No-Fault Case Law

The relevant facts the court considered were that Starrett Medical L.C.P.C was seeking to recover assigned first-party no-fault benefits from GEICO Casualty Insurance Company. The issues decided were whether the plaintiff's moving papers established entitlement to summary judgment and whether the defendant's denial of claim forms set forth a sufficient factual basis and medical rationale for denial based on lack of medical necessity. The holding of the court was that the plaintiff's moving papers were insufficient to establish the mailing of claim forms, but this deficiency was cured by the defendant's denial of claim forms. Additionally, the court held that the defendant was precluded from asserting lack of medical necessity as a defense due to the insufficient factual basis for the denial. Consequently, the order granting the plaintiff's motion for summary judgment was affirmed.

The relevant facts in this case involved a health care provider filing a lawsuit to recover reimbursement from a no-fault insurer for services rendered to the provider's assignors. The insurer had received eight separate bills, all unpaid and were not denied. Two main issues were presented: determining the statutory attorney's fees due to the plaintiff, and the statutory interest due to the plaintiff, as well as when the interest should accrue. The Court held that interest accrued on each claim 30 days from the date of submission of each claim, with the plaintiff being awarded attorney's fees for each individual claim. The Court rejected the insurer's argument to aggregate the claims and determined that the statutory attorney's fees were to be awarded as per each bill submitted through an NF-3 proof of claim.

The relevant facts the court considered were that the plaintiff, Vista Surgical Supplies, Inc., was seeking to recover assigned, first-party no-fault benefits from the defendant, American Transit Insurance Co. The main issue decided was whether the plaintiff had submitted the subject claim form to the defendant, as required in a no-fault benefits case. The court held that the plaintiff did not establish that the claim form had been submitted to the defendant, and that the evidence presented by the plaintiff's counsel in a reply affirmation was inadmissible and improperly introduced. Therefore, the court affirmed the lower court's decision to deny the plaintiff's motion for summary judgment.

In the case of Impulse Chiropractic P.C. v Travelers Ins. Co., the main issue was whether the plaintiff had established a prima facie entitlement to summary judgment in an action to recover assigned first-party no-fault benefits. The court considered the fact that the plaintiff did not adequately establish that it submitted its claim forms to the defendant, which is necessary to demonstrate a prima facie entitlement to summary judgment. The plaintiff failed to prove that it mailed the claims to the defendant, which is typically established by proof of proper mailing or proof of a standard office practice. The court found that the affidavit of the plaintiff's corporate officer was insufficient to establish that the claims were mailed, and the attorney's affirmation was not based on personal knowledge. Additionally, the plaintiff's attempt to demonstrate the defendant's receipt of the claims through delay letters was ineffective because the letters did not specifically refer to the claims in question. As a result, the court affirmed the lower court's decision to deny the plaintiff's motion for summary judgment.

The court considered an appeal from an order of the Civil Court that denied the plaintiff's motion for partial summary judgment in an action to recover first-party no-fault benefits for medical services rendered to its assignor. The main issue decided was whether a billing provider seeking to recover no-fault benefits for services rendered by treating health care providers who are independent contractors is considered a "provider" of the health care services within the meaning of the law. The court held that where a billing provider seeks to recover no-fault benefits for services rendered by independent contractors, it is not considered a "provider" of the health care services within the meaning of the law and is therefore not entitled to recover direct payment of assigned no-fault benefits from the insurer. The court also held that lack of specificity in the business relationship of the treating provider does not establish plaintiff's prima facie entitlement to summary judgment as a matter of law.

The relevant facts the court considered were that Avenue N Medical, P.C. initiated a compulsory arbitration proceeding against New York Central Mutual Fire Insurance Company to recover first-party no-fault benefits for medical services rendered to its assignor following an automobile accident. The arbitrator and master arbitrator both denied Avenue's claim for benefits. Avenue then sought to vacate the master arbitrator's award, but the court below denied the petition, finding a rational basis for the master arbitrator's determination. The main issue decided by the court was whether there was a rational basis for the master arbitrator's decision to deny Avenue's claim for benefits. The court held that there was a rational basis for the master arbitrator's determination, and, pursuant to CPLR 7511 (e), the court was required to confirm the award. Therefore, the holding of this legal case was that the court affirmed the denial of the petition to vacate the master arbitrator's award and added a provision confirming the award. The case concluded that a special proceeding should terminate in a judgment, not an order.

The court considered the fact that the plaintiff established its entitlement to summary judgment by showing that it submitted claims and that payment of no-fault benefits was overdue. The court also considered the defendant's verification requests for independent medical examinations (IMEs) and the plaintiff's assignor's failure to attend these IMEs. The main issues decided were that the plaintiff was awarded partial summary judgment in the principal sum of $357.94, and the matter was remanded for the calculation of statutory interest and an assessment of attorney's fees. The holding was that the defendant failed to show a triable issue of fact as to the medical necessity of the services rendered, and that the plaintiff is entitled to partial summary judgment in the principal sum of $357.94.

The relevant facts considered by the court in this case included 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. The main issue decided was whether the plaintiff had established a prima facie case by presenting proof that it submitted statutory claim forms and that payment of no-fault benefits was overdue. The court held that the affidavit executed by the plaintiff's corporate officer failed to establish submission of the claim form, and that the plaintiff did not adequately establish that it submitted the claim form to the defendant. Therefore, the order was affirmed without costs. In summary, the court considered the lack of evidence to support the submission of the statutory claim forms by the plaintiff, and ultimately held that the burden never shifted to the defendant, resulting in the denial of the plaintiff's motion for summary judgment.

The relevant facts considered by the court were that Delta Diagnostic Radiology, P.C. sought to recover first-party no-fault benefits for medical services rendered to its assignor. The plaintiff submitted a statutory claim form and claimed that payment of no-fault benefits was overdue. The main issue was whether the defendant's denial of the claim was sufficient, as the plaintiff argued that the denial did not explicitly set forth the reason for the denial. The court decided that the defendant "fully and explicitly" set forth the reasons for the denial in its peer review report, raising a triable issue of fact. The holding of the case was that the court affirmed the denial of the plaintiff's cross motion for summary judgment, finding that the defendant's denial was sufficient.

The court considered the requirements for a prima facie showing of entitlement to summary judgment in a first-party no-fault benefits case. The main issues decided were whether the plaintiff had submitted a claim and whether the defendant's denial was untimely. The holding of the case was that the plaintiff had failed to establish a prima facie entitlement to summary judgment, as it did not provide sufficient proof that it submitted the claim to the defendant. The court also found that the defendant's denial was untimely and that the defendant had failed to establish a triable issue of material fact as to fraud. The dissenting opinion argued that the majority's decision expanded the requirements for a prima facie case and allowed for a relaxed standard in no-fault matters.