No-Fault Case Law

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.

The relevant facts in this case were that Plaintiff was seeking to recover first-party no-fault benefits as the assignee of five different individuals involved in four separate accidents. The main issue in question was whether the Plaintiff was fraudulently incorporated and therefore ineligible for reimbursement of no-fault benefits. The court decided that the plaintiff's cross motion for summary judgment was premature pending the completion of discovery, as the opposition papers had raised issues about who really operated and controlled the plaintiff. Defendant's opposition papers also raised the issue of whether plaintiff was fraudulently incorporated, making the completion of discovery necessary. Therefore, the decision held that Plaintiff's cross motion for summary judgment was denied without prejudice to renewal upon the completion of discovery. Additionally, the court held that defendant's motion to sever the causes of action was also denied, as there was no showing of prejudice to a substantial right by having the five claims tried together.

The court considered the evidence presented in a case involving Delta Medical Supplies seeking recovery of first party no-fault benefits from NY Central Mutual Insurance Co. for medical services rendered to its assignor after an automobile accident. The main issue was whether or not the insurance company established the defense of lack of medical necessity for the medical supplies in question. The court found that the insurance company failed to meet its burden of proving lack of medical necessity, as the doctor's testimony was deemed insufficient and biased, and there was no evidence to show that the prescribed supplies were inconsistent with generally accepted medical practices. As a result, judgment was entered in favor of the plaintiff for the amount at issue, plus statutory interest, costs, and attorney's fees.

The relevant facts of this case were that Mega Supply & Billing, Inc. was seeking to recover assigned first-party no-fault benefits, and their motion for summary judgment was denied by the Civil Court of the City of New York, Kings County. Mega Supply's motion was supported by an affirmation from their counsel, an affidavit by a corporate officer, and various documents. However, the affidavit executed by the corporate officer was found to be insufficient in establishing that they possessed personal knowledge of the company's practices and procedures, so as to lay a foundation for the admission of the documents as business records. The main issue decided was whether Mega Supply had established a prima facie case for summary judgment, which the court found they had not. The holding of the case was that Mega Supply's motion for summary judgment was properly denied, as they failed to make a prima facie showing of their entitlement to summary judgment.

The court considered whether or not an assignee of a claim was entitled to statutory interest and attorney's fees from an insurance company for overdue assigned first-party no-fault benefits. The main issue decided in this legal case was whether the interest accrued when the payment of no-fault benefits was overdue, which was based on the date the insurer received the claim, or from the date the action was commenced. The court held that in the case of no payment and an untimely denial, interest accrues 30 days from the date the claim is submitted. It was also decided that the terms "applicant" and "assignee" are used interchangeably in regulations, and that the State Superintendent's interpretation of the regulations was entitled to deference.

The court considered the facts of an action to recover assigned first-party no-fault benefits, in which plaintiff's motion for summary judgment was granted. The main issue was whether the defendant provided sufficient evidence to demonstrate that there was a triable issue of fact as to whether the automobile accident in which the plaintiff's assignor was allegedly injured was staged and not a covered event. The court held that the defendant's affidavit by its claims representative was insufficient to demonstrate the existence of a triable issue of fact, and therefore, the plaintiff's motion for summary judgment was properly granted.

The court considered the fact that V.S. Medical Services P.C. was seeking to recover first-party no-fault benefits for medical services rendered to its assignor in the sum of $3,836.20. The main issue decided was whether a billing provider is entitled to recover "direct payment" of assigned no-fault benefits from the defendant insurer when the medical services were not rendered by the billing provider or its employees, but by an independent contractor treating provider. The court held that under the circumstances of the case, where the claim form stated that the treating professionals were independent contractors, the billing provider was not entitled to recover "direct payment" of assigned no-fault benefits, and the denial of plaintiff's motion for summary judgment was affirmed.

The relevant facts the court considered in this case centered around a dispute over the payment of no-fault benefits for health care services. Plaintiff Olympic Chiropractic, P.C. submitted claims which established the amounts of the losses and that payment of benefits was overdue, and defendant, American Transit Insurance Co., admitted to receiving the claims. The main issue decided by the court was whether the defendant had validly sought verification of the plaintiff's assignor's social security number before refusing to pay certain claims. The holding of the case was that the defendant appropriately requested the verification, the plaintiff's failure to provide it justified the defendant's refusal to pay the claims, and the plaintiff's lawsuit on those claims was deemed premature.

In this case, Vista Surgical Supplies Inc. sued Allstate Insurance Co. for not paying first-party no-fault benefits for medical supplies furnished to its assignor. Vista moved for summary judgment, but the court denied the motion and granted Allstate's cross-motion for summary judgment. The main issue in this case was whether Vista established a prima facie entitlement to summary judgment according to Insurance Law § 5106 (a). The court found that Vista failed to provide sufficient evidence to demonstrate that the claim was mailed to Allstate, and therefore, did not establish its prima facie entitlement to summary judgment. The court affirmed the lower court's order denying Vista's motion for summary judgment and granting Allstate's cross-motion for summary judgment.