No-Fault Case Law
Inwood Hill Med. v Allstate Ins. Co. (2004 NY Slip Op 50565(U))
June 18, 2004
The relevant facts the court considered in this case were the assignment of benefits from the injured party to the plaintiffs, the submission of completed proof of claims, and the denials of the claims by the defendant insurance company. The main issue decided was whether the plaintiffs had demonstrated a prima facie case by submitting completed proof of claims to the defendant, which were not paid or denied within 30 days. The holding of the court was that the plaintiffs had established their prima facie case, and the court granted summary judgment in favor of the plaintiffs in the sum of $8,418.49, with statutory interest at a rate of two percent per month and attorneys' fees of 20% thereof. The court also noted that the defendant failed to present sufficient evidence to support their defense and that their explanation in the denial of claim forms lacked the necessary specificity.
Hoss Med. Servs., P.C. v Government Empls. Ins. Co. (2004 NY Slip Op 24213)
June 17, 2004
In this case, the court considered the failure of the plaintiffs to appear for depositions in connection with actions commenced to recover first-party no-fault benefits. The defendant filed a motion to dismiss the complaints of the plaintiffs pursuant to CPLR 3126. The primary issue addressed by the court was whether plaintiffs' failure to appear for depositions warranted dismissal of their complaints according to the previously agreed stipulations. The court held that the stipulations entered into by the parties functioned as conditional orders of preclusion, which became absolute upon the plaintiffs' failure to comply, and therefore granted the defendant's motions to dismiss. The court reasoned that the plaintiffs' failure to produce a witness with personal knowledge, as agreed upon in the stipulations, precluded them from offering evidence at trial, thereby preventing them from establishing a prima facie case.
New York Hosp. Med. Ctr. of Queens v AIU Ins. Co. (2004 NY Slip Op 05217)
June 14, 2004
The court considered the plaintiffs' appeal of a denied motion for summary judgment on the first and second causes of action to recover no-fault benefits for medical services rendered by the plaintiff New York Hospital Medical Center of Queens. The main issue decided was whether the defendant's failure to object to the completeness of the hospital facility forms within 10 days of receipt constituted a waiver of any defenses based thereon. The holding of the court was that the Supreme Court erred in denying the plaintiffs' motion for summary judgment, as the defendant failed to raise a triable issue of fact and the plaintiffs had established their entitlement to the no-fault benefits, as well as to statutory interest and attorney's fees. Therefore, the matter was remitted to the Supreme Court, Nassau County, to calculate the amount owed to the plaintiff for no-fault benefits, statutory interest, and attorney's fees.
Victoria Ins. Co. v Utica Mut. Ins. Co. (2004 NY Slip Op 04859)
June 10, 2004
The main facts considered by the court were that Utica Mutual Insurance Company failed to answer a petition brought by Victoria Insurance Company to confirm three arbitration awards. Utica argued that the arbitrator committed misconduct by refusing to grant an adjournment to permit its investigator to appear. Utica also claimed that the claims paid by Victoria Insurance and for which it sought reimbursement were fraudulent. Additionally, Utica argued that the truck involved in the accident was not modified to increase its weight to more than 6,500 pounds and that there was no basis for reimbursement of nonreimbursable no-fault benefits. The main issue decided by the court was whether Utica made the necessary showing of merit in its application to vacate its default. The holding of the court was that Utica did not make the necessary showing of merit, and that the denial of the vacatur application was affirmed.
Melbourne Med., P.C. v Utica Mut. Ins. Co. (2004 NY Slip Op 24221)
June 7, 2004
The court unanimously affirmed the orders in this action to recover $765 in first-party no-fault benefits for medical treatment provided to the assignor Jose Cabreja. Once the prima facie case was established by plaintiff Melbourne Medical, P.C., the conceded failure of Utica Mutual Insurance Co. to pay or reject the claim within 30 days prevented them from interposing most defenses. The court decided that the insurance regulations did not provide for examinations under oath (EUOs) as a form of verification, and a new regulation was inapplicable to the instant claim. An insurer was not able to rely on letters merely informing a claimant that a decision on the claim was delayed pending investigation. The court then considered a fraud allegation and decided that the defense survives preclusion and would constitute a complete defense if substantiated, but defendant did not submit proof in admissible form to create a triable issue of fraud.
