No-Fault Case Law

The main issue in this case is whether the Civil Court had personal jurisdiction over the respondent, Eveready Insurance Company, due to an improper service of the notice of petition and petition by the petitioner, Queens Community Medical Centers. The court considered the method of service required for a special proceeding and whether serving the notice and petition on an attorney not authorized to receive service on behalf of the respondent was sufficient. The court held that the service on the attorney, Maria Weissman, was insufficient to obtain jurisdiction over the respondent, as it did not comply with the requirements of CPLR § 403(c) for a special proceeding. The court also denied the petitioner's request to properly serve the respondent and have such service relate back to the original service in order to comply with the statute of limitation, stating that it had no discretion to override the statute of limitation. Therefore, the petition was dismissed for lack of personal jurisdiction.

The relevant facts of the case are that S&M Supply Inc. filed a motion for summary judgment in an action to recover first-party no-fault benefits for medical supplies furnished to its assignors, Naum Bergman and Paul Showun. However, the affidavit submitted in support of the motion did not establish that the affiant had the requisite personal knowledge. As a result, the affidavit was considered to be of no probative value. The main issue decided by the court was whether the affidavit submitted by the plaintiff had the necessary personal knowledge to support the motion for summary judgment. The court held that the affidavit did not meet the requirements for personal knowledge and therefore, the court properly denied the plaintiff's motion for summary judgment.

The relevant facts considered by the court in this case included an action to recover assigned first-party no-fault benefits. The plaintiffs moved for summary judgment in the sum of $11,139.79, and established a prima facie entitlement to summary judgment by proof that they submitted the claims and that payment of no-fault benefits was overdue. In opposition, the defendant argued that certain claims were properly denied on the ground that the plaintiffs' assignor failed to attend scheduled independent medical examinations (IMEs). The main issue decided was whether the defendant's assertion of the plaintiffs' assignor's failure to comply with pre-claim IME requests rebutted the presumption of medical necessity which attaches to the claim form. The court found that the defendant had effectively rebutted the presumption of medical necessity due to the assignor's selective attendance at the IMEs, and raised a triable issue with respect to the lack of medical necessity of the services provided, denying the motion for summary judgment in the sum of $7,139.23. The holding of the case was that the court modified the order by granting the motion for summary judgment by plaintiff Daniel Kim's Acupuncture P.C. in the sum of $3,475.56, and remanding the matter for the calculation of statutory interest and an assessment of attorney's fees. The order was affirmed without costs.

The relevant facts considered by the court include a medical services provider, plaintiff Ocean Diagnostic Imaging P.C., seeking to recover first-party no-fault benefits for services rendered, as well as the defendant, State Farm Mutual Automobile Insurance Company, denying the claim based on the belief that the injuries did not arise out of an insured incident. The main issue decided by the court was whether the defendant's denial of the claim based on an alleged insurance fraud scheme was valid, despite being untimely. The court held that the defendant was precluded from raising most defenses due to the untimely denial of the claim, but was not precluded from asserting the defense that the collision was in furtherance of an insurance fraud scheme. The court found that the defendant demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage, and accordingly denied both plaintiff's motion for summary judgment and defendant's cross motion seeking summary judgment.

The court considered the defendant's motion to dismiss the complaint based on the plaintiff's failure to serve a bill of particulars as ordered by the court. The main issue decided was whether the plaintiff's failure to serve a bill of particulars within the specified time frame warranted the dismissal of the complaint. The court held that the plaintiff's failure to serve a bill of particulars within the specified time frame constituted an unexcused default, and as a result, the defendant's motion to dismiss the complaint was granted. The court ruled that in order to avoid the adverse impact of an order of preclusion, the plaintiff was required to demonstrate an excusable default and a meritorious claim, which the plaintiff failed to do. Therefore, the defendant's motion to dismiss the complaint was ultimately granted.

