No-Fault Case Law
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.
JSI Expert Serv. v Allstate Ins. Co. (2007 NY Slip Op 51484(U))
July 12, 2007
The court considered the timely denial of the claim form issued by the defendant and whether the insurance policy covered bodily injury or property damage only. The main issue decided was whether the insurance policy issued by the defendant obligated it to pay claims for no-fault benefits. The court held that the timeliness of the denial of claim form was irrelevant to the defense, as the insurance policy did not provide coverage for no-fault benefits. Additionally, the court found that the defendant's opposing papers were sufficient to demonstrate the existence of an issue of fact as to whether the insurance policy obligated the defendant to pay claims for no-fault benefits. Therefore, the order denying the plaintiff's motion for summary judgment was affirmed.
Pelham Parkway Neuro & Diagnostic, P.C. v Liberty Mut. Ins. Co. (2007 NY Slip Op 51336(U))
July 9, 2007
The court considered the defendant's appeal from an order denying its motion to dismiss the complaint and granting the plaintiff's cross motion for summary judgement in the amount of $3,360.94 in an action to recover assigned first-party no-fault benefits. The main issue before the court was whether the drastic sanction of precluding the defendant from asserting its defense of exhaustion of policy limits was warranted, given the defendant's single failure to comply with the parties' discovery stipulation. The court held that the sanction was unwarranted in the absence of a showing that the defendant's failure to comply was willful and contumacious, and remanded the matter for further proceedings consistent with the decision. The court also directed the defendant to comply with all outstanding discovery relevant to the issue of exhaustion of policy limits.
Bronx Advanced Med., P.C. v Liberty Mut. Ins. Co. (2007 NY Slip Op 51334(U))
July 9, 2007
The court considered the facts of the case, which involved an action to recover assigned first-party no-fault benefits. The main issue decided was whether the alleged injury arose out of an insured incident. The court held that defendant's submissions in opposition to plaintiff's motion for summary judgment raised triable issues of fact as to whether the injury did not arise out of an insured incident, and thus, plaintiff's motion for summary judgment should have been denied. Therefore, the court reversed the order granting plaintiff's motion for summary judgment and remanded the matter for further proceedings.
A Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51342(U))
July 3, 2007
The main issue in the case was the entitlement of the plaintiff to the summary judgment. The facts reveled that the affidavit submitted by the plaintiff's owner failed to lay a proper foundation for the documents annexed to the moving papers and it was insufficient to establish personal knowledge needed to lay a foundation for the admission of business records as documents. Hence, plaintiff failed to make a prima facie showing of entitlement to summary judgment. Defendant did not cross-appeal from so much of the order as denied its cross motion for summary judgment dismissing the action. However, the Court granted summary judgment to the non-appealing party. Defendant's peer review report established prima facie that there was no medical necessity for the MRIs performed by plaintiff, therefore defendant was entitled to the relief.
Inwood Hill Med. P.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 51309(U))
July 2, 2007
The court considered that the defendant did not deny the subject claims within the 30-day timeframe required by law. As a result, the defendant was precluded from asserting any statutory defenses, defenses predicated upon breach of conditions precedent or policy exclusion, or a defense of provider fraud based on fraudulent billing practices. The main issue decided was whether the defendant's untimely denial of the claims precluded them from asserting any statutory defenses or policy exclusions. The holding of the court was that the defendant's untimely denial did preclude them from asserting these defenses, and as a result, the plaintiffs' motion for summary judgment was granted in the principal amount of $21,913.39.
A.M. Medical Services, P.C. v Allstate Ins. Co. (2007 NY Slip Op 51312(U))
June 29, 2007
The main facts considered by the court were that the plaintiff's motion for summary judgment was denied due to the insufficiency of certain documents and the lack of justification for not presenting new facts. The main issue was whether the plaintiff had a reasonable justification for failing to present the new facts and whether there had been a change in the law that would warrant a renewed motion for summary judgment. The court held that the plaintiff failed to provide a reasonable justification for not presenting the new facts on the original motion and that the cases cited by the plaintiff did not represent changes in the decisional law. Therefore, the denial of the motion for summary judgment was affirmed, and it was determined that a motion should have been made to reargue if the plaintiff felt that the motion court had overlooked or misapprehended existing law.
Psychological Practice, P.C. v NY Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51304(U))
June 29, 2007
The main issue in this case was whether the plaintiff, Psychological Practice, P.C., was entitled to summary judgment in a lawsuit to recover assigned first-party no-fault benefits from NY Central Mutual Fire Ins. Co. The court considered the sufficiency of the affidavit submitted by the plaintiff's owner, which stated conclusorily that the documents attached to the motion papers were plaintiff's business records. The court found that the affidavit was insufficient to establish the owner's 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 plaintiff failed to make a prima facie showing of its entitlement to summary judgment, and the denial of the motion for summary judgment was affirmed. Therefore, the holding of the case was that the plaintiff's motion for summary judgment was properly denied.