No-Fault Case Law

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.

The court considered the appeal of Forrest Chen Acupuncture Services, P.C. as assignee of Igor Makler against Allstate Insurance Company, in which Forrest Chen Acupuncture Services sought to recover assigned first-party no-fault benefits. The main issue was whether the defendant's defenses were precluded by a defective denial of claim form. The court held that plaintiff made a prima facie showing for all purposes pursuant to CPLR 3212 (g), and since the defendant did not submit any opposition, plaintiff's motion for summary judgment should have been granted. The holding of the case was that the plaintiff's motion for summary judgment was granted, and the matter was remanded to the court for the calculation of statutory interest and an assessment of attorney's fees.

The Appellate Term, Second Department made a decision on November 20, 2007 in the case of Walter Karpinski Acupuncture, P.C. v Progressive Casualty Insurance Co. The main issue in the case was whether the provider had established a prima facie case to recover assigned first-party no-fault benefits. The court considered the affidavit by the plaintiff's officer, which stated in a conclusory manner that the documents attached to the motion papers were the plaintiff's business records. The court held that the affidavit submitted by the plaintiff's officer was insufficient to establish that the officer possessed personal knowledge of the plaintiff's practices and procedures, so as to lay a foundation for the admission of the documents as business records. As a result, the court affirmed the denial of the plaintiff's motion for summary judgment.

The court considered that a hospital was seeking to recover no-fault insurance benefits for services provided to a patient injured in a motor vehicle accident. The insurance company failed to request verification of the patient's assignment of benefits to the hospital in a timely manner, and the hospital filed a lawsuit against the insurance company for nonpayment. The main issue was whether the insurance company was precluded from contesting the validity of the assignment due to its failure to timely contest any deficiency in the assignment documents. The court held that the insurance company's failure to seek verification of the assignment in a timely manner precluded the carrier from contesting the issue, and thus affirmed the order of the Appellate Division.

The facts of the case involved plaintiff Nicholas Raffellini, who suffered back injuries in a car accident and sought recovery for damages under the supplementary uninsured/underinsured motorist (SUM) endorsement to his State Farm insurance policy. State Farm refused the demand for $75,000 in pain and suffering damages, claiming that he did not sustain a "serious injury" and therefore, his exclusive remedy was the receipt of no-fault benefits. The court considered whether a "serious injury" exclusion in the SUM endorsement was enforceable, and concluded that it is. The court held that the serious injury exclusion, as required by Regulation 35-D, which was promulgated by the Superintendent of Insurance, is consistent with the statutory language and its underlying purposes. Therefore, the order of the Appellate Division was reversed, and plaintiff's motion to strike defendant's fifth affirmative defense was denied. The decision was to reinstate State Farm's serious injury defense and hold the insurer entitled to pursue its serious injury defense.

The court considered the issue of whether the plaintiff was entitled to summary judgment on the complaint seeking no-fault medical payments. The plaintiff demonstrated their entitlement to judgment through billing forms, affidavits from billers, certified mail receipts, and signed return receipt cards which demonstrated that the defendant received the proof of the claims but failed to pay the bills or issue a denial of claim within the 30-day period required by law. The defendant failed to raise a triable issue of fact and did not make a showing of entitlement to judgment as a matter of law. The defendant's submissions were insufficient to establish that a verification request was received by the proper party. Thus, the court held in favor of the plaintiff and awarded them $13,491.40.