The relevant facts considered by the court were that the plaintiff, Capio Medical, sought to recover first-party no-fault benefits for medical services provided to an assignor. The main issue decided was whether the plaintiff had established a prima facie entitlement to summary judgment, and if the defendant's denial of claim forms were adequate to establish that the plaintiff sent and the defendant received the claims. The holding of the case was that the court found the plaintiff had indeed established a prima facie entitlement to summary judgment by proof of overdue payment, submission of claims, and the fact and amount of the loss sustained. The court also held that the lack of authentication of the assignor's signature did not constitute a defect, and that the defendant's failure to seek verification of the assignments resulted in a waiver of any defenses. Ultimately, the court determined that the defendant had failed to submit a timely denial of the claim, and therefore, was precluded from raising various defenses regarding non-conformity with Workers' Compensation schedules and lack of medical necessity.

The court considered the fact that plaintiff Ocean Diagnostic Imaging had submitted claims for first-party no-fault benefits for medical services rendered to its assignors, and that payment of the benefits was overdue. Defendant, New York Central Mutual Fire Insurance Company, had denied the claims, but the denial forms were not submitted within the statutorily prescribed 30-day period. The main issue decided was whether defendant was precluded from raising defenses due to the untimely denial of the claims. The court held that defendant was precluded from raising most defenses, but not precluded from asserting the defense that the alleged injuries were not causally related to the accident. The "Accident Analysis" report, along with a sworn certification, constituted admissible evidence in support of defendant's defense, and since defendant demonstrated the existence of a triable issue of fact, plaintiff's motion for summary judgment was properly denied.

The court decided on a case of Allstate Insurance Company by reversing an order that had been issued and denying the petition. The respondents had made a claim for uninsured motorist benefits but Allstate had sought to deny this. The court established that the requirement that a claimant file a sworn statement proving the involvement of a hit-and-run vehicle is a condition precedent to coverage under an uninsured motorist endorsement. It was ruled that the insurance company had been given inadequate notice of the claim and that the petition for a permanent stay should have been granted. The decision was made to reverse the order, grant the petition, and assess the costs to the respondents.

The case of Shell v. Fireman's Fund Ins. Co. involved an appeal against the dismissal of a complaint for the insurance company regarding an unsatisfied judgment. The plaintiff, Nathaniel Shell, was involved in a motor vehicle accident with Raul L. Park, whose vehicle was insured by the defendant Fireman's Fund Ins. Co. The plaintiff obtained a judgment against Park and attempted to recover that judgment from the defendant's insurer. The defendant argued that their disclaimer letter was dispositive and that they were not liable because the plaintiff's insurer failed to give prompt notice. The court determined that the disclaimer letter was ineffective at disclaiming coverage of the plaintiff's claim as it pertained to the accident. The court held that since the disclaimer came over 12 months after the plaintiff notified the defendant of the claim, it was not timely and should have been granted summary judgment in favor of the plaintiffs. Therefore, the dismissal and granting of the insurance company's cross-motion for summary judgment was reversed and the plaintiffs were awarded summary judgment.

The New York and Presbyterian Hospital appealed from an order of the Supreme Court, Nassau County dated January 6, 2004 that granted the defendant's motion for summary judgment dismissing the first cause of action by the Hospital in an action to recover no-fault medical payments under an insurance contract. The Hospital's assignor, Marco Rizzi, received treatment for injuries related to an automobile accident covered under its policy with Government Employees Insurance Company (GEICO) from February 22, 2002, through April 3, 2002. GEICO had paid the Hospital $60,961.44, but the Hospital sought an additional $32,961.15. GEICO claimed to have sent the initial request for verification on April 22, 2002, and the parties disagreed as to when the claim was actually mailed. The Hospital raised a triable issue of fact as to whether the claim was mailed on May 9, 2002 and not received until May 13, 2002. The motion for summary judgment by GEICO should have been denied. The Court considered that the Hospital raised a triable issue of fact through the affidavit of Peter Kattis, a billing agent for the Hospital, stating that the Hospital's first claim was mailed on May 9, 2002, and not received until May 13, 2002. The main issue decided was whether GEICO's motion for summary judgment dismissing the Hospital's first cause of action on the ground that it had paid out all the money available under the no-fault portion of the policy should be granted. The holding of the case was that GEICO's motion for summary judgment dismissing the first cause of action should have been denied.