No-Fault Case Law
Boai Zhong Yi Acupuncture Servs., P.C. v Allstate Ins. Co. (2007 NY Slip Op 51601(U))
August 16, 2007
The court considered the evidence presented by the plaintiff in support of their motion for summary judgment, which included an affirmation from plaintiff's counsel, an affidavit by a corporate officer of the plaintiff, and various documents. The main issue decided in the case was whether the affidavit executed by the plaintiff's corporate officer was legally sufficient to establish the officer's personal knowledge of the plaintiff's practices and procedures to lay a foundation for the admission of the documents as business records. The court held that the affidavit was insufficient to establish personal knowledge, and therefore, the plaintiff failed to make a prima facie showing of its entitlement to summary judgment. As a result, the court affirmed the order denying plaintiff's motion for summary judgment.
Prestige Med. & Surgical Supply, Inc. v Clarendon Natl. Ins. Co. (2007 NY Slip Op 27344)
August 16, 2007
This case involves a dispute over first-party no-fault benefits. The plaintiff, the medical supplier, moved for summary judgment based on the argument that the defendant insurance company failed to provide claim forms in a timely manner. Defendant's opposing papers did not present proof to establish that the denial of claim forms were timely mailed to plaintiff. The court held that the defendant's failure to establish timely mailing precluded them from raising the defense of lack of medical necessity. Thus, the court reversed the trial court's order and granted plaintiff's summary judgment. It also remanded the matter back to the trial court for a calculation of statutory interest and attorney's fees.
Union Physician Health Care, P.C. v American Mfrs. Mut. Ins. Co. (2007 NY Slip Op 51505(U))
July 24, 2007
The main issue in this case was whether the plaintiff, a healthcare provider seeking to recover first-party no-fault benefits, was entitled to summary judgment. The defendant had timely denied the claims, and the court ruled that the affidavit submitted by the plaintiff's corporate officer did not lay a proper foundation for the documents annexed to the moving papers. As a result, the plaintiff failed to make a prima facie case for entitlement to summary judgment. The court affirmed the lower court's denial of the motion for summary judgment, and the parties' remaining contentions were not addressed. Therefore, the holding of the case was that the plaintiff's motion for summary judgment was properly denied.
St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co. (2007 NY Slip Op 06227)
July 24, 2007
St. Vincent's Hospital & Medical Center sought to recover no-fault medical payments from AllState Insurance Company. AllState appealed an order by the Supreme Court, Nassau County, which denied its motion to vacate a clerk's judgment entered upon its failure to appear or answer, and for leave to serve a late answer. The defendant claimed a reasonable excuse for its delay in appearing, and a potentially meritorious defense, and the Appellate Division concluded that the Supreme Court had improvidently exercised its discretion in denying the motion. The Appellate Division reversed the order, allowing the defendant's motion, vacating the clerk's judgment, and deeming the answer served on the plaintiff. The Supreme Court's decision was reversed and the defendant's motion to vacate the judgment and serve a late answer was granted.
St. Vincent’s Hosp. & Med. Ctr. v Nationwide Mut. Ins. Co. (2007 NY Slip Op 06226)
July 24, 2007
The case involved St. Vincent's Hospital and Medical Center seeking to recover no-fault benefits for medical services provided to an individual that was injured in a car accident. St. Vincent's motioned for summary judgment in order to recover a specific sum from the insurance company, arguing that the company did not provide a timely denial of claim form as required by law. In opposition to St. Vincent's claim, the insurance company submitted evidence of a denial form that had been mailed. St. Vincent's sued for the lack of information included in the denial form. The court found in favor of the insurance company, ruling that they did issue a timely denial of the claim, allowed by law, which led to a triable issue of fact. St. Vincent's argument that the denial was inadequate was not considered by the court because it was raised for the first time in its reply papers.
Omega Diagnostic Imaging, P.C. v State Farm Mut. Ins. Co. (2007 NY Slip Op 51405(U))
July 20, 2007
The main issue in this case was whether a stipulation of settlement in a judicial action, on the advice of counsel, is subject to the same rules as an ordinary contract. In this case, the court found that it was not. The court declared that a stipulation of settlement such as the one at bar is merely a variant of a judgment on consent. The defendant consents to entry of judgment for the full amount of the complaint, subject to a condition subsequent that payment of a reduced sum within a time certain will satisfy the obligation. The holding of the case was that the entry of judgment for the full amount of the complaint did not constitute an unconscionable penalty for a few days' delay, and Plaintiff's remedy was not limited to a few days of statutory interest on the settlement amount. Therefore, the motion was denied and there was no stay in effect against enforcement of the judgment.
Brooklyn Chiropractic Assoc., P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 27323)
July 13, 2007
The main issue that the court considered was whether Progressive Casualty Insurance Company was required to pay interest on a judgment after paid the entire amount due to the plaintiff. The relevant facts that the court considered were that the insurance company failed to pay the plaintiff within 30 days of receiving the claims, and as such, interest began to accrue 30 days after the dates on which the company received the claims. The plaintiff failed to commence the action within 30 days of receiving the denials issued by the defendant with respect to plaintiff's claims, which tolled the accrual of interest until plaintiff commenced the instant action. The holding of the case was that the matter must be remanded to the court below for entry of an appropriate amended judgment. The order was modified to grant the plaintiff's motion, with the judgment being affirmed without costs.
101 Acupuncture, P.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 51488(U))
July 12, 2007
The court considered the scope of a master arbitrator's powers in reviewing an arbitrator's decision and determined that the master arbitrator is limited to reviewing the decision based on specific grounds enumerated in article 75. The main issue decided was whether the master arbitrator's determination upholding the arbitrator's award, which denied the petitioner's claims for first-party no-fault benefits, was rational. The holding of the case was that upon review, the court found that there was a rational basis for the master arbitrator's determination, and therefore affirmed the denial of the petition to vacate the award. The court also confirmed the master arbitrator's award and noted that the petition was timely filed.
Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 51487(U))
July 12, 2007
The main issue in the case was whether the plaintiff, Delta Diagnostic Radiology, P.C., was entitled to summary judgment in their action to recover assigned first-party no-fault benefits from Progressive Casualty Insurance Company. The court considered the evidence presented by the plaintiff, which included an affirmation from plaintiff's counsel, an affidavit by a corporate officer of the plaintiff, and various documents. The court found that the affidavit executed by the plaintiff's corporate officer was insufficient to establish their personal knowledge of the plaintiff's business practices and procedures to lay a foundation for the admission of the documents as business records. As a result, the plaintiff failed to make a prima facie showing of their entitlement to summary judgment. Therefore, the court affirmed the order denying the plaintiff's motion for summary judgment, and did not reach any other issue in the case.
Bronxborough Med., P.C. v Travelers Ins. Co. (2007 NY Slip Op 51485(U))
July 12, 2007
The court considered a case in which a medical provider was seeking to recover first-party no-fault benefits, but the motion for summary judgment was denied and the defendant was awarded $50 in costs. The main issue decided was whether the documents and affidavit submitted by the plaintiff were sufficient to establish their entitlement to summary judgment. The court held that the affidavit submitted was insufficient to establish that the officer had personal knowledge of the plaintiff's practices and procedures, so the plaintiff failed to make a prima facie showing of entitlement to summary judgment. The court also upheld the award of $50 in costs to the defendant, as the court was vested with discretion to impose costs not in excess of $50, and in this case, the imposition of costs was not an improvident exercise of the court's discretion.