No-Fault Case Law

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.

The relevant facts considered by the court were that the plaintiff, Andrew Carothers, M.D., P.C., was seeking to recover first-party no-fault benefits for medical services provided to its assignor. The plaintiff established a prima facie entitlement to summary judgment by proving that it submitted claims and that payment of the benefits was overdue. In response, the defendant demonstrated that it timely mailed the denial of claim forms based on its standard office practice or procedure. The main issue decided was whether the plaintiff was entitled to summary judgment, and the holding of the court was that the plaintiff's motion for summary judgment should have been denied because the defendant's papers were sufficient to demonstrate the existence of an issue of fact with respect to the defense of lack of medical necessity. Therefore, the order granting the plaintiff's motion for summary judgment was reversed and the plaintiff's motion was denied.

The main issue in this case was whether the defendant provided sufficient evidence to demonstrate that there was an issue of fact as to whether the injuries sustained by the plaintiff's assignor arose from an insured incident. The court found that the affidavit submitted by the defendant's investigator was sufficient to demonstrate a "founded belief that the alleged injuries do not arise out of an insured incident." As a result, the judgment was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion for summary judgment was ultimately denied. The court determined that because the defendant demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage, the plaintiff was not entitled to summary judgment.

The relevant facts were that the plaintiff was seeking to recover first-party no-fault benefits for medical supplies provided to its assignor, and the defendant's cross motion for summary judgment was denied. The main issue decided was whether the defendant had proffered enough evidence to demonstrate that there was an issue of fact as to whether the injuries sustained by the plaintiff's assignor arose from an insured incident. The holding of the case was that the defendant's investigator submitted an affidavit that was sufficient to demonstrate a "founded belief that the alleged injuries did not arise out of an insured incident," and therefore, the plaintiff was not entitled to summary judgment. Additionally, the court noted that the plaintiff's assertion that the affidavit of the defendant's investigator was inadmissible because it did not comply with CPLR 2309(c) was waived since it was raised for the first time on appeal.

The court considered the fact that the plaintiff, A.M. Medical Services, P.C., was seeking to recover assigned first-party no-fault benefits. The plaintiff's motion for summary judgment was supported by an affirmation from plaintiff's counsel, an affidavit by a corporate officer of plaintiff, and various documents annexed thereto. In opposition, the defendant argued that the plaintiff's moving papers did not proffer facts in admissible form to establish plaintiff's entitlement to judgment as a matter of law. The main issue decided was whether the affidavit submitted by the plaintiff's corporate officer was sufficient to establish that the officer possessed personal knowledge of 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 and, therefore, the plaintiff failed to make a prima facie showing of entitlement to summary judgment. As a result, the order denying plaintiff's motion for summary judgment was affirmed, albeit on different grounds.

The court considered the fact that the plaintiff, Great Wall Acupuncture, moved for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue was whether the affidavit submitted by the plaintiff's corporate officer established a proper foundation for the admission of the documents annexed to the plaintiff's moving papers. The court held 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, and therefore failed to lay a foundation for the admission of the documents as business records. As a result, the court reversed the order granting plaintiff's motion for summary judgment and denied the motion.

The main issues in this case were whether the plaintiff's assignor attended duly requested examinations under oath and an independent medical examination, and whether the affidavit submitted by the plaintiff's corporate officer laid a proper foundation for the admission of documents annexed to the plaintiff's moving papers. The court denied the plaintiff's motion for summary judgment, finding that there was an issue of fact regarding the attendances at the examinations and the sufficiency of the affidavit. On appeal, the defendant argued that the affidavit failed to lay a proper foundation for the admission of the documents, and the court agreed. The court affirmed the order denying the plaintiff's motion for summary judgment on other grounds, finding that the plaintiff failed to make a prima facie showing of its entitlement to summary judgment. Therefore, the holding of the case was that the order denying the plaintiff's motion for summary judgment was affirmed.

The court considered the fact that Great Wall Acupuncture was seeking to recover assigned first-party no-fault benefits from Peerless Ins. Co. The main issue decided was whether Great Wall Acupuncture had established its prima facie entitlement to summary judgment by proving the submission of a statutory claim form and the fact and amount of the loss sustained. The holding of the court was that Great Wall Acupuncture had indeed established its prima facie case, and the motion for summary judgment was granted. The matter was remanded to the court for the calculation of statutory interest and an assessment of attorney's fees. The court also found that the facts offered in support of the defense by Peerless Ins. Co. were not submitted in admissible form and were insufficient to establish a triable issue of coverage.