No-Fault Case Law

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the defendant's motion to strike the plaintiff's complaint unless the plaintiff served a bill of particulars and responded to discovery demands within 45 days. The plaintiff had filed a cross motion for summary judgment, which was denied by the court. The main issue decided was whether the plaintiff had made a prima facie showing of its entitlement to summary judgment, and whether the plaintiff's failure to submit written opposition to the defendant's motion to strike the complaint resulted in the order being entered on default. The holding of the court was that the plaintiff had failed to make a prima facie showing of its entitlement to summary judgment, and that the order requiring the plaintiff to serve a bill of particulars and respond to the defendant's disclosure demands was entered on default, therefore the appeal from so much of the order as granted the defendant's motion was dismissed.

The court considered the fact that the plaintiff, Support Billing & Management Co., was seeking first-party no-fault benefits, and that their motion for summary judgment was denied by the lower court due to the presence of two peer review reports that raised an issue of fact regarding the medical necessity of the benefits. The main issue decided was whether the peer review reports, which contained facsimile signatures of the doctor who performed the reviews, were admissible as evidence. The court held that the peer review reports were not in admissible form because they only contained stamped facsimile signatures, and defendant failed to establish that they were placed there by the doctor. As a result, the plaintiff was granted summary judgment on both of its claims, and the case was remanded for a calculation of statutory interest and assessment of attorney's fees.

Facts: Plaintiff sought to recover no-fault benefits assigned to him by defendant's insureds. Defendant denied the claims, resulting in the plaintiff commencing an action in August 2005. Following a motion by the defendant, the court granted plaintiff partial summary judgment on four causes of action, directing the parties to settle the judgment accordingly. Issues: The main issue at hand was whether attorney's fees should be awarded to the plaintiff based on each "proof of claim" or the aggregate of all claims for the same assignor. Holding: The court determined that the plaintiff is entitled to a minimum attorney's fee of $60 for each of the "claims" he asserted on behalf of his assignor. The motion to revise the attorney's fees was denied. The court also dismissed defendant's failure to provide a copy of the proposed judgment as part of the consideration for the revision.

The relevant facts the court considered in this case were that Bedford Park Medical Practice, P.C. was seeking to recover no-fault benefits from Progressive Casualty Insurance Co. After failing to provide documentation required by a so-ordered stipulation, Bedford Park Medical Practice was precluded from offering any evidence at trial. The main issues decided by the court were whether Bedford Park Medical Practice made a prima facie showing of entitlement to summary judgment and whether defendant's cross motion was entered on default. The holding was that since the affirmation of the plaintiff's counsel was of no probative value, due to the absence of an affidavit of merit executed by a person with personal knowledge of the facts, Bedford Park Medical Practice failed to make a prima facie showing of entitlement to summary judgment. Additionally, since Bedford Park Medical Practice failed to submit written opposition to the branch of the defendant's cross motion which was based on its failure to comply with the so-ordered stipulation, that branch of the order was entered on default and no appeal lies therefrom by the defaulting party. Therefore, the court dismissed the appeal from so much of the order as granted defendant's cross motion.

The main issues in this case were whether the plaintiff, a medical services provider, made a prima facie showing of entitlement to summary judgment in a case to recover assigned first-party no-fault benefits, and whether their evidence constituted admissible business records. The court found that the affidavit submitted by plaintiff's corporate officer was insufficient to establish that the officer possessed personal knowledge of the plaintiff's practices and procedures, and therefore, plaintiff failed to make a prima facie showing of entitlement to summary judgment. Additionally, the court determined that since plaintiff failed to submit written opposition to the defendant's motion to strike the complaint, that part of the order was entered on default, meaning no appeal lies from the defaulting party. As a result, the appeal from the part of the order granting defendant's motion was dismissed. The holding of the court was that plaintiff's cross motion for summary judgment was properly denied, and the appeal from the motion to strike the complaint by the defendant was dismissed.

