No-Fault Case Law

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.

Facts: This case involves an action for first-party benefits brought pursuant to the No-Fault Insurance Law by a health services provider who rendered medical services to a patient in exchange for the patient's rights to collect no-fault benefits. The plaintiff's claim for medical services was received by the defendant insurer on August 11, 2005, and the defendant made an initial verification request that was mailed on August 22, 2005. The plaintiff, however, did not respond to these verification demands. Issues: The main issue in this case is whether the production of an electronic signature assignment of benefits and NF-3 claim form in response to an insurer's verification demand recommences the running of a tolled 30-day no-fault insurance claim denial period. Decision: The court held that the insurer was not obligated to accept electronic records or signatures and may require that such records and signatures are submitted in hard copy form. Thus, the defendant's verification request was proper, and the plaintiff's claim was determined to be premature. As a consequence, the defendant's motion to dismiss the plaintiff's complaint was granted, and the plaintiff's cross motion for summary judgment was denied as moot.

The relevant facts considered by the court were that Capri Medical, P.C. sought to recover first-party No-Fault benefits for medical services provided to Nail Abusov. The plaintiff submitted proof of submitted statutory claim forms and alleged that the defendant issued untimely denials in response. The main issue decided by the court was whether the plaintiff was entitled to summary judgment as a matter of law. The holding of the case was that the plaintiff's motion for summary judgment was granted, and the plaintiff was awarded judgment in the amount of $4,204.33 plus statutory interest, costs, and attorneys' fees. The court found that the defendant failed to raise a triable issue of fact and that the plaintiff established a prima facie entitlement to summary judgment.

The main issue before the court was whether the plaintiff's assignor, Jonathan Laul, qualified for MVAIC no-fault benefits. The defendant argued that there was no coverage with MVAIC due to Laul's failure to qualify for these benefits and because the statute of limitations had expired. The plaintiff claimed that it had rendered services to Laul and submitted bills and claims to the defendant in accordance with no-fault regulations. The court considered the evidence submitted by both parties and ultimately held that the defendant failed to meet its burden of proof for summary judgment. Therefore, the motion for summary judgment by the defendant was denied.

The court considered the facts of a motor vehicle accident on January 27, 2003, and subsequent acupuncture treatments received by the injured party, along with the requirement to provide timely notice of claim to the defendant, Motor Vehicle Accident Indemnification Corporation (MVAIC). The main issue decided was whether the plaintiff fulfilled the reporting requirements of Insurance Law Article 52, specifically the requirement to provide a police report and notarized household affidavit to MVAIC to qualify for benefits. The holding of the court was that the plaintiff failed to establish that the claimant was a "covered person" entitled to MVAIC benefits by not timely filing a proper notice of claim, and therefore, the defendant's motion for summary judgment was granted, resulting in the dismissal of the plaintiff's cause of action for unpaid medical bills in the amount of $1,080.00.

The court considered the appeal of an order from the Civil Court of the City of New York, Queens County, which denied the plaintiff's motion for summary judgment in a case involving the recovery of assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had established a prima facie entitlement to judgment as a matter of law, and the court held that the plaintiff failed to do so due to deficiencies in the affidavit of the plaintiff's "corporate officer" and a lack of sufficient personal knowledge concerning the plaintiff's office practices with regard to the subject claims. Therefore, the court affirmed the judgment without costs, concluding that the denial of the plaintiff's motion for summary judgment was proper. No other issues were considered in light of this determination.

The relevant fact considered was that plaintiff's motion to recover assigned first-party no-fault benefits was supported by an affirmation from plaintiff's counsel, an affidavit by a corporate officer of plaintiff, and various documents annexed thereto. The main issue decided was whether the affidavit by plaintiff's corporate officer was sufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures so as to lay a foundation for the admission of the documents annexed to plaintiff's moving papers as business records. The court held that the affidavit submitted by plaintiff's corporate officer was insufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures, and as a result, plaintiff failed to make a prima facie showing of its entitlement to summary judgment. Therefore, the order was affirmed without costs.

The main issue in this case was whether the plaintiff, Delta Diagnostic Radiology, P.C., had demonstrated its prima facie entitlement to judgment as a matter of law in its action to recover assigned first-party no-fault benefits. The court considered the evidence presented by the plaintiff in support of its motion for summary judgment, which included an affirmation from counsel, an affidavit from a corporate officer, and various documents. The defendant argued that the plaintiff had failed to show that the documents constituted business records and lacked a statement from someone with personal knowledge regarding the documents annexed to the motion papers. The court ultimately held that the plaintiff had failed to demonstrate its prima facie entitlement to judgment as a matter of law, and affirmed the denial of the motion for summary judgment. The decision was based on the failure of the plaintiff's corporate officer to lay a foundation for the admission of the documents as business records.

The Supreme Court, Appellate Term, Second Department heard the case of Dan Medical, P.C., as Assignee of Renee Dyette v New York Central Mutual Fire Insurance Co. The dispute was over a claim for first-party no-fault benefits, with the health care provider plaintiff, Dan Medical, P.C., seeking to recover assigned benefits. Dan Medical filed a motion for summary judgment, and New York Central Mutual Fire opposed the motion and cross-moved for the depositions of various parties. The plaintiff's motion was granted, and the defendant's cross motion was implicitly denied. The court held that the plaintiff did not demonstrate a prima facie case for summary judgment because it failed to lay a proper foundation for its documents due to a lack of personal knowledge of the corporate officer's understanding of office practices. Therefore, the court reversed the order, denied plaintiff's motion for summary judgment, and sent the matter back to the lower court for de novo determination.

The relevant facts considered by the court included a case to recover first-party no-fault benefits for health care services provided. Plaintiff submitted claims and proof that the payment of benefits was overdue. Defendant submitted timely claim denials citing a lack of medical necessity, based on peer review and independent medical examination reports. The main issue was whether the denial forms provided were factually insufficient, conclusory, or vague, rendering the defense of no merit as a matter of law. The court decided that while the defendant was not required to attach the peer review and IME reports to the denial forms, the lack of medical necessity defense should have been interposed clearly and explicitly. The holding of the case was that the lower court's decision was reversed, and plaintiff's motion for summary judgment was granted, while the defendant's cross motion was denied, and the case was remanded for the calculation of statutory interest and an assessment of attorney's fees.