No-Fault Case Law

The main issues in the case were whether the plaintiffs were entitled to first-party, no-fault benefits for medical services provided to their assignor after he was injured in a car accident, and whether the insurer was within its rights to deny the claims on the basis of medical necessity. The court held that because the insurer did not pay or deny the claims within the 30 days allowed by the regulations, and because the insurer had not requested verification or objected to the form or sufficiency of the assignment of benefits within the required timeframe, the plaintiff had established its prima facie entitlement to summary judgment. Therefore, the court granted the plaintiffs' motion for partial summary judgment.

The court considered the facts of a rear-end collision between two vehicles insured by State Farm and Progressive insurance companies. State Farm disclaimed coverage for the collision, claiming it was an intentional, staged event to defraud the insurance company. The main issues decided were whether State Farm's disclaimer of coverage was valid, and whether the injured parties could seek arbitration under Progressive's uninsured motorist endorsement. The court held that State Farm's disclaimer was valid and that the collision was indeed an intentionally staged event. As a result, the injured parties could not seek compensation under Progressive's uninsured motorist endorsement, and the insurer's application for a permanent stay of arbitration was granted. The court also noted the injustice of innocent victims of intentional collisions being left without any recourse for compensation.

The case involved an action to recover no-fault medical payments, with the plaintiffs appealing from an order denying their motion for summary judgment. The plaintiffs argued that the defendant insurance company had not responded to their claims for no-fault medical benefits within the required 30 days. However, the defendant submitted evidence that the claims had been billed over a year earlier and denial of claim forms had been mailed at that time. The defendant's evidence raised triable issues of fact as to the timing of the claims and whether the defendant properly denied them. The court ultimately held that the evidence submitted by both parties created a genuine issue of fact and denied the motion for summary judgment.

The relevant facts considered by the court in this case were that the plaintiff submitted a claim for payment for medical treatment provided under the no-fault law to its assignor. The defendant denied the claim based on a lack of medical necessity, citing the opinion of a nurse in support of their denial. The main issue decided by the court was whether the denial of coverage based on lack of medical necessity needed to be supported by the opinion of a peer review doctor exclusively, or if a file-based review methodology could be used. The court held that since the defendant failed to prove lack of medical necessity through a medical examination or peer review, the denial was ineffective, and therefore summary judgment was granted in favor of the plaintiff. The holding of the case was that the plaintiff was entitled to judgment in the sum of $879.73, plus statutory interest, attorney's fees, and costs and disbursements.

The relevant facts considered by the court include a dispute between a no-fault insurance provider and medical corporations who employed acupuncturists to treat patients under the insurance policies. The main issues were whether a medical corporation could lawfully employ an acupuncturist and whether the corporation is entitled to reimbursement by the insurer for medical services provided. The court held that the insurance provider's fraud claim failed to state a cause of action and the unjust enrichment claim was unavailing. The court also granted the insurance provider's motion for summary judgment dismissing the counterclaim of one of the medical corporations, resulting in the dismissal of the complaint as against all defendants. The court addressed the lack of precedent directly addressing the issues and conflicting results in lower courts, providing a thorough analysis to reach its decision.

The court heard a motion from Lumbermans Mutual Insurance Company for a protective order denying Westbury Medical Care, P.C. disclosure of its entire no-fault file with respect to its assignor, Elaine McKeithan. Lumbermans Mutual Insurance Company provided no-fault insurance benefits to McKeithan as a result of an automobile accident on July 14, 2000. The provider, Westbury Medical Care, P.C., sought recovery of no-fault benefits from the insurer in the sum of $2,950.36, for medical services provided to its assignor. The main issue for the court to decide was whether the plaintiff was entitled to review the defendant's entire no-fault claims file, despite the defendant's objection. The court held that the plaintiff is entitled to disclosure of only those documents specifically concerning the alleged concurrent treatment and declined to permit the disclosure of protected health information of the entire no-fault file. The court found that an assignment, which the plaintiff had previously filed, did not constitute a valid authorization under HIPAA, as it failed to comply with HIPAA regulations. Therefore, the plaintiff was only entitled to review documents concerning the issue of concurrent care.

The relevant facts of this case are that Aviyon Medical Rehabilitation, P.C. brought an action against Allstate Insurance Company for its failure to pay the total amount due on assigned no-fault claims, leaving an unpaid balance of $105,218.78. Allstate Insurance Company moved to sever and dismiss the claims, arguing that the claims did not arise from a series of transactions or occurrences and that joinder would cause prejudice and lead to jury confusion. The main issues decided by the court were whether the claims should be severed and dismissed, and whether the court had subject matter jurisdiction. The holding of the court was that defendant's motion to sever and dismiss the claims was denied, and the court retained subject matter jurisdiction over the case. The court based its decision on the liberal joinder policy to prevent multiplicity of suits and the absence of logistical difficulties in preparing a defense to the claims.

The relevant facts the court considered in this case were the provisions of the New York State No-Fault law governing optional arbitration procedures, and the complaints by the plaintiffs that these provisions violated the Due Process Clauses of the United States and New York Constitutions. The main issue decided was whether the no-fault arbitration regulations violated procedural due process, as claimed by the plaintiffs, and whether they were facially unconstitutional. The holding of the case was in favor of the defendants, stating that the regulations governing arbitration procedures did not violate procedural due process, and the court dismissed the claims by the plaintiffs that the regulations were unconstitutional.

The court considered the plaintiff's motion for summary judgment on the grounds that they were entitled to No-Fault benefits for transportation services provided to a patient who was injured in a motor vehicle accident. The plaintiff claimed that they provided necessary transportation services to the patient and were owed a balance of $950 after being reimbursed $700 by the defendant. The main issue decided was whether the plaintiff had established a prima facie case of entitlement to No-Fault benefits, which required proof of claim and amount of loss, along with a valid assignment. The court held that the plaintiff had failed to establish a valid assignment for the right to collect payment from the defendant, therefore failing to establish a prima facie case of entitlement to judgment as a matter of law, and consequently, denied the motion for summary judgment.

The court considered the facts of a case in which a medical supply company sued an insurance company to recover first-party no-fault benefits for medical supplies furnished to the company's assignor. The main issues decided were whether the insurance company was justified in denying the claim for medical supplies and whether the denial was timely for other claims. The court held that the insurance company failed to provide sufficient evidence to defeat the medical supply company's motion for summary judgment, and that the insurance company had also failed to deny certain claims within the required time frame, thereby precluding the defense of medical necessity. As a result, the court granted the medical supply company's motion for partial summary judgment in the principal sum of $2,365 and remanded the matter for the calculation of statutory interest and assessment of attorney's fees.