No-Fault Case Law

The relevant facts considered by the court in the case involved an insurance company denying a claim for first-party no-fault benefits on the ground of medical necessity, and the plaintiff's contention that the denial of claim form was defective. The main issues decided by the court were whether the denial of claim form was timely and whether it was defective due to being issued by an unlicensed insurance adjuster. The holding of the case was that the court affirmed the denial of the plaintiff's motion for summary judgment, as the affidavits submitted by the defendant sufficiently established the timely mailing of the verification requests and the denial of claim form. Additionally, the court found that the plaintiff had failed to establish that the denial of claim form was defective.

The main issue in this legal case was whether a radiological medical provider, seeking to recover no-fault benefits provided to a patient based upon a referring physician's prescription, was required to produce an individual with personal knowledge of the medical necessity for the radiological scans or X-rays it performed for the patient. The court held that it was not necessary for the radiological medical provider to produce a person for its deposition with personal knowledge of the necessity of the services rendered, and that the defendant's remedy to obtain such information was to depose the patient/assignor's nonparty referring or treating physician. The court also found that the notice to take deposition issued by the defendant was too broad, as it directed the plaintiff to produce a person to contest the defense to be offered by the defendant insurer at the trial, and required the plaintiff to produce records and reports of other persons and companies. As a result, the defendant's notice to take deposition was deemed improper and was stricken.

The court considered the fact that the plaintiff moved for summary judgment to recover assigned first-party no-fault benefits, and the defendant opposed the motion by asserting questions concerning the nature of the loss and whether it arose out of an insured incident. The court granted the plaintiff's motion for summary judgment finding that the defendant failed to support its claim of fraud. The main issue decided was whether the defendant was precluded from asserting the defense that the collision was in furtherance of an insurance fraud scheme. The holding of the case was that the defendant's affidavit was insufficient to demonstrate that the defense was based on a "founded belief that the alleged injuries do not arise out of an insured incident," and since the defendant failed to raise a triable issue of fact as to whether there was a lack of coverage, the judgment was affirmed.

The court considered a case in which a medical services provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The provider moved for summary judgment, which was denied by the lower court. The insurance company had submitted opposition papers claiming that the denial of the claims was based on peer review reports and excess fees. The court found that there were several triable issues of fact raised by the insurance company's opposition papers. However, the court also found that the insurance company did not provide sufficient evidence to rebut the presumption of receipt of certain claim forms, so the provider was entitled to summary judgment on those specific claims. The court ultimately granted partial summary judgment in favor of the provider in the sum of $2,630.44 and remanded the case for further proceedings on the remaining claims, including the calculation of interest and attorney's fees.

The court considered the plaintiff's motion for summary judgment in a case seeking to recover assigned first-party no-fault benefits. The motion was supported by an affirmation from the plaintiff's counsel, an affidavit by an officer of the plaintiff, and various documents. However, the court denied the motion on the ground that the affidavit executed by the plaintiff's corporate officer failed to set forth facts sufficient to demonstrate personal knowledge of the facts. The main issue decided was whether the affidavit provided sufficient personal knowledge to establish the admissibility of the documents as business records. The holding was that the plaintiff failed to make a prima facie showing of its entitlement to summary judgment due to the insufficiency of the affidavit, and thus the denial of the motion for summary judgment was upheld. The appeal from the denial of the motion to vacate the previous order and renew the motion for summary judgment was dismissed as abandoned.

The court considered the motion for summary judgment in an action by a provider to recover first-party no-fault benefits, which was supported by an affirmation from plaintiff's counsel, an affidavit by a corporate officer of plaintiff, and various documents. The main issue decided was whether the affidavit executed by plaintiff's corporate officer was legally sufficient to establish that the officer possessed personal knowledge of plaintiff's practices and procedures, in order to lay a foundation for the admission of the documents as business records. The court held that the affidavit was insufficient to establish the officer's personal knowledge, and therefore plaintiff failed to make a prima facie showing of its entitlement to summary judgment. As a result, the court affirmed the denial of plaintiff's motion for summary judgment.

The relevant facts the court considered were that Great Wall Acupuncture was seeking to recover assigned first-party no-fault benefits from Liberty Mutual Ins. Co. Plaintiff's motion for summary judgment was supported by an affirmation from plaintiff's counsel, an affidavit by an employee of plaintiff, and various documents. The main issue decided was whether plaintiff's moving papers established plaintiff's prima facie entitlement to judgment as a matter of law. The holding of the case was that the affidavit submitted by plaintiff's employee was insufficient to establish that the employee had personal knowledge of plaintiff's practices and procedures, and therefore, plaintiff failed to make a prima facie showing of its entitlement to summary judgment. The denial of plaintiff's motion for summary judgment was affirmed without costs.

The court considered the fact that plaintiff moved for summary judgment to recover assigned first-party no-fault benefits which defendant opposed on the ground that plaintiff did not establish that defendant issued an untimely denial of the claim. The issue at hand was whether plaintiff needed to demonstrate that defendant's denial was untimely as part of plaintiff's prima facie case. The court held that a provider generally establishes its prima facie entitlement to summary judgment through proof of the submission of a statutory claim form, setting forth the fact and the amount of the loss sustained, and that payment of no-fault benefits was overdue. Since defendant failed to raise any substantive defense in admissible form, the timeliness of defendant's denial was rendered academic and the order was affirmed.

The court considered the fact that the plaintiff, a provider seeking to recover no-fault benefits, had moved for summary judgment, while the defendant had cross-moved to compel examinations before trial of the plaintiff and the plaintiff's assignor. The main issue decided was whether the defendant's motion to compel examinations before trial should be granted. The court ultimately held that the appeal was dismissed as academic, as the action had been dismissed by the Civil Court for failure to obtain a stay of enforcement and for failure to appear for the ordered examinations before trial. The holding of the case was that the dismissal of the action rendered the appeal academic.

The court considered the fact that A.M. Medical Services, P.C. was seeking to recover assigned first-party no-fault benefits, and that their 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. However, the affidavit executed by plaintiff's corporate officer was insufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures so as to lay a foundation for the admission, as business records, of the documents annexed to plaintiff's moving papers. The main issue decided was whether or not the plaintiff had made a prima facie showing of its entitlement to summary judgment. The holding was that the plaintiff's motion for summary judgment was properly denied, as they failed to make a prima facie showing of their entitlement to it.