No-Fault Case Law

The court considered a motion for summary judgment in an action to recover assigned first-party no-fault benefits in which plaintiffs were denied their motion. The denial was based on the failure of the plaintiffs' assignor to comply with properly noticed independent medical examination (IME) requests. The main issue decided was whether the affidavit submitted by the defendant was sufficient to establish that the IME notices were mailed. The holding of the court was that the affidavit submitted by the defendant was indeed sufficient to establish that the IME notices were mailed, and therefore, the order denying plaintiffs' motion for summary judgment was affirmed.

The court considered a motion for summary judgment in an action by a 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 annexed thereto. However, the affidavit executed by the corporate officer was insufficient to establish that the officer possessed personal knowledge of the provider's practices and procedures so as 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, holding that the moving papers failed to establish a prima facie case. The main issue decided was whether the provider's motion for summary judgment should be granted, and the holding was that the motion was properly denied due to the insufficiency of the affidavit to establish a prima facie case.

The court considered the fact that the defendant served an untimely answer, and the plaintiff sought and obtained a default judgment. The main issue decided was whether the plaintiff waived the untimeliness of the answer by failing to reject it, and whether this precluded the grant of a default judgment. The court held that a plaintiff's retention of an answer without a timely objection constitutes a waiver of objection as to untimeliness, and such a waiver precludes the grant of a default judgment. Therefore, the default judgment entered against the defendant was vacated, and the defendant's motion was granted to that extent. The court also held that to the extent the defendant sought to compel acceptance of the answer, that branch of the defendant's motion was denied as academic.

The main issues in this case revolve around an action to recover assigned first-party no-fault benefits, where the plaintiff, Vista Surgical Supplies, Inc., sought summary judgment after the denial of their motion by the Civil Court of the City of New York, Kings County. The court considered the fact that the plaintiff established its prima facie entitlement to summary judgment by 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. The defendant's denial was based upon the plaintiff's assignor's nonattendance at independent medical examinations (IMEs), but the defendant failed to establish by proof in admissible form that the IME notifications were mailed and that plaintiff's assignor failed to appear. Therefore, the appellate court reversed the order without costs, granted plaintiff's motion for summary judgment, and remanded the case to the court below for the calculation of statutory interest and an assessment of attorney's fees.

The relevant facts considered by the court in the case of Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. included a dispute over first-party no-fault benefits, with the insurance company denying the claims. The main issue decided was whether the insurance company had timely denied the claims, as required by the 30-day prescribed period. The holding of the court was that the insurance company was precluded from raising most defenses, including lack of medical necessity, fraudulent billing, and excessive fees, due to its failure to pay or deny the claims within the prescribed period. However, the insurance company was not precluded from asserting its defense of an insurance fraud scheme, as it raised a triable issue of fact as to whether there was a lack of coverage. As a result, the lower court's denial of the plaintiff's motion for summary judgment was affirmed by the appellate court.

The court considered the fact that the insured's claim for workers' compensation benefits had been denied, as he was deemed to be self-employed and not required to carry workers' compensation insurance on himself as a cab driver. The petitioner argued that the insured's "base affiliation" with Kenmore Cab Dispatch Service obligated the latter to secure workers' compensation coverage for the insured, but failed to provide evidence that Kenmore was the insured's employer at the time of the accident. Additionally, the petitioner did not submit evidence in admissible form that the insured had actually violated his insurance contract. As a result, the court denied the petition to permanently stay arbitration of the insured's no-fault insurance claim. The main issue decided was whether there was a basis for permanently staying arbitration of the insured's no-fault insurance claim, and the holding was that the petitioner failed to provide sufficient evidence to support their argument, and thus the order was affirmed with costs.

The court considered the evidence presented in the form of an affirmation from plaintiff's counsel, an affidavit by a corporate officer of plaintiff, and various supporting documents. The main issue was whether plaintiff's motion for summary judgment in a case to recover assigned first-party no-fault benefits should be granted. The court held that the affidavit executed by plaintiff's corporate officer was insufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures to lay a foundation for the admission of the documents annexed to plaintiff's moving papers as business records. Therefore, the court affirmed the denial of plaintiff's motion for summary judgment.

The court considered the appeal from an order of the Civil Court of the City of New York, Kings County, which had granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment. The main issue in this action to recover assigned first-party no-fault benefits was whether the defendant had established timely mailing of its denial forms. The holding of the court was that the defendant failed to establish timely mailing of its denial forms, as the affidavit of its claims processor did not provide a sufficiently detailed description of the standard office mailing procedure to give rise to the presumption of mailing. Additionally, the defendant's additional affidavits produced for the first time in its papers submitted in reply to the plaintiff's opposition were disregarded by the court and may not be considered on appeal, thus defendant was precluded from raising the defense asserted. Therefore, the order of the Civil Court of the City of New York, Kings County, was affirmed without costs.

In this case, Long Island Radiology commenced an action against several insurance companies to recover assigned no-fault benefits for MRIs provided to patients injured in motor vehicle accidents pursuant to prescriptions from physicians and/or medical providers. The defendants moved for summary judgment on the issue of whether they may raise lack of medical necessity as a basis to deny reimbursement claims to radiologists for MRIs. The Supreme Court denied the defendants' motion, and instead granted the plaintiff's cross motion which asked for a determination that the defense of lack of medical necessity is not available against radiologists performing MRIs pursuant to prescriptions. The appellate division reversed the decision, and held that a radiologist who accepts assignments of no-fault benefits stands in the shoes of the injured party and thus the defense of lack of medical necessity is available to the defendants against such radiologists. In summary, the main issue decided was whether the defense of lack of medical necessity is available to deny reimbursement claims by radiologists for MRIs provided to no-fault patients pursuant to prescriptions. The holding of the case was that the defense of lack of medical necessity is indeed available against radiologists who accept assignments of no-fault benefits, allowing the defendants to raise this defense to deny claims for reimbursement to radiologists seeking payment for MRIs.

The court considered the motion for summary judgment by Bath Medical Supply, Inc. to recover assigned first-party no-fault benefits. The court below denied the motion on the grounds that the plaintiff's moving papers failed to allege personal knowledge of the mailing of the claims. On appeal, the defendant raised the argument that the affidavit by plaintiff's corporate officer failed to lay a proper foundation for the documents annexed to plaintiff's moving papers. The court found that the affidavit submitted by plaintiff's corporate officer was insufficient to establish personal knowledge of plaintiff's practices and procedures, leading to a failure to make a prima facie showing. Therefore, the court affirmed the denial of the motion for summary judgment, holding that plaintiff failed to establish a prima facie case. The main issues decided in this case were whether the plaintiff's moving papers alleged personal knowledge of the mailing of the claims and whether the affidavit by plaintiff's corporate officer laid a proper foundation for the documents annexed to plaintiff's moving papers. The court's holding was that plaintiff's motion for summary judgment was properly denied due to the failure to establish a prima facie case.