A.B. Med. Servs. Pllc v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50575(U))
June 4, 2004
The relevant facts of the case include that the plaintiffs were seeking to recover assigned first-party no-fault benefits and the defendant submitted an affidavit from an investigator employed within defendant's Special Investigations Unit. The main issue at hand was whether there was a lack of coverage because the alleged injuries did not arise from an insured incident. The court found that the investigator's detailed affidavit set forth ample facts and founded beliefs to establish the existence of a triable issue of fact, therefore denying plaintiffs' motion for summary judgment. The holding of the case was that the denial of plaintiffs' motion for summary judgment was affirmed, and plaintiffs' remaining contentions were also considered lacking in merit.
S & M Supply, Inc. v Nationwide Mut. Ins. Co. (2004 NY Slip Op 50557(U))
June 3, 2004
The court considered whether plaintiff was entitled to summary judgment for first-party no-fault benefits for medical supplies provided to its assignor. Defendant delayed more than 30 days in denying the claim and the plaintiff moved for summary judgment on this ground. Defendant cross-moved for summary judgment seeking dismissal based on the assignor's failure to submit to examinations under oath. The main issue decided was that plaintiff was entitled to summary judgment as defendant did not pay or deny the claim within 30 days, and the time period for payment or denial was not tolled by the requirement for the assignor to submit to an examination under oath. The holding was that plaintiff's motion for summary judgment was granted, and the matter was remanded to the court for the calculation of statutory interest and attorney's fees.
Rockaway Blvd. Med. P.C. v Progressive Ins. (2004 NY Slip Op 24184)
June 2, 2004
The court considered the claim form submitted by the plaintiff to the defendant, the absence of disclosure of the business relationship between the treating provider and the billing provider, and the significance of the information required by form N-F 3. The main issues decided were whether the claim submitted by the plaintiff was sufficient to establish its right to payment from the defendant, and whether the plaintiff submitted a proper proof of claim. The holding of the case was that the plaintiff did not submit a proper proof of claim, and therefore did not establish a prima facie case of entitlement to payment of no-fault benefits, resulting in the denial of the motion for summary judgment.
Nyack Hosp. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 04304)
June 1, 2004
The court considered an action to recover no-fault benefits, with the defendant appealing from an order that granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment. The main issue in the case was whether the plaintiff demonstrated its entitlement to summary judgment by establishing that the defendant did not deny or pay the two claims in question within 30 days, and if the defendant submitted sufficient evidence to raise a triable issue of fact regarding the medical treatment alleged in the first cause of action and whether the underlying contract of insurance alleged in the third cause of action had been cancelled. The holding of the case was that the plaintiff's motion for summary judgment was properly granted because the defendant did not submit sufficient evidence in admissible form to raise a triable issue of fact, and as a result, the defendant's remaining contentions were deemed academic.
Ocean Diagnostic Imaging v Geico Ins. (2004 NY Slip Op 50511(U))
May 28, 2004
The relevant facts considered by the court were that Ocean Diagnostic Imaging, a health service provider, sought assigned first-party no-fault benefits from Geico Insurance. The main issue decided was whether Ocean Diagnostic Imaging was entitled to summary judgment, and the court held that they were. The court found that Ocean Diagnostic Imaging had established a prima facie entitlement to summary judgment by submitting proper proof of the claim and the amount of the loss, and that Geico Insurance had failed to raise any triable issues of fact. The court also found that Geico Insurance did not respond to the claim within the required 30-day period and that their requests for examinations under oath did not toll the 30-day period, therefore Ocean Diagnostic Imaging's motion for summary judgment should have been granted. The matter was remanded for the calculation of statutory interest and an assessment of attorney's fees.