No-Fault Case Law

The relevant facts considered by the court were that the plaintiff, LMS Medical Care, P.C., sought to recover assigned first-party no-fault benefits, and their motion for summary judgment was granted. The main issue decided by the court was whether the defendant, State Farm Mutual Auto. Ins. Co., provided sufficient evidence to demonstrate a triable issue of fact regarding the belief that the alleged injuries did not arise from a covered incident. The holding of the court was that the defendant failed to establish a founded belief, as the accident reports and other documents offered by the defendant did not constitute evidentiary proof in admissible form and were without probative value. The court affirmed the order granting plaintiff's motion for summary judgment, with one justice dissenting.

The court considered the submission of a Notice to Admit as the sole evidence to establish a prima facie case to recover no-fault first party benefits for unpaid medical services. The main issue was whether the submission of a Notice to Admit is sufficient to establish a prima facie case, and whether the failure to respond to a Notice to Admit should be deemed as an admission to material facts. The holding of the case was that Notice to Admit could not be used as the sole evidence to establish a prima facie case, and the failure to respond to the Notice to Admit cannot be deemed as an admission to material facts. The plaintiff failed to provide any additional evidence at trial, and thus was unable to prove through admissible evidence that payment was not made on a timely submitted claim, resulting in the dismissal of the plaintiff's action.

The main issue in this case was whether the defendant, GEICO General Insurance Co., was entitled to summary judgment in the principal sum of $6,139.59 against A.I.D. Medical Supplies. The court considered the fact that the defendant had timely denied the plaintiff's no-fault claim on the grounds of lack of medical necessity, supported by a peer review report. The court determined that the defendant had raised a triable issue of fact and was entitled to deny the claim, as the regulations provide that if a claim is denied based on a medical examination or peer review report, the insurer must release a copy of the report to the applicant or its attorney. The court held that the denial of claim form did not require the carrier to set forth a medical rationale, reversing the order of the Civil Court and remanding the matter for further proceedings.

The main issue in this case was the interpretation of 11 NYCRR 65-4.6 (e), which pertained to attorney's fees in a case with multiple claims in the same action. The defendant and plaintiff disagreed on the interpretation of the statute. The defendant argued that the $850 limitation applied to the action as a whole, whereas the plaintiff argued that it applied to each individual cause of action. The court held that the limitation of $850 for attorney's fees applied to each cause of action, supporting the plaintiff's position in its interpretation of the statute. The court concluded that the plaintiff should be able to enter judgment for any amounts that remained unpaid per cause of action and denied the defendant's motion to the contrary.

The court considered an action to recover no-fault insurance benefits under certain contracts of insurance. The plaintiff, Westchester Medical Center, as assignee of Demetrio Recinos (hereinafter WMC), sought recovery from the defendant, Safeco Insurance Company of America, for its failure to pay or deny the claim within the requisite 30-day period. WMC demonstrated its prima facie entitlement to judgment as a matter of law by submitting the necessary billing forms, certified mail receipt, signed return receipt card referencing Recinos and the forms, and an affidavit of its biller. The defendant failed to raise a triable issue of fact in opposition. The Supreme Court correctly granted WMC's cross motion for summary judgment on the first cause of action. The main issue decided was whether WMC was entitled to recover no-fault insurance benefits from Safeco Insurance Company of America, and the court held that WMC was entitled to judgment as a matter of law due to Safeco's failure to pay or deny the claim within the requisite 30-day period.

The plaintiff, Westchester Medical Center, filed a lawsuit to recover no-fault benefits from Liberty Mutual Insurance Company. The plaintiff appealed to the Supreme Court, Nassau County, after the court granted the defendant's cross motion for summary judgment dismissing the second, third, and fourth causes of action. The second and third causes of action involved health services provided to Kevin Kane and Gladys Navarro. The plaintiff demonstrated its entitlement to judgment by proving that necessary billing documents were mailed to and received by the defendant and that payment of the no-fault benefits was overdue. Therefore, the defendant's cross motion for summary judgment was denied, and the Supreme Court erred in awarding summary judgment to the defendant. As it pertains to the fourth cause of action, involving health services to Alyssa Arater, the plaintiff similarly demonstrated its entitlement to judgment, and the Supreme Court should have granted summary judgment in favor of the plaintiff on that cause of action. Therefore, the order was reversed, and the plaintiff's motion for summary judgment was granted. The defendant's cross motion for summary judgment was denied.

The court considered the fact that the defendant, AIU Insurance Company, sought leave to renew and reargue a decision and order granting summary judgment to the plaintiffs, Devonshire Surgical Facility and Carnegie Hill Orthopedic Services. The main issues decided were whether the defendant had established good cause for seeking discovery relating to its defenses and the plaintiffs' corporate structure, and whether there were triable issues of fact concerning the plaintiffs' prima facie case. The court held that the defendant failed to establish good cause for seeking discovery relating to the plaintiffs' alleged fraudulent incorporation, and that the plaintiffs' affidavit supporting their motion for summary judgment was sufficient to lay a foundation for the admission of their business records. Ultimately, the court denied the defendant's motion for leave to renew and reargue.

The relevant facts considered by the court involved a case where the plaintiff was seeking to recover no-fault benefits as an assignee of five individuals, with claims arising out of five separate accidents. The main issue decided was whether the defendant's motion to sever the five causes of action in the complaint into separate actions should be granted. The court held that the particular facts relating to each claim were likely to raise few, if any, common issues of law or fact, and that each claim should be severed into a separate action. The court also found that the defendant's answer, without more, placed at issue the basis for severance, and therefore, the defendant's motion to sever the causes of action should have been granted.

The relevant facts in this case involve an action to recover no-fault insurance medical benefits, in which the plaintiff appealed from an order in the Supreme Court, Nassau County. The order granted the defendant's motion to vacate a judgment entered upon its default in answering, and denied the plaintiff's motion to punish the defendant for contempt. The main issue decided was whether the Supreme Court properly exercised its discretion in granting the defendant's motion to vacate the default judgment pursuant to CPLR 317, and whether it properly denied the plaintiff's motion to punish the defendant for contempt. The holding of the court was that the Supreme Court did exercise its discretion properly in granting the defendant's motion to vacate the default judgment pursuant to CPLR 317 and properly denied the plaintiff's motion to punish the defendant for contempt. Therefore, the order was affirmed with costs.

The relevant facts considered by the court included the denial of plaintiff's motion for summary judgment in an action by a provider to recover first-party no-fault benefits. The main issue decided in this case was whether the defendant proffered 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 holding of the court was that the affidavit submitted by the defendant's investigator was sufficient to demonstrate that the denial of coverage was based on a "founded belief that the alleged injuries do not arise out of an insured incident." As a result, the court reversed the order and denied the plaintiff's motion for summary judgment.