No-Fault Case Law
AVA Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 51756(U))
September 14, 2007
The court considered the fact that the defendant served various discovery demands to the plaintiff in an action to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff failed to respond to the discovery demands, and if so, whether this warranted the granting of the defendant's motion to strike the complaint. The holding of the court was that the defendant's motion to strike the complaint was granted, as the plaintiff's conduct was shown to be willful and contumacious by its failure to respond to the discovery demands and its failure to submit written opposition to defendant's motion. Therefore, the drastic remedy of dismissing the complaint pursuant to CPLR 3126 was warranted in this case.
AVA Acupuncture, P.C. v GEICO Gen. Ins. Co. (2007 NY Slip Op 27371)
September 14, 2007
The relevant facts in the AVA Acupuncture, P.C. v. GEICO Gen. Ins. Co. case include an action to recover assigned first-party no-fault benefits and the denial of claims submitted by the plaintiff for acupuncture sessions conducted from February 9 through May 12, 2004. The main issue decided in this case is whether the defendant was justified in denying reimbursement for the unpaid balance of the acupuncture sessions based on the grounds that the fees charged exceeded the "maximum allowance under the applicable fee schedule[s]." The holding of the court was that the defendant was justified in denying the plaintiff's claim for the remaining 23 acupuncture sessions based on the workers' compensation fee schedule for acupuncture services performed by chiropractors. Therefore, it was held that the defendant should not be required to pay the entire amount claimed by the plaintiff.
Multiquest, P.L.L.C. v Allstate Ins. Co. (2007 NY Slip Op 51737(U))
September 12, 2007
The court considered the fact that the plaintiff brought the action to recover $1,340.30 in assigned first-party no-fault benefits, and that the defendant moved for summary judgment, which was denied. The main issue decided was whether the denial of the defendant's motion for summary judgment was proper, and the holding of the case was that the order denying the motion should be modified by providing that the motion is denied without prejudice to renewal upon proper papers. The court affirmed the order without costs, and the decision was made on September 12, 2007.
Multiquest, P.L.L.C. v Allstate Ins. Co. (2007 NY Slip Op 51735(U))
September 12, 2007
The court considered the fact that plaintiff brought an action to recover $1,236.99 in assigned first-party no-fault benefits, and defendant moved for summary judgment which was denied for failure to support it with a copy of the pleadings. The main issue decided was whether the defendant's motion for summary judgment should have been denied for failure to support it with a copy of the pleadings. The holding of the case was that, under the circumstances presented, the matter should have been denied without prejudice to renewal upon proper papers, and the motion for summary judgment was denied. The court did not reach the parties' contentions with regard to the merits of the motion.
Multiquest, P.L.L.C. v Allstate Ins. Co. (2007 NY Slip Op 51734(U))
September 12, 2007
The relevant facts considered by the court were that plaintiff brought the action to recover $1,236.99 in assigned first-party no-fault benefits, and defendant moved for summary judgment, which was denied by the court for failure to support it with a copy of the pleadings. The main issue decided by the court was whether the defendant's motion for summary judgment should be denied for failure to support it with a copy of the pleadings, a ground not raised by the plaintiff. The holding of the case was that the order denying defendant's motion for summary judgment should be modified to provide that the motion is denied without prejudice to renewal upon proper papers, and as so modified, the order was affirmed without costs.
Multiquest, P.L.L.C. v Allstate Ins. Co. (2007 NY Slip Op 27366)
September 12, 2007
The court considered the issue on whether Multiquest, P.L.L.C would be eligible to receive reimbursement of no-fault benefits because the plaintiff was fraudulently incorporated, which is based on the defense of "improper incorporation." Defendant cross-moved for summary judgment, arguing that plaintiff was ineligible to receive reimbursement of no-fault benefits because they were fraudulently incorporated based on the State Farm Mut. Auto. Ins. Co. v Mallela (4 NY3d 313 [2005]). The court decided to grant defendant's cross motion for summary judgment as the plaintiff performed psychological services in violation of Limited Liability Company Law §§ 1203 and 1207, and thus was entitled to summary judgment upon defendant's cross motion. The judgment was reversed without costs, the order was vacated, plaintiff's motion for summary judgment denied and defendant's cross motion for summary judgment granted.
Mount Sinai Hosp. v Chubb Group of Ins. Cos. (2007 NY Slip Op 06650)
September 11, 2007
The case involves an action to recover no-fault medical payments. Mount Sinai Hospital, as assignee of Sidney Weingarten, brought a lawsuit against Chubb Group of Insurance Companies for not paying the benefits within the 30-day requirement. The main issue was whether the defendant was required to pay or deny the claim within the 30-day period. The court held that since the plaintiff's action was brought prematurely, approximately two months before the defendant was required to pay or deny the claim, the defendant was entitled to summary judgment dismissing the plaintiff's first cause of action. The court also noted that the defendant's remaining argument regarding a protective order has been rendered academic.
KOI Med. Acupuncture v State Farm Ins. Co. (2007 NY Slip Op 51705(U))
September 10, 2007
The relevant facts considered were that the Plaintiff commenced an action to recover no-fault first-party benefits for medical services provided to its assignor that were not paid, and the Defendant alleged that the claim was denied due to the Plaintiff's assignor's failure to cooperate and that it alleged the accident was staged. The main issue was whether the Plaintiff's motion for summary judgment should be granted, and whether the Defendant's cross-motion for summary judgment should be granted. The holding of the court was that the Plaintiff's motion and the Defendant's motion were both denied for multiple reasons, including failure to tender evidentiary proof in admissible form and failure to lay a proper business records foundation for the documents submitted. Therefore, both motions were denied.
Ave T MPC, Corp. v Progressive Ins. Co. (2007 NY Slip Op 51760(U))
September 5, 2007
The court considered the fact that the plaintiff's assignor, Cheryl Brown, was involved in a motor vehicle accident while driving a vehicle rented from Budget Rent A Car, while having an insurance policy with Progressive Insurance Company which covered another vehicle. The plaintiff submitted claims to Progressive for medical equipment related to the accident, which were denied based on a failure to cooperate with the insurance policy. The main issue was whether the loss was a covered accident, and whether the matter should have been submitted to arbitration for a priority of payment issue. The court held that the burden of explanation or of "going forward with the case" fell upon the defendant to show a lack of coverage and that the defendant failed to introduce a copy of the insurance policy in question, therefore did not meet its burden. Additionally, the court held that the dispute of priority of payments between insurers must be determined and submitted to mandatory arbitration, and since it was not, the complaint was dismissed.
Midisland Med., PLLC v New York Cent. Mut. Ins. Co. (2007 NY Slip Op 51983(U))
September 4, 2007
The relevant facts in this case involved a dispute over first-party no-fault benefits, where the plaintiff sought to recover assigned benefits from the defendant insurance company. The main issue decided was whether the defendant had timely denied the plaintiff's claims based on the failure of the plaintiff's assignor to appear for independent medical examinations. The court held that the defendant failed to establish that the denial of claim forms were timely mailed, and as a result, the plaintiff's motion for summary judgment was granted, and a judgment was entered in favor of the plaintiff. The court did not address the issue of the plaintiff's establishment of its prima facie case, as the defendant failed to raise a triable issue of fact with regard to the claims. The judgment was affirmed on other grounds.