-fault benefits, and defendant Progressive Insurance Company cross-moved to compel discovery. The main issue was whether the plaintiff had demonstrated that the no-fault claim forms underlying the action were admissible as business records within the meaning of CPLR 4518[a], in order to establish their entitlement to summary judgment. The court held that the plaintiff did not meet its burden to demonstrate the admissibility of the claim forms, as the affidavit submitted was insufficient and lacked details as to how the claim forms were generated. Therefore, the court denied plaintiff's motion for summary judgment and granted defendant's cross-motion to compel discovery, directing the plaintiff to serve answers to defendant's interrogatories within 45 days.

The main issue before the court was whether the defendant, State Farm Mutual Insurance Company, had provided enough evidence to demonstrate that there was an issue of fact as to whether the injuries claimed by the plaintiff's assignor were related to an insured incident. The court found that State Farm had submitted an affidavit from its investigator that was sufficient to demonstrate a "founded belief" that the alleged injuries did not arise from an insured incident. However, the court also noted that the defendant's submission consisted of hearsay and speculative assertions and did not satisfy its burden of demonstrating the existence of a triable issue of fact. Therefore, the judgment in favor of the plaintiff was reversed, and the matter was remanded for further proceedings. The court also noted that absent a timely and valid denial, the defendant was precluded from raising most defenses to a cause of action for payment of the claim.

The relevant facts considered by the court were that the plaintiff, Kings Highway Diagnostic Imaging, P.C., sought recovery of first party no-fault benefits from the defendant, Autoone Insurance Company, for medical services rendered to its assignors. The main issue decided by the court was whether the magnetic resonance imaging (MRI) tests of the plaintiff's assignor's cervical and lumbar spine were medically necessary. The court held in favor of the plaintiff in the amount of $1,791.00, as it found that the defendant's medical evidence demonstrated that the services were not medically necessary, but the plaintiff sufficiently rebutted the defendant's medical testimony and demonstrated the medical necessity of its claims. Therefore, judgment was entered in favor of the plaintiff with statutory interest, costs, and attorney fees.

The court considered an appeal from an order and judgment in favor of New York & Presbyterian Hospital in a case to recover no-fault benefits issued by American Transit Insurance Company. The main issue was whether the plaintiff was entitled to summary judgment in its favor. The holding of the case was that the Supreme Court should not have granted the plaintiff's motion for summary judgment, as the defendant raised a triable issue of fact as to whether the benefits were overdue. The defendant provided evidence that the plaintiff's claim for benefits was denied on the ground that the forms were submitted more than 45 days after the last date of medical service. Therefore, the motion for summary judgment was denied.

The main issue in this case was whether Plaintiff was collaterally estopped from enforcing a Default Judgment awarding No-Fault insurance benefits, based on a previous Declaratory Judgment from the Supreme Court. The court considered the fact that Plaintiff was not named in the Declaratory Judgment nor notified of its pendency, and had no opportunity to contest the determination. The court also analyzed the grounds for vacating a default judgment, as provided by Section 5015 of the CPLR, and took into consideration previous case law where judgments were vacated in the interests of justice. Ultimately, the court held that the entry of judgment was a nullity and vacated the default judgment, as questions of fact existed. In simpler terms, the court decided that Plaintiff could not be collaterally estopped from enforcing the No-Fault award, as Plaintiff was not a party to the previous Supreme Court action and had no opportunity to defend against the assertions. Additionally, the court vacated the default judgment because the Declaratory Judgment, along with the arguments presented by Defendant, raised questions of fact that precluded summary judgment. The court emphasized the importance of deciding issues after a full hearing on the merits, rather than by default, and exercised its discretion in vacating the judgment in the interests of efficient administration of justice.

The court considered the facts surrounding a motion for summary judgment in a case where Impulse Chiropractic, P.C. sought to recover assigned first-party no-fault benefits from Countrywide Insurance. The supporting evidence for the motion included an affirmation from plaintiff's counsel, an affidavit from an officer of the plaintiff, and various documents. The main issue decided was whether the affidavit from plaintiff's officer demonstrated personal knowledge of the facts and procedures, thereby establishing a prima facie case for summary judgment. The holding of the court was that the affidavit submitted by plaintiff's officer was insufficient to establish personal knowledge, and therefore plaintiff failed to make a prima facie showing of entitlement to summary judgment. The denial of plaintiff's motion for summary judgment was affirmed based on these grounds.

The court considered the appeal of a judgment entered in favor of V.S. Medical Services, P.C., as assignee of Clara Crespo, against Farm Family Insurance. The main issue in the case was whether the affidavit submitted by V.S. Medical Services' corporate officer laid a proper foundation for the admission of documents annexed to the moving papers, in order to establish a prima facie case for summary judgment. The court held that the affidavit submitted was insufficient to show that the officer had personal knowledge of the company's practices and procedures, and therefore, failed to establish a prima facie case for summary judgment. As a result, the judgment in favor of V.S. Medical Services was reversed, and their motion for summary judgment was denied. The court did not address any other issues in light of this decision.

The case involved an appeal from a judgment of the Civil Court of the City of New York, Kings County, which denied the petition to vacate the master arbitrator's award. The main issue in the case was whether there was a rational basis for the determination of the master arbitrator upholding the arbitrator's award which denied petitioner's claim for assigned first-party no-fault benefits. The court found that there was a rational basis for the master arbitrator's determination and therefore the petition to vacate the award was properly denied. However, the court modified the judgment by adding a provision confirming the master arbitrator's award, and affirmed the judgment. The holding of the case was that there was a rational basis for the master arbitrator's determination and the petition to vacate the award was properly denied.

The relevant facts considered in this case were that Bedford Park Medical Practice, P.C. was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Insurance Company. The main issue decided was whether State Farm Mutual Insurance Company provided sufficient evidence to demonstrate that there was an issue of fact as to whether the injuries sustained by Bedford Park Medical Practice's assignor arose from an insured incident. The holding of the case was that State Farm Mutual Insurance Company demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage, and therefore, Bedford Park Medical Practice was not entitled to summary judgment. The judgment in favor of Bedford Park Medical Practice was reversed, and their motion for summary judgment was denied.

The court considered the fact that the plaintiff, Delta Diagnostic Radiology, P.C., was seeking to recover assigned first-party no-fault benefits from the defendant, Farmers New Century Insurance Co. The main issue decided was whether the defendant's prior election to arbitrate a related no-fault matter arising from the same accident precluded the plaintiff's action. The court held that the defendant failed to establish that the instant action was barred, as they did not offer evidence to support their contention that there was a prior election to arbitrate a claim for no-fault benefits. Additionally, the court found that the defendant failed to establish that the denials of the plaintiff's claims were timely mailed, resulting in the defendant being precluded from raising most defenses, including lack of medical necessity and excessive fees. Therefore, the judgment in favor of the plaintiff was affirmed.