No-Fault Case Law

The petitioner was State Farm Mutual Automobile Insurance Company, and the respondent was William Tubis. Tubis sustained injuries in a car accident with a vehicle insured by Legion Insurance Company. Tubis applied for no-fault benefits and uninsured/underinsured motorist benefits from State Farm about three months later. Legion was declared insolvent in 2003, and Tubis sent State Farm a demand for arbitration for uninsured motorist benefits in 2004. The main issue was whether Tubis's claim for uninsured motorist benefits was time-barred, as the insurance policy required that notice of the claim be given "as soon as practicable". The court held that Tubis did not notify the insurance company of his uninsured motorist claim as soon as practicable and State Farm promptly submitted reply papers, disclaiming coverage, which satisfied its statutory obligation. The petition to stay arbitration was granted and arbitration was permanently stayed.

The court considered the plaintiffs' complaint, the defendant's motion to dismiss, and the plaintiffs' cross motion for summary judgment and to amend the complaint. The main issue decided was the sufficiency of the complaint and the denial of the plaintiffs' right to amend the complaint. The holding of the court was that the plaintiffs did not seek leave to amend the complaint to plead the essential elements of a cause of action to recover no-fault benefits for specific claims, and therefore, their argument for the right to replead was not properly before the Court. The court also found that nurses' reviews denying no-fault claims for lack of medical necessity were not per se invalid, and that the insufficiency or lack of merit of the complaint was clear and free from doubt.

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.