No-Fault Case Law

The case involved Westchester Medical Center and two other hospitals appealing the denial of their motion for summary judgment in a lawsuit to recover no-fault medical payments under an insurance contract. The Supreme Court had denied their motion for summary judgment on the second cause of action arising from the treatment rendered by St. Vincent's Hospital & Medical Center to Brian Cardimone, and the third cause of action arising from the treatment rendered by New York and Presbyterian Hospital to Stanislaw Zarod. The Appellate Division reversed the order, granting the plaintiffs' motion and remitting the matter to the Supreme Court to calculate the amount owed for no-fault benefits, statutory interest, and an attorney's fee. The court found that the defendant had failed to pay or deny the claim within 30 days as required by law, and therefore could not raise defenses based on payment in accordance with the correct code or verification of claims.

The plaintiff was attempting to recover unpaid no-fault benefits from the defendant after being involved in an automobile accident. However, several years before the current action, the plaintiff had commenced an arbitration proceeding against the defendant to recover the same benefits. By electing to arbitrate, the plaintiff waived his right to commence an action to litigate subsequent disputes over no-fault benefits. The defendant did not move for summary judgment on this ground, but the court had the authority to search the record and award summary judgment to a nonmoving party with respect to a cause of action or issue that was the subject of the motion before the Supreme Court. Therefore, the court awarded summary judgment to the defendant and dismissed the complaint. The decision was also based on these circumstances and the plaintiff being precluded from maintaining the action. As a result, the judgment in favor of the plaintiff was reversed and the complaint was dismissed.

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.