No-Fault Case Law

The main issue in this case was to recover first-party no-fault benefits for medical services rendered to the plaintiff's assignors. Plaintiff Ocean Diagnostic Imaging P.C. sought summary judgment based on their proof of submitting claims and the overdue payment of no-fault benefits, while defendant New York Central Mutual Fire Insurance Company contended that the claims were denied due to the assignors' failures to attend independent medical examinations (IMEs). The court held that the plaintiff was entitled to summary judgment, as defendant failed to establish proper mailing of the pre-claim IME requests for two of the assignors, and the claim for services rendered to another assignor was not timely denied. As a result, the matter was remanded to the court below for the calculation of statutory interest and an assessment of attorney's fees. The dissenting opinion disagreed with the majority's decision, finding that the defendant's timely denials of all the plaintiff's claims on the grounds of nonattendance at requested pre-claim IMEs warranted denial of the plaintiff's motion for summary judgment.

The main issues in this case revolved around a plaintiff's motion for summary judgment in a first-party no-fault benefits claim against an insurance company. The plaintiff sought to recover statutory interest and attorney's fees, as well as medical expenses for services rendered to their assignor. The court considered whether the plaintiff had made a prima facie showing of entitlement to judgment as a matter of law and whether the insurance company had failed to pay or deny the claim within the statutory 30-day period. The court held that the plaintiff's motion for summary judgment was denied as they failed to make a sufficient showing of entitlement to judgment, and their submissions did not constitute evidentiary proof in admissible form. Therefore, there were issues of fact requiring a trial, and summary judgment was unwarranted.

The relevant facts considered by the court were that plaintiff, a healthcare provider, submitted a claim for first-party no-fault benefits for medical services rendered to its assignor. The insurance company, the defendant, denied the claim more than two months after its receipt. The main issue decided was whether defendant's requests for examinations under oath tolled the 30-day claim determination period. The holding was that the denial of the claim was not tolled by the requests for examinations under oath because the insurance regulations in effect at the time lacked a provision entitling an insurer to an examination under oath. However, even though the denial was untimely, the defendant was not precluded from asserting the defense that the collision was in furtherance of an insurance fraud scheme. The court found that there were triable issues of fact, and thus, plaintiff's motion for summary judgment was denied. The defendant's cross motion was properly denied, and the order was modified to deny plaintiff's motion for summary judgment.

The court considered the facts of the case, where the plaintiffs were seeking to recover first-party no-fault benefits for medical services rendered to their assignor. The main issue decided was whether the plaintiffs were entitled to summary judgment, as they had established a prima facie entitlement to payment of the benefits, but the defendant asserted a defense that the injuries were not causally related to the accident. The holding of the case was that the defendant's affidavit set forth sufficient facts to demonstrate a founded belief that the injuries did not arise out of an insured incident, therefore creating a triable issue of fact. As a result, the plaintiffs' motion for summary judgment was properly denied.

The court considered the facts of the case, in which Medwide Medical Supply Inc. sought to recover $2,616.29 in first-party no-fault benefits for medical equipment supplied to its assignors. The main issue decided by the court was whether Medwide established its entitlement to summary judgment by proof that it submitted statutory claim forms and that payment of no-fault benefits was overdue. The court held that the plaintiff was entitled to summary judgment and remanded the case to the court below for a calculation of the statutory interest and an assessment of attorney's fees. The court found that the defendant's untimely denial of the claims precluded defenses to the action and that the unsworn nurse's "medical reviews" of the treatment files offered by the defendant did not constitute competent evidence sufficient to defeat the motion for summary judgment. The court also rejected the defendant's challenge to the assignment of benefits form as without merit.

The relevant facts of the case include a dispute between Rockaway Boulevard Medical P.C. and Progressive Insurance over first-party no-fault benefits. Rockaway Boulevard Medical P.C. sought partial summary judgment in the sum of $1,791.73 for medical services rendered to an assignor. The main issue decided was whether Rockaway Boulevard Medical P.C. was entitled to recover no-fault benefits directly from the insurer for services rendered by an independent contractor. The court reversed the lower court's decision, granted Rockaway Boulevard Medical P.C.'s motion for partial summary judgment, and remanded the case for a calculation of statutory interest and attorney's fees. The court determined that a billing provider may not recover no-fault benefits for services rendered by an independent contractor, and defendant failed to assert the nonwaivable defense that plaintiff was not a "provider" under the applicable insurance regulations. Additionally, the lack of authentication of an assignor's signature was not a defect in the absence of any statutory and regulatory requirement for the same, and defendant's failure to seek verification of the assignments constituted a waiver of any defenses with respect to them. A defense that a plaintiff in an assigned first-party no-fault action may not maintain the action because it is not a "provider" within the meaning of the insurance regulations, and hence that no-fault benefits are not assignable to it, is nonwaivable and not subject to the preclusion rule.

The courts considered the case of A.B. Medical Services PLLC et al. v. Liberty Mutual Insurance Company, in which the plaintiffs were seeking to recover first-party no-fault benefits from the defendant insurer. The case revolved around the applicable insurance regulations, specifically in regards to "direct payments" of no-fault benefits by the insurer. The main issue concerned whether the plaintiff was entitled to recover direct payment of assigned no-fault benefits from the defendant insurer. The court held that A.B. Medical, who was seeking recovery of no-fault benefits for medical services not performed by them but by an independent contractor, was not considered a "provider" within the meaning of the relevant insurance regulations and therefore, was not entitled to recover direct payment of assigned no-fault benefits from the defendant insurer. The decision was consistent with the Insurance Department's interpretation of the insurance regulations and dismissed the appeal with respect to the remaining appellants.

The relevant facts the court considered in this case include the plaintiff's submission of the functional equivalent of the statutory claim forms and the assignment of benefits forms for medical equipment, and the defendant's alleged absence of proof of an assignment. The main issue decided by the court was whether the plaintiff was entitled to summary judgment to recover assigned first-party no-fault benefits for medical equipment provided to its assignor. The holding of the court was that the plaintiff's motion for summary judgment should have been granted, and the matter was remanded to the court below for a calculation of statutory interest and an assessment of attorney's fees pursuant to the Insurance Law. The court also held that the defendant's challenges to the authenticity and accuracy of the assignments and the lack of authentication of the assignor's signature were unpreserved and without merit.

The court heard a case where a service technician working at a motor vehicle repair shop was injured after being struck by a customer's vehicle. The technician sought legal approval for a personal injury settlement after receiving benefits through his employer's workers' compensation carrier. The case involved the issue of whether the compensation provider was entitled to assert a lien against the settlement for the full amount of the benefits paid. The court ruled that the workers' compensation benefits paid were in lieu of first party benefits, and therefore, the lien was limited to the amount paid in excess of $50,000. In addition, the court decided that the injured technician was eligible to collect no-fault benefits under the Insurance Law and therefore rejected the compensation provider's contention in this regard. The court ultimately affirmed the order without costs.

The relevant facts in the case State Farm Mut. Auto. Ins. Co. v Karpen involved an insurance company, State Farm, seeking to recover monies paid to its insured for injuries arising from a 2001 accident. The insurance company filed a lawsuit to recover excess no-fault benefits, but the defendant argued that the action was barred by the statute of limitations. The main issue decided in this case was whether the action was time-barred, and the court determined that it was. The court held that since the action was commenced more than three years after the accident, it was indeed time-barred, and thus the complaint was properly dismissed.