No-Fault Case Law

The relevant fact considered by the court in this case was whether the defendant had received the claim forms underlying the plaintiff's second and third causes of action. The main issue decided in this case was whether the defendant had received the claim forms at issue. The holding of the court was that the defendant had submitted sufficient proof to demonstrate, prima facie, that it had not received the claim forms, but the affidavit of the plaintiff's billing administrator raised an issue of fact as to whether those claim forms had been mailed to the defendant. Therefore, the court held that there was an issue of fact as to whether the defendant had received the claims at issue, and consequently denied the branches of the plaintiff's motion seeking summary judgment upon the second and third causes of action.

The court considered the facts that the defendant, Ameriprise Insurance, had timely mailed initial and follow-up letters scheduling an examination under oath, which the plaintiff's assignor had failed to appear for. The defendant had also timely denied the claims on that ground. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint for failure to appear for the examination under oath. The holding of the court was that the defendant's motion for summary judgment was granted, and the plaintiff's cross motion for summary judgment was denied. Therefore, the complaint was dismissed.

The court considered the fact that the plaintiff, Silver Lotus Acupuncture, P.C., was seeking to recover assigned first-party no-fault benefits, but the defendant, Global Liberty Ins. Co. of NY, had moved for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs). The court determined that the record was sufficient to establish the proper mailing of the IME scheduling letters to the plaintiff's assignor and that the assignor had indeed failed to appear for the scheduled IMEs. The main issue decided was whether the plaintiff had satisfied the requirements for the assigned first-party no-fault benefits, and the holding was that the defendant's motion for summary judgment was granted because the plaintiff's assignor had failed to appear for the scheduled IMEs. The court affirmed the order, with costs, and the decision was entered on November 13, 2020.

The court considered the fact that the plaintiff, NL Quality Medical, P.C., was seeking to recover assigned first-party no-fault benefits, and that defendant, GEICO Ins. Co., had moved for summary judgment to dismiss the complaint on the basis that the plaintiff had failed to appear for scheduled examinations under oath (EUOs). The main issue was whether the plaintiff had indeed failed to appear for the scheduled EUOs. The court held that the defendant had submitted sufficient proof to demonstrate that the plaintiff had failed to appear for the EUOs, and that the plaintiff had failed to rebut this showing. Additionally, the court found that the defendant had provided sufficient proof that the EUO scheduling letters and denial of claim forms had been timely mailed, and therefore granted the defendant's motion for summary judgment dismissing the complaint.

The court considered a motion for summary judgment dismissing the complaint by the defendant, who argued that the claims at issue were properly denied due to the plaintiff's failure to provide requested verification within 120 days after the initial request. The main issue decided was whether the defendant demonstrated that it had not received all of the requested verification, and if the dismissal of the complaint without prejudice was appropriate. The holding of the court was that the defendant demonstrated prima facie that it had not received all of the requested verification, and as the order dismissed the complaint without prejudice, the plaintiff's remaining contention was deemed academic. The court affirmed the order, with costs.

The relevant facts in this case include an action by a provider to recover assigned first-party no-fault benefits. The defendant alleged that the amount of available coverage had been exhausted after partially denying the claims that are the subject of the action and making subsequent payments. However, the court found that this allegation did not warrant summary judgment dismissing the complaint on the basis of an exhaustion of available coverage defense. The defendant also argued that it had fully paid the claims in accordance with the workers' compensation fee schedule, but failed to demonstrate, as a matter of law, that the fees charged exceeded the amount set forth in the workers' compensation fee schedule. Therefore, the court reversed the order and denied defendant's motion for summary judgment dismissing the complaint. The main issue decided in this case was whether the defendant's allegations of exhausting the available coverage and fully paying the claims in accordance with the workers' compensation fee schedule warranted summary judgment dismissing the complaint. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was denied because the allegations did not warrant such a dismissal.

The court considered the fact that the plaintiff, a provider, failed to appear for duly scheduled examinations under oath (EUOs) and the insurer issued a timely denial of the claims. The main issue decided was whether the defendant insurer was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to appear for the EUOs. The court held that the insurer must demonstrate, as a matter of law, that it twice duly demanded an EUO from the provider, that the provider twice failed to appear, and that the insurer issued a timely denial of the claims, which the insurer had established. The court also held that the plaintiff failed to raise a triable issue of fact, and therefore the defendant was entitled to summary judgment dismissing the complaint.

The court considered the facts of the case, where an insurance company sought to dismiss a complaint by a medical supply company for failure to provide discovery. The medical supply company had entered into a stipulation agreeing to provide responses to the insurance company's demands for discovery within 60 days, but failed to do so. The main issue decided was whether the lower court was correct in granting the insurance company's motion to dismiss the complaint. The holding of the case was that the lower court had erred in granting the motion to dismiss, as the medical supply company's failure to comply with discovery demands was not willful, contumacious, or in bad faith. As a result, the judgment was reversed and the case was remanded for the medical supply company to provide the requested discovery within 60 days.

The relevant facts the court considered in Total Chiropractic, P.C. v Hereford Ins. Co. include an action by a provider to recover assigned first-party no-fault benefits. The appellant, Hereford Insurance Co., appealed from an order of the Civil Court which granted the plaintiff's motion for summary judgment and denied the appellant's cross motion. The appellant argued that the plaintiff failed to make a prima facie showing of its entitlement to summary judgment and that it is entitled to summary judgment dismissing the complaint based on the plaintiff's assignor's failure to appear for independent medical examinations (IMEs). The main issue that was decided is whether the plaintiff made a prima facie showing of its entitlement to summary judgment and whether the appellant is entitled to summary judgment dismissing the complaint based on the plaintiff's assignor's failure to appear for IMEs. The holding of the case was that the judgment is reversed, so much of the order entered September 12, 2018 as granted plaintiff's motion for summary judgment is vacated, and plaintiff's motion is denied. Therefore, the appellant was not entitled to summary judgment dismissing the complaint based on the plaintiff's assignor's failure to appear for IMEs.

The relevant facts were that Live In Grace Acupuncture, P.C. sued GEICO General Ins. Co. to recover first-party no-fault benefits, and GEICO cross-moved for summary judgment to dismiss the complaint, claiming it had fully paid the plaintiff in accordance with the workers' compensation fee schedule for services billed under CPT codes 97813 and 97814 for acupuncture services. The main issue decided was whether GEICO had fully paid Live In Grace Acupuncture, P.C. in accordance with the workers' compensation fee schedule for the services at issue. The court held that defendant demonstrated that it had fully paid plaintiff in accordance with the workers' compensation fee schedule for the services billed under CPT codes 97813 and 97814 for acupuncture services that plaintiff had rendered after April 1, 2013. As a result, the branch of defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims using CPT codes 97813 and 97814 was granted and plaintiff's motion for summary judgment upon those claims was denied.