No-Fault Case Law

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County that denied the plaintiff's motion for summary judgment for first-party no-fault benefits for health care services rendered. The main issues decided were whether the plaintiff was entitled to the sum of $1,856.42 and whether the denials of the claims were proper. The court held that the plaintiff was entitled to summary judgment and granted the motion for the sum of $1,856.42. The court also remanded the matter to the court below for the calculation of statutory interest and an assessment of attorney's fees pursuant to Insurance Law § 5106 (a) and the regulations promulgated thereunder.

The court considered the motion for summary judgment filed by the defendants in a case involving a dispute over first party no-fault benefits. The defendants argued that they were entitled to summary judgment as the plaintiffs' assignors did not respond to their requests for statements regarding the accident and medical treatment, and that they did not receive the remaining claims. The main issue decided was whether the defendants were entitled to summary judgment dismissing the complaint. The holding of the case was that the defendants were entitled to summary judgment, as it was uncontroverted that the plaintiffs' assignors did not comply with the defendants' requests for statements, and the plaintiffs' submissions in opposition were insufficient to raise triable issues of fact. Therefore, the court reversed the order of the Civil Court and granted the defendants' motion for summary judgment dismissing the complaint.

The court considered the case of Booth Chiropractic & Acupuncture PLLC a/a/o Andre Rosemond v State Farm Mutual Automobile Insurance Company, where the plaintiff sought to recover first-party no-fault benefits. The plaintiff moved for summary judgment, and the defendant cross-moved for summary judgment dismissing the action. The main issue was whether plaintiff's submission of inconsistent affidavits from its treating physician raised a triable issue of fact. The court held that plaintiff's motion for summary judgment was properly denied because of the inconsistent affidavits, which raised a triable issue of fact. The order was affirmed without costs.

The court considered the case of Prestige Medical & Surgical Supply, Inc., seeking to recover first-party no-fault benefits for medical supplies furnished to its assignor. The main issue decided was the provider's right to summary judgment when it establishes a prima facie entitlement to no-fault benefits by submitting a claim setting forth the fact and amount of the loss sustained and showing that payment of benefits was overdue. The holding of the court was that the lower court erred in denying the plaintiff's motion for summary judgment, and the matter was remanded for the calculation of statutory interest and assessment of attorney's fees. The court found that the plaintiff established a prima facie case, and the burden shifted to the defendant to demonstrate a triable issue of fact, which they failed to do by failing to establish timely denial of claim forms. The court also did not find the defense's argument regarding verification requests to be credible.

The main issue in this case was whether Allstate Insurance Company could obtain a judicial stay on an arbitration commenced by Sallie Merrick on the grounds that the claim was barred by the statute of limitations. Allstate argued that it was still free to seek a stay despite its participation in the arbitration because Merrick did not comply with the provisions of CPLR 7503(c). However, the court held that because Allstate participated in the arbitration proceedings by making an opening statement, cross-examining Merrick, and submitting evidence, it waived its rights to seek a judicial stay. The court also ruled that Allstate's argument, that there were statute of limitations issues, was unavailing as Allstate was required to commence a special proceeding before participating in the arbitration. Therefore, the court denied Allstate's petition and dismissed the proceeding.

The court considered the case of A.M. Medical Services, P.C. seeking to recover first-party no-fault benefits for medical services rendered to its assignor. The relevant fact considered was the submission of statutory claim forms and the denial of the claim by the insurance company. The main issue decided was the entitlement to summary judgment by the medical service provider for overdue payment of no-fault benefits. The holding of the case was that the plaintiff established a prima facie entitlement to summary judgment, particularly in relation to the $1,784.95, $205.77, $2,290 and $390.85 claims, due to the insurance company's failure to establish the mailing of verification requests, and was granted partial summary judgment for those claims. They affirmed the defendant's denial of the claim for $1,968.36, as the insurance company timely denied the plaintiff's claim based on a sufficiently detailed affirmed peer review. The court also denied the defendant's cross motion for summary judgment dismissing the action.

The court considered the fact that the case involved a claim to recover assigned first-party no-fault benefits, and involved a dispute over the medical necessity of certain diagnostic tests conducted by the plaintiff. The main issue decided was whether the testimony of the defendant's expert, which was based on medical records prepared by the plaintiff, should be precluded. The court held that the plaintiff's challenge to the reliability of the medical records was not valid because they were prepared by the plaintiff's principal, who personally treated the assignor and conducted the tests in question. Therefore, the defendant's expert opinion, based on those records, was deemed to be derived from a reliable source and not precluded. The case was reversed, with costs, and remanded for a new trial.

The main issue in this legal case was whether the plaintiff had established a prima facie entitlement to summary judgment in an action to recover no-fault benefits for medical supplies furnished to its assignor. The plaintiff moved for summary judgment and the defendant cross-moved to compel examinations before trial of the plaintiff, plaintiff's assignor, and plaintiff's treating physicians. The court denied the plaintiff's motion for summary judgment and granted the defendant's cross-motion to the extent of directing all parties to appear for examinations before trial. The plaintiff failed to establish that it submitted the claim forms to the defendant or that the payment of no-fault benefits was overdue. The court held that the plaintiff failed to establish its prima facie entitlement to summary judgment and affirmed the denial of the plaintiff's motion for summary judgment. The plaintiff's appeal was dismissed, and the decision was made on August 14, 2006.

The court in this case considered a dispute between Pueblo Medical Treatment, P.C. and State Farm Mutual Automobile Insurance Company regarding the denial of no-fault benefits. The main issues decided were the dismissal of the third and fourth causes of action pertaining to an assignor, Ramon Albino, due to the claims being submitted to arbitration prior to the commencement of the action. The court also affirmed the denial of State Farm's cross-motion for summary judgment seeking dismissal of the causes of action pertaining to assignors Odilis Garcia and Gilberto Hernandez, stating that there were issues of fact regarding the defenses raised by the insurance company. The holding of the court was that the denial of State Farm's cross-motion for summary judgment was affirmed, but certain aspects of the discovery and the dismissal of certain causes of action were modified.

The court considered the defendant's appeal from an order of the Civil Court, which denied its cross motion to compel discovery and granted the plaintiff's motion for a protective order. The main issue decided was whether the plaintiff must fully respond to item 10 of the defendant's demand for discovery and inspection, and comply with the defendant's amended notice of examination before trial. The court held that the plaintiff is directed to fully comply with item 10 of the demand for discovery and inspection, as it pertains to the employment status of the treating health provider and is relevant to the issue of whether the medical services were performed by an independent contractor. The court also held that the plaintiff's motion for a protective order with regard to the defendant's remaining discovery demands was properly granted, as the disclosure sought was deemed improper, duplicative, unduly burdensome, irrelevant, and pertaining to defenses not at issue in the case. Furthermore, the court ruled that the defendant did not meet the threshold requirement of "good cause" and was not entitled to disclosure pertaining to a defense related to potential fraudulent incorporation of a professional corporation.