No-Fault Case Law

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.

The court considered the issue of whether the acupuncturists who rendered services for the plaintiffs were employees or independent contractors. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaints should be granted, based on the defense that the treating acupuncturists were independent contractors. The court held that summary judgment was unwarranted, as there were issues of fact as to whether the acupuncturists were employees or independent contractors. The reporting of annual pay on an IRS 1099 form was noted as being significant in assessing the relationship, but was only one of the relevant factors. Therefore, the court denied the defendant's motion for summary judgment and the decision and order of the court was that the employer-employee relationship issue should be further assessed.

The court considered the plaintiff's motion for summary judgment to recover first-party no-fault benefits for medical services rendered to its assignor. The main issue was whether the plaintiff established its prima facie entitlement to summary judgment, and whether the defendant raised a triable issue of fact. The court held that the plaintiff's affidavit and submitted documents were sufficient to establish its prima facie entitlement to judgment, as it demonstrated that it submitted claims and that payment of no-fault benefits was overdue. However, the defendant's affidavit and peer review reports raised triable issues of fact as to medical necessity, and the denials were found to be timely mailed. As a result, the court affirmed the order denying plaintiff's motion for summary judgment and awarded defendant $50 in costs.

The relevant facts the court considered in this case were that the plaintiff, Vista Surgical Supplies, Inc., was seeking to recover assigned first-party no-fault benefits for medical supplies furnished to its assignor. The main issue decided was that the plaintiff failed to establish a prima facie entitlement to summary judgment and the lower court's denial of plaintiff's cross motion for summary judgment was upheld. The holding of the case was that the lower court properly denied plaintiff's cross motion for summary judgment and the appeal by plaintiff, as a defaulting party, was dismissed. The court found that the plaintiff did not establish proof of proper mailing of the claims to the defendant, and therefore, failed to establish its prima facie entitlement to summary judgment. The defendant's motion to dismiss the complaint to the extent of directing plaintiff to provide responses to defendant's discovery demands was granted. The court also noted disagreement with certain propositions of law set forth in cases cited in the majority opinion.

The relevant facts in this case included Midborough Acupuncture P.C.'s action to recover $1,107.51 in first-party no-fault benefits for health care services rendered to its assignor. The insurance company, State Farm, did not deny the claims within the 30-day claim determination period and failed to establish that it tolled the statutory time period by mailing verification and follow-up requests to plaintiff. Following this, plaintiff moved for summary judgment, but the court reversed the order, denied the motion and granted defendant's cross motion to the extent of directing that plaintiff shall respond to those discovery demands which seek information regarding whether plaintiff was fraudulently incorporated, within 30 days or within such other reasonable time period as the parties stipulate. The main issue decided by the court was whether plaintiff, as a provider of health care services, was eligible for reimbursement of no-fault benefits. The holding of the case was that the defense that plaintiff was not eligible for reimbursement was not subject to preclusion, and that discovery requests seeking information to determine whether the owners of a medical service corporation are improperly licensed are germane to the question of whether said corporation is eligible for reimbursement. Thus, plaintiff's motion for summary judgment was denied and defendant's cross motion was granted to the extent of directing that plaintiff shall respond to defendant's discovery demands which seek information regarding the ownership, control, and licensing of plaintiff corporation within 30 days of the date of the order entered hereon.

The court considered whether a medical corporation that was fraudulently incorporated under specific business laws is entitled to be reimbursed by insurers for medical services rendered by licensed medical practitioners. The main issue was whether a medical corporation, in violation of Business Corporation Law and Education Law, is eligible for reimbursement from insurers for medical services performed. The Court of Appeals decision in State Farm Mut. Auto. Ins. Co. v Mallela established that such medical corporations were not entitled to reimbursement. Furthermore, the court found that the regulation did not apply retroactively, but prospectively, and concluded that these fraudulently incorporated medical corporations were not entitled to recover a judgment against an insurer for assigned first-party no-fault benefits. Therefore, the order was affirmed, and the regulation altered the common law prospectively.

The relevant facts considered by the court were that plaintiffs A.B. Medical Services PLLC and D.A.V. Chiropractic P.C. were attempting to recover first-party no-fault benefits for health services rendered to their assignor. These plaintiffs established their prima facie entitlement to summary judgment by proving that they submitted claims, setting forth the fact and amounts of the losses sustained, and that payment of no-fault benefits was overdue. The main issues decided by the court were the sufficiency of the denial of claim forms by the defendant and whether the plaintiffs had established the validity of the assignments as part of their prima facie case. The holding of the court was that the denial was inadequate to establish a factual basis and medical rationale sufficient to demonstrate the lack of medical necessity and that the plaintiffs did not have to establish the validity of the assignments as part of their prima facie case. Therefore, the denial of some of the claims was deemed insufficient and summary judgment was awarded to the plaintiffs in the principal sum of $8,682.82 and partial summary judgment was awarded to another plaintiff in the principal sum of $370.70. The case was remanded for entry of judgment and the calculation of statutory interest and attorney's fees.

The case involved a dispute over an action to recover no-fault benefits. The plaintiffs appealed an order of the Supreme Court, Nassau County, which denied their motion for summary judgment, and granted the defendant's motion to dismiss the cause of action. The main issue was whether the defendant had established a meritorious defense to the first cause of action, which was based on the defendant's alleged cancellation of the policy of insurance covering the subject vehicle before the date of the accident. The holding of the court was that the defendant had indeed established a defense, as the policy did not provide coverage for the claim, and the insurer effectively canceled the policy. Therefore, the appeal was dismissed, and the order of the Supreme Court was affirmed.

The relevant facts considered by the court were that Accessible and Advance Medical P.C. provided medical services to an individual, and was seeking to recover first-party no-fault benefits for these services from Allstate Ins. Co. The main issue before the court was whether Accessible and Advance Medical P.C. was entitled to summary judgment for its claim of $1,546.20, and whether Allstate Ins. Co. was entitled to summary judgment for the denial of the claim. The court held that Accessible and Advance Medical P.C. was entitled to summary judgment on both of its claims and that the matter was remanded to the court for the calculation of statutory interest and an assessment of attorney's fees pursuant to Insurance Law § 5106(a) and the regulations promulgated thereunder.