No-Fault Case Law

The main issue in this case was whether the provider, Fortune Medical, P.C., was entitled to recover assigned first-party no-fault benefits from Kemper Insurance Co. The court considered the evidence presented by Fortune Medical, including an affirmation from their counsel, an affidavit by an officer of the company, and various documents. However, the court found that the affidavit executed by the officer was insufficient to establish that the documents constituted admissible evidence as business records. As a result, the court held that Fortune Medical failed to make a prima facie showing of its entitlement to summary judgment, and the motion was properly denied. Therefore, the holding of the case was that the order denying plaintiff's motion for summary judgment was affirmed.

The court considered the denial of first-party no-fault benefits to Alternative Health Care of N.Y. Their claims were upheld by the master arbitrator, and the court had to decide whether to confirm the master arbitrator's award. The main issue was whether the master arbitrator's determination had a rational basis. The court held that there was a rational basis for the master arbitrator's decision and confirmed the award, modifying the lower court's order to include the confirmation of the arbitrator's award. The court also noted that the special proceeding should have terminated in a judgment, not an order.

The court considered the affidavit submitted by plaintiff's corporate officer in support of the motion for summary judgment and whether it laid a proper foundation for the documents annexed to the moving papers. The main issue was whether the affidavit established that the officer possessed personal knowledge of the plaintiff's practices and procedures to lay a foundation for the admission of the documents as business records. The holding was that the affidavit submitted by the corporate officer was insufficient to establish the officer's personal knowledge, and as a result, the plaintiff failed to make a prima facie showing of entitlement to summary judgment. Therefore, the court reversed the order granting summary judgment and denied the plaintiff's motion.

The court considered the evidence presented by the plaintiff in support of their motion for summary judgment, which included an affirmation from the plaintiff's counsel, an affidavit by a corporate officer of the plaintiff, and various documents. However, the court found that the affidavit executed by the corporate officer was conclusory and failed to establish a proper foundation for the documents attached to the motion papers. As a result, the plaintiff failed to establish a prima facie case for their entitlement to summary judgment. The main issue decided was whether or not the plaintiff had provided sufficient evidence to support their motion for summary judgment in a case to recover assigned first-party no-fault benefits. The holding of the court was that the plaintiff's motion for summary judgment was properly denied because the affidavit submitted was insufficient to establish that the officer possessed personal knowledge of the plaintiff's practices and procedures to lay a foundation for the admission of the documents as business records. Therefore, the denial of the plaintiff's motion for summary judgment was affirmed.

The relevant facts considered by the court in this case were that the plaintiff, a medical provider, was seeking to recover first-party no-fault benefits from the defendant insurance company. The plaintiff's motion for summary judgment was denied by the lower court because the affidavit by the plaintiff's corporate officer failed to establish personal knowledge of the mailing of the claims. The main issue decided by the court on appeal was whether the affidavit submitted by the plaintiff's corporate officer laid a proper foundation for the documents submitted as business records. The holding of the court was that the affidavit was insufficient to establish that the officer possessed personal knowledge of the plaintiff's practices and procedures, and therefore, the plaintiff failed to make a prima facie showing of entitlement to summary judgment, and the denial of the motion for summary judgment was affirmed.

The court considered that in an action by a provider to recover assigned first-party no-fault benefits, the plaintiff's motion for summary judgment was supported by an affirmation from the plaintiff's counsel, an affidavit by a corporate officer of the plaintiff, and various documents annexed thereto. However, the affidavit executed by the plaintiff's corporate officer stated in a conclusory manner that the documents attached to the plaintiff's motion papers were plaintiff's business records. The defendant argued that the affidavit by the plaintiff's corporate officer failed to lay a proper foundation for the documents annexed to the plaintiff's moving papers, thus, the plaintiff failed to establish a prima facie case. The main issue decided was whether the affidavit submitted by the plaintiff's corporate officer was sufficient to establish that the officer possessed personal knowledge of the plaintiff's practices and procedures, and whether it laid a foundation for the admission, as business records, of the documents annexed to the plaintiff's moving papers. The holding of the case was that since the affidavit submitted by the plaintiff's corporate officer was insufficient to establish that said officer possessed personal knowledge of the 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 plaintiff failed to make a prima facie showing of its entitlement to summary judgment. Therefore, the plaintiff's motion for summary judgment was properly denied.

The court considered the plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits, which was supported by an affirmation from the plaintiff's counsel, an affidavit by a corporate officer of the plaintiff, and various documents. The main issue decided was whether the affidavit by plaintiff's corporate officer laid a proper foundation for the admission of the documents as business records, and whether this established a prima facie case. The holding was that the affidavit submitted by the plaintiff's corporate officer was insufficient to establish personal knowledge of the plaintiff's practices and procedures, and therefore failed to make a prima facie showing of entitlement to summary judgment. As a result, the plaintiff's motion for summary judgment was properly denied.

The main issue in the case was whether the court could grant summary judgment in favor of the plaintiff upon the default of the defendant in not responding to the plaintiff's motion. The court held that judicial notice of the regulations of the New York State Insurance Department was required, and that the lower court had no authority to ignore those regulations and grant judgment to the plaintiff for an amount which may be in excess of the amount permitted by the regulations. The court concluded that the lower court was required to establish that the charges were in accordance with the "workers' compensation" rate, and did not have the authority to grant judgment to the plaintiff for an amount which may be in excess of the amount permitted by the regulations. The appeal from the judgment was dismissed.

The case involved an appeal from an order of the Civil Court of New York denying the plaintiff's motion for partial summary judgment and granting the defendant's cross motion for summary judgment in a case to recover assigned first-party no-fault benefits. The plaintiff's motion was supported by an affirmation of plaintiff's counsel, an affidavit by a corporate officer of the plaintiff, and various documents annexed thereto. The affidavit executed by the corporate officer stated that the documents attached to plaintiff's motion papers were plaintiff's business records, however, the court found the affidavit insufficient to establish the officer's personal knowledge of the plaintiff's practices and procedures, and thus plaintiff failed to establish a prima facie case. The court also found that defendant failed to submit evidence from someone with personal knowledge of the timely mailing of its claim denials which led to an issue of fact as to whether the defendant was precluded from interposing its defense of lack of medical necessity. The judgment was reversed, the order granting defendant's cross motion for summary judgment was vacated, and the complaint was reinstated.

The main issue in this case was whether the defendant's denial of the claim form for first-party no-fault benefits provided sufficient facts and a medical rationale to support the denial. The court considered the denial form's reference to a negative peer review report, which the plaintiff argued did not provide enough specificity for the denial. The court ultimately held that the denial form was sufficient to apprise the plaintiff of the basis for determining that the medical services provided were medically unnecessary. The court affirmed the lower court's decision to deny the plaintiff's motion for summary judgment, finding that related cases with conflicting decisions should no longer be followed.