No-Fault Case Law

The plaintiffs sought to recover no-fault medical payments for services rendered to Richard Udland and Cindy Garone to which they believe they were entitled. They filed a motion for summary judgment on their second cause of action, but it was denied by the Supreme Court, Nassau County. The main issue before the Appellate Division, Second Department, was whether the plaintiffs could provide proof that the prescribed statutory billing forms were mailed and received, and that payment of no-fault benefits was overdue. The court found that the plaintiffs failed to submit proper evidence to establish that the subject hospital bill was mailed and received by the defendant. As a result, the order of the Supreme Court was affirmed as appealed, with the plaintiffs failing to meet their initial burden of showing prima facie entitlement to judgment as a matter of law.

The court considered the defendant's failure to appear and answer in this action to recover first-party no-fault benefits. The main issues decided were whether the plaintiffs had provided sufficient proof of submitting the claims to the defendant in order to be entitled to a default judgment, and whether the defendant had a reasonable excuse for their default in answering the claim. The holding of the case was that the plaintiffs had failed to establish the submission of the claim forms to the defendant, and upon reargument, the defendant's motion for renewal should have been granted and the underlying motion for leave to enter a default judgment denied. The court also found that the defendant had a reasonable excuse for their default in answering and that they had a meritorious defense. Therefore, the decision was modified to grant defendant's cross motion and to permit defendant to file and serve its answer within 30 days.

The court considered an appeal from an order of the Civil Court that denied the plaintiff's motion for partial summary judgment to recover $6,544.71 in first-party no-fault benefits for medical services rendered. The main issue decided was whether the health care providers had established a prima facie entitlement to partial summary judgment by proving the submission of claims, the amounts of losses sustained, and that payment of no-fault benefits was overdue. The court held that the affidavit provided by the medical billing manager of the plaintiff provider companies was insufficient to establish the plaintiff's prima facie entitlement to partial summary judgment. Therefore, the order of the court below was affirmed without costs.

The relevant facts considered by the court in this case involved an action to recover no-fault insurance benefits on behalf of Mount Sinai Hospital, as the assignee of Lily Sagiv. The main issue that was decided was whether the defendant, Allstate Insurance Company, was entitled to summary judgment dismissing the first cause of action on the ground that the policy limits had been exhausted. In its holding, the court reversed the lower court's decision, granting summary judgment to the plaintiffs, and instead granted the defendant's cross motion for summary judgment dismissing the first cause of action, as the defendant had established its entitlement to judgment as a matter of law based on the exhaustion of policy limits. The court found that the plaintiffs had failed to raise a triable issue of fact, and therefore dismissed the first cause of action.

The court considered two consolidated cases involving a health services provider's claim for compensation for an electrical diagnostic test known as current perception threshold testing (CPT) and sensory nerve conduction threshold testing (sNCT). The defendant argued that the medical tests are not compensable under Medicare and that the tests constituted "provider fraud." The court took judicial notice of statements issued by the federal Centers for Medicare and Medicaid Services, which classified CPT and sNCT as procedures not compensable under Medicare. The court found that the available scientific evidence did not demonstrate the accuracy of sNCT as compared to nerve conduction studies and concluded that the scientific and medical literature did not demonstrate the tests' necessity for diagnosing sensory neuropathies in Medicare beneficiaries. Therefore, the court held that the health services provider's claims for compensation for CPT and sNCT were denied.

The main issue in the case is whether the "no-prejudice" rule applies and whether the requirement for timely notice was satisfied. American Transit Insurance Company sought a judgment declaring that it did not have to defend or indemnify the insureds or the victim, arguing that neither the insureds nor the victim provided timely notice of litigation, and that a showing of prejudice was not required before it could disclaim on this basis. Leong cross-moved to dismiss American Transit's complaint, claiming that American Transit's motion was premature and that he had given it timely notice. The court held in favor of the victim, finding that American Transit had timely knowledge of the accident and was well aware of Leong's counsel's involvement in the matter, and it would not permit American Transit to manipulate its own notice requirements to deny coverage to a victim.

The court considered the facts that a plaintiff had submitted claims for first-party no-fault benefits, that payment of these benefits was overdue, and that the defendant had denied the claims. The main issue decided was whether the plaintiff provider had established a prima facie entitlement to summary judgment, and whether the defendant's denials of the claims were timely made within the 30-day statutory period. The holding of the court was that while the plaintiff had established entitlement to summary judgment, the defendant's denial of the claims were not untimely, and therefore, the plaintiff's motion for summary judgment was denied. The court also held that the defendant was not precluded from asserting the defense that the collision was in furtherance of an insurance fraud scheme, despite its untimely denial of the claims.

The relevant facts considered by the court in this case were that New York and Presbyterian Hospital was seeking to recover no-fault benefits under an insurance contract with Allstate Insurance Company. The main issue decided was whether the hospital was entitled to summary judgment on the first cause of action and whether the insurer's cross motion for summary judgment dismissing that cause of action should be granted. The holding of the court was that the Supreme Court should have denied the hospital's motion for summary judgment as it failed to establish entitlement to judgment as a matter of law. Additionally, the insurer's cross motion for summary judgment dismissing the first cause of action should have been granted as it was shown that the policy's coverage limits had been exhausted before the obligation to pay the hospital's claim arose. The court found that the insurer had made a prima facie showing through the affidavits of its claims representatives, denial of claim forms, and payment log that it had complied with 11 NYCRR 65-3.15, and the hospital failed to raise a triable issue of fact in opposition. Therefore, the first cause of action was dismissed.

The main issue in this case was whether the plaintiff, Staten Island Chiropractic Assoc., P.C., was entitled to recover $8,388.13 in first-party no-fault benefits for health care services provided to their assignor. Plaintiff had moved for summary judgment, but the court denied the motion. The court considered the fact that the defendant, Long Island Insurance Company, denied receiving the claims from the plaintiff. The plaintiff's only proof that it submitted its claims was a provider's statement that failed to prove a standard office practice or procedure designed to ensure that items are properly addressed and mailed. The court also considered that although plaintiff proved a claim denial form used by the defendant, the form admitted receipt of no specific claim and cannot be construed to concede that defendant received the specific claims at issue. In the end, the court affirmed the decision to deny plaintiff's motion for summary judgment.

The case involved an action to recover $7,762.98 in assigned first-party no-fault benefits from a motor vehicle accident. The provider of health care services, the plaintiff, established their entitlement to summary judgment by submitting statutory claim forms indicating the fact and amounts of the losses sustained. The burden then shifted to the defendant to create a triable issue of fact. The claim denial form issued by the defendant was found to be untimely, except for a few claims, and was also found to be fatally defective due to the omission of numerous items of requested information, making it incomplete. As a result, the court granted the plaintiffs' motion for summary judgment and remanded the matter to the court for a calculation of statutory interest and an assessment of attorney's fees.