The court considered the plaintiff's attempt to recover first-party no-fault benefits for medical services rendered. The defendant moved for an order dismissing the case, claiming that the plaintiff was attempting to relitigate a previous claim and that the prior action was dismissed for failure to comply with discovery demands. The plaintiff argued that the prior action was dismissed due to failure to comply with discovery demands, but they maintained that they were not precluded from commencing a new action. The court held that the plaintiff was in fact precluded from commencing a new action under a new index number because they failed to comply with discovery demands and were dismissed for neglect to prosecute. Therefore, the defendant's motion to dismiss was granted, and the complaint was dismissed without the imposition of sanctions.

The main issue in this case was whether the provider, V.S. Medical Services, P.C., was entitled to recover assigned first-party no-fault benefits from Allstate Insurance Co. V.S. Medical Services moved for summary judgment, which was granted by the court below. However, on appeal, Allstate Insurance Co. argued that the affidavit submitted by V.S. Medical Services' corporate officer failed to lay a proper foundation for the documents annexed to their moving papers, and therefore, they did not establish a prima facie case. The appellate court agreed with Allstate Insurance Co., finding that the affidavit was insufficient to establish that the officer possessed personal knowledge of V.S. Medical Services' practices and procedures to lay a foundation for the admission of the documents as business records. As a result, V.S. Medical Services failed to make a prima facie showing that they submitted their claim forms to Allstate Insurance Co., and the judgment in their favor was reversed, the order granting summary judgment was vacated, and V.S. Medical Services' motion was denied.

The court considered the fact that the defendant insurance company had issued timely initial and follow-up verification requests for the assignor's social security number in response to the plaintiff's claims for medical services. The main issue decided was whether the insurance company had properly denied payment based on the unsatisfied verification requests. The court held that the insurance company had established the basis for its knowledge of the preparation and issuance of the verification request letters, and therefore, the court affirmed the denial of the plaintiff's motion for summary judgment and granted the defendant partial summary judgment on its cross motion. The court also dismissed those claims for which the insurance company had issued verification requests as premature, and found that there was a triable issue for the remaining claim.

The relevant facts considered by the court included a motion for summary judgment by the plaintiff to recover assigned first-party no-fault benefits, and a cross-motion for summary judgment by the defendant. The main issue decided was whether the defendant had properly established that the 30-day prescribed period in which to deny the claims was tolled, and whether the alleged injuries arose out of a covered incident. The holding of the case was that the court affirmed the order without costs, as the defendant had failed to establish the mailing of requests for examinations under oath and had failed to assert facts with sufficient particularity to establish a founded belief that the injuries did not arise out of an insured incident. Therefore, the court properly granted the plaintiff's motion for summary judgment and denied the defendant's cross motion.

The relevant facts of this case were that Great Wall Acupuncture, acting on behalf of Manuel Delva and Mario Faustin, moved for summary judgment to recover first-party no-fault benefits. Utica Mutual Insurance Company opposed, claiming that Delva and Faustin failed to attend scheduled independent medical examinations (IMEs) and that there was a factual issue regarding whether their injuries were caused by an insured incident. The court granted plaintiff's motion, and a judgment was entered for $10,088.84. On appeal, Utica reiterated its arguments from the lower court, but failed to present competent evidence that it had mailed the IME requests or that it had knowledge of the nonappearances. Additionally, its claims of fraudulent conduct were not sufficiently supported. The judgment was affirmed without costs. The main issues decided in this case were whether the failure to attend scheduled IMEs and allegations of fraudulent conduct by the claimants precluded them from recovering first-party no-fault benefits, and whether the defendant insurance company had presented sufficient evidence to support its claims. The holding of the case was that the court found in favor of Great Wall Acupuncture, affirming the judgment in their favor, as the defendant insurance company had failed to demonstrate that it had mailed the IME requests and had submitted insufficient evidence to establish its defenses.