No-Fault Case Law

The relevant facts the court considered were that M.G.M. Psychiatry Care P.C. had submitted claims for first-party no-fault benefits to Utica Mutual Insurance Company, and that payment was overdue. The main issue decided was whether the defendant had timely denied the claims within the 30-day statutory period. The holding of the case was that the deficiencies in the plaintiff's moving papers were cured by the denial of claim forms, and that the defendant had failed to timely deny the claims, making them precluded from raising certain defenses. Therefore, the order granting the plaintiff's motion for summary judgment was affirmed.

The relevant facts the court considered were that the plaintiff, Bronxborough Medical, P.C., was seeking to recover assigned first-party no-fault benefits from Allstate Insurance Co., who denied the claim on the grounds that the injuries were not caused by the accident. The main issue decided by the court was whether the plaintiff's failure to respond to defendant's discovery demands and appear for an examination before trial warranted the dismissal of the complaint, or if the plaintiff should be compelled to respond to the discovery demands and appear for an examination before trial. The holding of the court was that the plaintiff's failure to challenge the defendant's notice of discovery within the prescribed time "foreclosed inquiry into the propriety of the information sought except with regard to requests that are privileged under CPLR 3101, or as to requests which are palpably improper" and therefore, the order compelling plaintiff to respond to defendant's discovery demands and appear for an examination before trial was affirmed.

The relevant facts considered in this case were that Vista Surgical Supplies, Inc. was seeking to recover no-fault benefits from Liberty Mutual Insurance Co. after having its motion for summary judgment denied. The main issue decided was whether Vista Surgical Supplies, Inc. had submitted the claims for no-fault benefits and established that payment was overdue in order to be entitled to summary judgment. The court determined that in order to establish a prima facie entitlement to summary judgment, Vista Surgical Supplies, Inc. had to prove that it submitted the claims and that payment was overdue. The holding of the case was that Vista Surgical Supplies, Inc. failed to provide competent proof that the claim forms were mailed to Liberty Mutual Insurance Co., and therefore their motion for summary judgment was properly denied.

The court considered an appeal from an order denying plaintiff's motion for summary judgment and granting defendant's cross motion to compel discovery in a case to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff health care provider had established a prima facie entitlement to summary judgment by proving submission of claim forms to the defendant. The court held that the plaintiff failed to adequately establish proof of proper mailing and submission of claim forms, as required by law. The court also dismissed the appeal from the portion of the order granting defendant's cross motion to compel discovery, as the plaintiff failed to submit written opposition to the cross motion, resulting in a default. Therefore, the court affirmed the order to deny plaintiff's motion for summary judgment and dismissed the appeal from the portion of the order granting defendant's cross motion to compel discovery.

The relevant facts of the case were that Bronx Expert Radiology, P.C. had filed a motion for summary judgment, as it believed that it had responded to Travelers Insurance Co.'s verification request. However, the affidavit of plaintiff's representative did not create a presumption of mailing, as it did not state that the verifications were actually mailed to the defendant, nor did it describe the plaintiff's mailing office practice and procedures. The main issue was whether the insurer was obligated to pay or deny a claim before receiving verification of all relevant information requested. The holding of the case was that the motion for summary judgment should have been denied, as the plaintiff's submission was insufficient to raise a presumption of receipt, and the matter was remanded to Civil Court for further proceedings.

The relevant facts the court considered in this case were that the plaintiff was seeking first-party no-fault benefits for medical services rendered to its assignors, and the defendant, an insurance company, had moved for summary judgment dismissing the complaint based on allegations of fraud related to the accident. The main issue decided was whether the plaintiff had standing to bring the action and whether the defendant's untimely denial of the claims was justified. The holding of the court was that defendant's motion for summary judgment was denied, plaintiff's cross motion for summary judgment was granted, and the matter was remanded for the calculation of statutory interest and an assessment of attorney's fees pursuant to Insurance Law. The court found that the defendant had waived any defenses based on the assignment of benefits forms and failed to demonstrate the existence of a triable issue of fact related to the lack of coverage.

The court considered the facts surrounding a dispute between Amol, Inc. and Travelers Ins. Co. regarding the denial of plaintiff's claim for first-party no-fault benefits. The main issue decided was whether defendant's denial of plaintiff's claim was untimely, and if defendant was precluded from raising its defense of lack of medical necessity. The court held that the denial of plaintiff's claim was not untimely, as the affidavit of plaintiff's owner failed to establish the date the claim was mailed to defendant. It was also established that defendant denied plaintiff's claim on the ground of lack of medical necessity, and since plaintiff failed to establish that the denial of claim form was untimely, defendant was not precluded from raising its defense. Therefore, the lower court's denial of plaintiff's cross motion for summary judgment was affirmed.

The relevant facts considered by the court in this case involved a dispute between Mary Immaculate Hospital and Countrywide Insurance Company over $55,105.27 in medical services provided to Thomas Matamoros. The main issue decided by the court was whether the insurance company was required to pay for the medical services or whether they could deny the claim based on an alleged exclusion in the insurance policy. The holding of the case was that the hospital was awarded summary judgment against the insurance company for the amount of $55,105.27, along with statutory interest, attorney's fees, costs, and disbursements, as the court found that the insurance company failed to provide evidence to establish entitlement to apply the alleged exclusion from coverage.

The case involved a commercial claim brought by Proscan Radiology of Buffalo, Proscan Imaging, Buffalo, & Dr. Gurmeet Dhillon against Progressive Casualty Insurance Company. It began in the small claims part of the City Court of Buffalo and was adjourned at the consent of both parties. The main issue decided was the amount of payment owed by Progressive Casualty Insurance Company to the claimants. The court considered the evidence presented by both parties and ultimately held that Progressive Casualty Insurance Company was required to make a payment of $2,297.74 to the claimants.

The court considered the fact that the plaintiff filed a motion for summary judgment to recover first-party no-fault benefits for health care services rendered to its assignor. The defendant had timely sent requests for verification, which it argued tolled the 30-day period within which it was obligated to pay or deny the claims. The main issue decided was whether the defendant had established the timely mailing of its verification requests. The holding of the court was that the defendant's opposition papers established the timely mailing of the verification requests, therefore tolling the 30-day period. As a result, the denials of claims were not untimely, and the plaintiff's motion for summary judgment was denied.