No-Fault Case Law

The court in the case of Meridian Acupuncture Care v Geico Ins. Co. considered the plaintiff's proposed class action to recover payments for acupuncture treatments. The main issue was whether New York Insurance Department regulation 68 required the defendant to use only licensed acupuncturists for independent medical examinations of patients who received acupuncture treatment. The court determined that the regulation did not contain such a requirement, and no license or certification was necessary for a physician conducting an independent medical examination of a patient who received acupuncture treatment. Therefore, the court held that the plaintiff's claims were based on an erroneous proposition and the complaint was properly dismissed for failure to state a cause of action. The court decided in favor of the defendant, Geico Insurance Company, and affirmed the dismissal of the complaint.

The Supreme Court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion to dismiss the action pursuant to CPLR 3211 (a) (5) in an action to recover no-fault benefits under a policy of automobile insurance. The court's decision was based on the doctrine of collateral estoppel, which bars a party from relitigating an issue raised and decided against them in a prior action or proceeding. The defendant demonstrated that the issues raised in a prior arbitration proceeding were identical to and decisive of the plaintiff's present cause of action, and the plaintiff failed to demonstrate that she did not have a full and fair opportunity to litigate those issues. The court found that the arbitrator's determination should have collateral estoppel effect, and therefore affirmed the order without costs or disbursements.

The court considered that the plaintiff had submitted a claim for no-fault benefits and established prima facie entitlement to summary judgment, as well as that the defendant had failed to timely seek verification of the assignment or the NF-3 form. The main issue in the case was whether the court erred in denying the plaintiff's cross-motion for summary judgment. The court held that the deficiencies referred to by the court below were waived because the defendant failed to timely seek verification of the assignment or the NF-3 form, and that the defendant failed to create a triable issue of fact in opposition to plaintiff's cross motion for summary judgment. Therefore, the court reversed the order, granted plaintiff's cross motion for summary judgment, and remanded the matter for the calculation of statutory interest and an assessment of attorney's fees.

The main issue in the case was whether the defendant, Progressive Casualty Insurance Co., was precluded from asserting the defense of lack of coverage, despite their untimely denial of the plaintiff's claim for no-fault benefits. Plaintiff, Psychology & Massage Therapy Assoc., PLLC, had moved for partial summary judgment as to its ninth cause of action, which was a $1,360.48 claim of its assignor, Isabel Gonzalez. The court found that the defendant was not precluded from asserting the defense of lack of coverage, and that their assertion that Isabel Gonzalez did not reside with the insured was sufficient to demonstrate a "founded belief" that the alleged injuries did not arise out of an insured incident. As a result, the court affirmed the order granting plaintiff's motion for partial summary judgment as to its ninth cause of action, and denied defendant's cross motion for partial summary judgment as to said cause of action. The defendant's arguments were deemed sufficient to raise a "founded belief" that the plaintiff's assignor was not an eligible insured entitled to receive no-fault benefits.

The court considered the fact that New York and Presbyterian Hospital was seeking to recover no-fault benefits from New York Central Mutual Fire Insurance Company under an insurance contract. The main issue in the case was whether the plaintiff hospitals had standing to bring the action. The court decided that the plaintiff hospitals lacked standing, as the proof presented at trial included unsigned assignment of benefit forms as evidence. As a result, the judgment in favor of the plaintiffs was reversed, the defendant's motion was granted, and the complaint was dismissed. The decision was supported by the concurring Justices Schmidt, Adams, Luciano and Lifson.

The court considered a notice to admit sent to the defendant by the plaintiff regarding assigned first-party no-fault benefits for medical service provided to Guillermo Rios and Criselda Rodriquez. The plaintiff relied on the defendant's failure to respond to establish a prima facie case. The court determined that the defendant was deemed to have admitted all the facts alleged in the notice to admit because it did not respond within 20 days. However, the court also found that the plaintiff did not make out a prima facie case, as copies of the NF-3 claim forms or their functional equivalent were not received in evidence. Therefore, the court ordered judgment to be entered in favor of the defendant, dismissing the action.

The relevant facts considered by the court were that the plaintiff was seeking to recover excess no-fault benefits paid on behalf of its insured due to a motor vehicle accident caused by the defendant's truck driver. The main issue decided was whether the defendant's negligence in the operation of the truck was established, and whether the plaintiff was entitled to summary judgment on the issue of liability to recover the excess no-fault benefits. The court held that the plaintiff met its initial burden in establishing the defendant's negligence through an affidavit by its insured, and the burden shifted to the defendants to raise any triable issue. Since the defendants failed to provide an affidavit from the driver and did not raise any triable issue, the court found it an established fact that the accident was solely caused by the defendant's culpable conduct. However, the plaintiff was not entitled to summary judgment on the issue of liability due to triable issues of fact regarding a release executed by the insured in favor of the defendants.

The primary factual matter considered was whether the defendant had sent a timely mailing of a denial form to the plaintiff. The main issue in this case was whether the defendant successfully established a triable issue of material fact in opposition to the plaintiff's motion for summary judgment. The court held that the defendant had provided sufficient evidence through an affidavit with personal knowledge of the facts, which demonstrated the form's actual mailing, as well as the defendant's standard operating procedures for ensuring the mailing of the denial. Therefore, the court deemed that the defendant had established a triable issue of fact, and the order was affirmed with some modification. The plaintiff's motion for summary judgment was ultimately denied.

The relevant facts considered by the court were that the plaintiff, Boai Zhong Yi Acupuncture Services P.C., sought to recover first-party no-fault benefits for health care services rendered to its assignor, Stefaniya Martynuk, and moved for summary judgment. The plaintiff submitted three NF-3 forms, but on two of the forms, the required information was not completed. On the third form, the treating provider was identified as an independent contractor. The main issue decided was whether a billing provider who seeks to recover no-fault benefits for services rendered by an independent contractor treating provider is entitled to recover "direct payment" of assigned no-fault benefits from the insurer. The court held that the plaintiff's motion for summary judgment was properly denied due to the factual issues raised by the plaintiff's submissions, and therefore affirmed the order without costs. The court did not address any other issues in the case.

The court considered the denial of the plaintiff's cross motion for summary judgment in an action to recover overdue first-party no-fault benefits for a CAT scan provided to its assignor. The main issue decided was whether the defendant's affirmed peer review report established a triable issue of the procedure's medical necessity. The court held that the peer reviewer's conclusion, which stated that the available medical documentation did not establish the medical necessity of a CAT scan, was sufficient to raise a triable issue of the procedure's medical necessity. Therefore, the court affirmed the order denying the plaintiff's cross motion for summary judgment.