No-Fault Case Law

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.

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.

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.

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.