No-Fault Case Law

The court considered a case involving an action to recover assigned first-party no-fault benefits. The plaintiff's motion for summary judgment upon six claims submitted to the defendant was granted to the extent of awarding plaintiff summary judgment upon five of the claims totaling $1,146.80. The main issue was whether the defendant had raised any issue with respect to plaintiff's establishment of its prima facie case, and whether the defendant introduced competent evidence establishing that it possessed a founded belief that the alleged injuries did not arise out of an insured incident. The holding was that the judgment was affirmed without costs as the defendant failed to introduce competent evidence to demonstrate that the injuries did not arise from an insured incident. Therefore, the judgment in favor of the plaintiff was affirmed.

The relevant facts considered by the court were that Better Health Medical, PLLC was seeking to vacate the master arbitrator's award which denied their claim for assigned first-party no-fault benefits. The main issue decided by the court was whether there was a rational basis for the determination of the master arbitrator upholding the arbitrator's award. The holding of the court was that upon a review of the record, they found a rational basis for the determination of the master arbitrator, and therefore, the court denied the petition to vacate the master arbitrator's award. However, the court also held that pursuant to CPLR 7511 (e), they were required to confirm the award, and modified the judgment to add a provision confirming the master arbitrator's award. Therefore, the judgment was affirmed without costs.

The main issue in the case was whether the master arbitrator's decision to deny the petitioner's claim for assigned first-party no-fault benefits was based on a rational basis. The court considered the record and found that there was a rational basis for the master arbitrator's decision. Therefore, the court upheld the arbitrator's award and denied the petition to vacate the master arbitrator's award. However, the court also found that pursuant to CPLR 7511 (e), it was required to confirm the award upon denying the petition. Therefore, the judgment was modified to add a provision confirming the master arbitrator's award. The holding of the case was that the master arbitrator's decision to deny the petitioner's claim for assigned first-party no-fault benefits was upheld and the award was confirmed.

The relevant facts the court considered were that S.P. Medical Center had filed a petition to vacate the master arbitrator's award that denied their claims for assigned first-party no-fault benefits from Allstate Insurance Company. The main issue decided by the court was whether there was a rational basis for the determination of the master arbitrator upholding the arbitrator's award. The holding of the court was that upon reviewing the record, they found a rational basis for the determination of the master arbitrator upholding the arbitrator's award, and therefore, the court properly denied the petition to vacate the master arbitrator's award. The court also modified the judgment to add a provision confirming the master arbitrator's award.

The relevant facts the court considered in this case were that Astoria Quality Medical Supply, acting on behalf of certain individuals, was seeking to recover first-party no-fault benefits from Allstate Insurance Company. Astoria Quality Medical Supply moved for summary judgment, which was denied by the lower court. On appeal, the main issue decided was whether Astoria Quality Medical Supply had presented sufficient evidence to establish a prima facie case for summary judgment. The holding of the court was that the affidavit submitted by Astoria's employee was insufficient to establish that the employee had personal knowledge of the company's practices and procedures, and therefore failed to lay a foundation for the admission of the documents annexed to the moving papers. As a result, Astoria Quality Medical Supply failed to make a prima facie showing of its entitlement to summary judgment, and the lower court's order was affirmed.

The court considered an action to recover no-fault medical payments under certain insurance contracts. The main issue was whether the evidence submitted in support of the motion by Mary Immaculate Hospital (the plaintiff) was sufficient to establish that it was entitled to judgment as a matter of law. The defendant, Allstate Insurance Company, appealed from an order of the Supreme Court, Nassau County, which granted the plaintiff's motion for summary judgment on the causes of action to recover no-fault medical payments allegedly due to the Hospital as an assignee of two patients. The court held that the evidence submitted by the Hospital did not establish that the billing representative, or anyone else, mailed the documents related to the claims for treatment rendered to the patients. Therefore, the Hospital failed to establish prima facie that it was entitled to judgment as a matter of law, and the order was reversed, denying the branches of the plaintiff's motion for summary judgment on the causes of action to recover no-fault medical payments.

The main issues in this case were whether an insurance company was obligated to pay for no-fault claims submitted by a medical provider, and whether the medical provider's failure to appear for an examination under oath (EUO) constituted a material breach of the policy. The court held that the insurance company was not obligated to pay the claims because the medical provider did not willfully fail to submit to an EUO, and the insurer failed to show that the provider's failure to appear for the EUO was willful, persistent, or demonstrative of a pattern of noncooperation. Additionally, the court dismissed the complaint as against the medical provider and other defendants for failing to state a cause of action. Ultimately, the court granted the medical provider's motion to dismiss, denied the plaintiff's cross-motion for leave to amend, denied the plaintiff's motion for a default judgment, and dismissed the complaint in its entirety against the remaining defendants.

The case involves a dispute over the payment of no-fault benefits. Plaintiff, Delta Diagnostic Radiology, sought payment from defendant, Chubb Group of Insurance, for services rendered to Lidaine Philogene. Chubb Group of Insurance moved to strike the complaint due to Delta's failure to comply with its discovery demands, and in the alternative, for an order to compel Delta to comply. Delta cross-moved for summary judgment. The court held that Delta was not entitled to summary judgment as the evidence showed that Chubb Group of Insurance timely mailed the denial of claim forms based on its standard office practice, and established a defense of lack of medical necessity. The court also granted Chubb Group of Insurance's motion to compel Delta to respond to its discovery demands within a certain time frame. Therefore, the decision was in favor of Chubb Group of Insurance and against Delta's claim for no-fault benefits.

The relevant facts in this case revolved around V.S. Medical Services, P.C. seeking to recover first-party no-fault benefits from Allstate Insurance Co. The provider's motion for summary judgment was supported by an affirmation from plaintiff's counsel, an affidavit by a corporate officer, and various documents. However, the court denied the motion as the affidavit did not establish that the officer had personal knowledge of the plaintiff's practices and procedures to lay a foundation for the admission of the documents as business records. As a result, the main issue decided was whether the plaintiff had made a prima facie showing of entitlement to summary judgment. The holding of the case was that the plaintiff's motion for summary judgment was properly denied, as they failed to establish their entitlement to it due to the insufficiency of the affidavit.

The court considered the motion for summary judgment made by the plaintiff, a provider seeking to recover first-party no-fault benefits. The motion was supported by an affirmation from plaintiff's counsel, an affidavit by a corporate officer of the plaintiff, and various documents attached. The defendant argued that the affidavit by plaintiff's corporate officer failed to lay a proper foundation for the documents annexed to plaintiff's moving papers, thus plaintiff failed to establish a prima facie case. The court denied plaintiff's motion, finding that there was an issue of fact. The main issue decided was that the affidavit submitted by the plaintiff's corporate officer was insufficient to establish that the officer possessed personal knowledge of the plaintiff's practices and procedures to lay a foundation for the admission of the documents as business records. Therefore, the plaintiff failed to make a prima facie showing of entitlement to summary judgment. The holding was that the order denying plaintiff's motion for summary judgment was affirmed.