No-Fault Case Law

The court considered the defendant's motion for summary judgment in a case to recover first-party no-fault benefits for health care services rendered by the plaintiff to its assignor. The defendant claimed that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs) which had been scheduled prior to the defendant's receipt of the claim forms. In support of the motion, the defendant submitted evidence of mailing of the claim denials and the IME scheduling letters to the assignor. The court denied the defendant's motion for summary judgment, finding that there was a triable issue of fact as to medical necessity. The main issue decided was whether the defendant had established, prima facie, that it mailed the notices of the IMEs and that the plaintiff's assignor failed to appear for the IMEs. The holding of the case was that the defendant failed to meet its burden of proof in admissible form because it did not submit evidence in admissible form from anyone with personal knowledge of the nonappearances, and therefore its motion for summary judgment was properly denied.

In this case, there was a dispute over whether or not an insurance company had to pay out uninsured motorist benefits to a man who reported a hit-and-run accident. The man failed to file a sworn statement with the insurance company as required under the policy's supplementary uninsured motorist endorsement. The court found that this failure vitiated his coverage and denied his claim for benefits. The court also held that the policy language was not ambiguous, and the man's notice of the accident through a no-fault benefits application did not negate his breach of the policy requirements. Therefore, the court reversed the judgment, granted the petition to permanently stay arbitration, and ruled in favor of the insurance company.

The court considered the peer review report relied upon by the defendant in denying the plaintiff's first party no-fault claims, as well as the independent medical examination (IME) report of the defendant's neurologist. The main issue decided was whether the peer review report and IME report provided an adequate factual basis and medical rationale for the determinations made by the defendant. The holding of the court was that the peer review report was insufficient to defeat the plaintiff's prima facie showing of entitlement to summary judgment for the $1,796.18 and $340 first party no-fault claims. Additionally, the IME report raised an issue of fact as to the medical necessity of the acupuncture treatments billed for in connection with a $765 claim. Therefore, the court modified the order to grant the plaintiff partial summary judgment on its claims in the sums of $1,796.18 and $340, and affirmed the decision.

The main issue in this case was whether the plaintiff, a medical provider, was entitled to recover assigned first-party no-fault benefits from the defendant, an insurance company. The court considered the affidavit submitted by the plaintiff's corporate officer in support of the motion for summary judgment, which failed to lay a proper foundation for the documents annexed to the moving papers. The court also considered defendant's argument that the plaintiff's corporate officer did not possess personal knowledge of the plaintiff's practices and procedures to establish a prima facie case. The court found that the affidavit was insufficient to establish the plaintiff's entitlement to summary judgment and ultimately denied the motion. The holding of the court was that the denial of plaintiff's motion for summary judgment was affirmed without costs.

The case involved an appeal from an order of the Civil Court of the City of New York, Kings County, denying the plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits from Progressive Casualty Insurance Co. The appellate court affirmed the lower court's decision, stating that the plaintiff had failed to make a prima facie showing of its entitlement to summary judgment. The court found that the plaintiff's moving papers were insufficient, citing a previous case as precedent. Judge Golia concurred with the result but expressed disagreement with certain propositions of law cited in the majority decision. The holding of the court was to affirm the order denying the plaintiff's motion for summary judgment.

The court considered an appeal from an order of the District Court of Nassau County denying the plaintiff's motion for summary judgment in a case to recover first-party no-fault benefits for health care services provided. The main issue was whether the plaintiff's supporting affidavit established a proper foundation to admit plaintiff's exhibits as business records. The court held that the affidavit failed to assert a proper foundation, as it did not set forth the affiant's personal knowledge of plaintiff's business practices and procedures for creating bills to establish the admissibility of the claims forms and other documents. The court also noted that even where an insurer's denial of claim form acknowledges receipt of claims, it does not concede the admissibility of the purported claim forms or the facts set forth therein. Therefore, the order denying the plaintiff's motion for summary judgment was affirmed.

The court considered the motion for summary judgment brought by a health care provider to recover assigned first-party no-fault benefits. The motion was supported by an affirmation from the provider's counsel, an affidavit by a corporate officer of the provider, and various documents. However, the affidavit by the corporate officer was found to be insufficient to establish that the officer had personal knowledge of the provider's practices and procedures, and thus, failed to lay a foundation for the admission of the documents as business records. As a result, the court denied the provider's motion for summary judgment. The main issue decided was whether the affidavit submitted by the provider's corporate officer established a proper foundation for the admission of the documents as business records, and the court held that it did not. Therefore, the denial of the motion for summary judgment was affirmed.

The court considered a case in which Fair Price Medical Supply Corp. was seeking to recover assigned first-party no-fault benefits from Nationwide Mutual Insurance Company. Fair Price's motion for summary judgment was based on an affirmation from their counsel, an affidavit by a corporate officer, and various documents. However, the affidavit by the corporate officer was deemed insufficient to establish personal knowledge of the facts, specifically regarding Fair Price's office practices and procedures, to lay a proper foundation for the documents to be admitted as business records. The court held that Fair Price failed to make a prima facie showing of its entitlement to summary judgment, and therefore, the motion was properly denied. The main issue decided was whether Fair Price had established a proper foundation for the documents to be admitted as business records, and the holding was that they had not, leading to the denial of their motion for summary judgment.

The relevant facts that the court considered in this case were that the defendant moved for summary judgment dismissing the complaint based on the plaintiff's assignor's failure to attend independent medical examinations (IMEs). The plaintiff argued that the defendant failed to adequately prove mailing of the IME requests, but the court found that the defendant provided sufficient proof of having mailed the IME requests. The main issue decided in this case was whether the defendant was entitled to summary judgment dismissing the action, as the plaintiff's assignor failed to appear for the IMEs, and whether the defendant's requests and follow-up requests for IMEs were mailed in accordance with the time periods prescribed by the insurance regulations. The holding of the case was that the defendant was entitled to summary judgment dismissing the complaint, as the affidavits submitted by the defendant were sufficient to establish that the IME requests and follow-up requests were mailed in accordance with the regulations, and there was no support in the record for the court's finding of a question of fact regarding the reason for the plaintiff's assignor's nonappearance at the IMEs.

The court considered the fact that the plaintiff medical supply company was seeking to recover first-party no-fault benefits as the assignee of five individuals injured in separate motor vehicle accidents. The defendant insurance company moved to sever the five causes of action, arguing that they involved different questions of fact and law. The issue was whether the claims should be severed, as the plaintiff argued that all the claims were denied for the same reason and sought payment for the same type of medical equipment. The court held that the decision to grant a severance is an exercise of judicial discretion, and in the absence of a showing of prejudice to a substantial right, should not be disturbed on appeal. Since the denial of the claims was based on five different peer reviews, resulting in testimony at trial from different doctors on the issue of medical necessity, the court affirmed the order granting severance.