No-Fault Case Law
New York & Presbyt. Hosp. v Selective Ins. Co. of Am. (2007 NY Slip Op 06848)
September 18, 2007
The case involved an action to recover no-fault benefits under an insurance contract. The plaintiff, a hospital, filed a complaint against the defendant insurance company seeking payment for overdue benefits. The defendant appealed from an order granting the plaintiff's motion for summary judgment and from a judgment in favor of the plaintiff. The issue before the court was whether the plaintiff had made a prima facie showing of entitlement to judgment as a matter of law under the statutory billing forms and whether the defendant insurer had raised a triable issue of fact in opposition. The court held that the plaintiff had made a prima facie showing by submitting evidentiary proof that the forms were mailed and payment was not received within 30 days, and that the defendant failed to raise a triable issue of fact in opposition. Therefore, the court affirmed the judgment in favor of the plaintiff.
Lexington Acupuncture, P.C. v State Farm Ins. Co. (2007 NY Slip Op 51758(U))
September 14, 2007
The relevant facts considered by the court were that plaintiff failed to provide adequate discovery responses and failed to amend or supplement incomplete responses. Defendant had moved to strike the complaint on the grounds of plaintiff's inadequate response to discovery demands. The main issue decided by the court was whether defendant's motion to strike plaintiff's complaint should be granted. The court held that plaintiff's conduct was willful and contumacious, as evidenced by its inadequate response to discovery demands, failure to supplement or amend its responses, and failure to offer any response to supplemental interrogatories. Consequently, defendant's motion to strike the complaint was granted.
PDG Psychological, P.C. v State Farm Mut. Ins. Co. (2007 NY Slip Op 51757(U))
September 14, 2007
The main issue in the case was whether the plaintiff, PDG Psychological, P.C., should be compelled to provide responses to the defendant's discovery demands and produce their principal for an examination before trial. The court considered the fact that the defendant had raised concerns about the plaintiff's licensing, which could make them ineligible to receive reimbursement of no-fault benefits. The court denied the plaintiff's motion for summary judgment, as the defendant was unable to set forth sufficient facts to establish their defense due to the plaintiff's failure to comply with discovery demands. The court also determined that the appeal from the part of the order which granted the defendant's cross motion to compel disclosure was dismissed, as it was entered on default and no appeal lies therefrom by the defaulting party. Therefore, the plaintiff was required to provide responses to the defendant's discovery demands and appear for an examination before trial, and the decision of the lower court was affirmed.
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.