No-Fault Case Law

The main issue in this case was whether the appellant was timely notified of the insurance company's notification provisions. The appellant was in an automobile accident and filed a no-fault claim with the insurance company, from which she initially received benefits. The benefits were later cancelled after an independent medical examination found her injuries non-serious. She later claimed underinsured coverage under the SUM provisions of her policy, but the insurance company disclaimed coverage based on her failure to timely notify them of her claim. The court reversed the order and judgment of the Supreme Court, Nassau County, and ordered a new determination of the petition after a hearing on the issue of prejudice to the insurance company. The legal holding of this case is that the insurance company had to show prejudice before relying on the policy provisions requiring timely notice of the SUM claim, and a hearing was required on this issue prior to the determination of the petition.

The case involved an action for a declaratory judgment by the plaintiff, an injured police officer, against the defendant, the Incorporated Village of Lake Success, seeking to determine whether he is obligated to reimburse the village for the money paid to him pursuant to General Municipal Law § 207-c. The plaintiff was also seeking underinsured motorist benefits from a separate defendant, the American Protection Insurance Company, the insurer of the police vehicle. The main issue was whether the village was entitled to assert a lien against any arbitration award the plaintiff might recover from the insurance company in the amount that the village had paid to him pursuant to General Municipal Law § 207-c. The court held that the village was not entitled to assert a lien pursuant to General Municipal Law § 207-c (6), and therefore improperly granted the village's cross-motion. The court concluded that the plaintiff was not obligated to reimburse the village for the money it paid pursuant to General Municipal Law § 207-c, and the village was not entitled to a lien against any award the plaintiff receives in his underinsured motorist arbitration.

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.