No-Fault Case Law

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.

The main facts considered in the case were that the respondent submitted claims for no-fault insurance benefits for injuries he sustained in a motor vehicle accident in September 1995. Petitioner denied his claims, and respondent served a demand for arbitration through Federal Express overnight mail, to which petitioner sought a permanent stay of arbitration on the grounds that the service was jurisdictionally defective due to the method of mailing. The court decided that the service of the demand for arbitration by Federal Express mail was not jurisdictionally defective, and that the demand was properly served within the statute of limitations. The main issue was therefore whether the petitioner's participation in a prior arbitration proceeding, or lack thereof, constituted a waiver of their right to seek a stay of arbitration. The holding was that the issue was a threshold question requiring a trial forthwith to determine whether the claim was time-barred or not.

The court considered the fact that the petitioner, Georgia Taylor, sustained work-related injuries in 1990 and received workers' compensation benefits. In 1992, the respondent, Continental Insurance Company, notified Taylor that they reserved the right to a lien on any recovery she received from the accident, and Taylor would need written consent from Continental to settle any third-party lawsuit related to the accident. Taylor breached this obligation when she settled a third-party action in 1993 without obtaining Continental's consent. In 2002, Taylor sought judicial approval of the settlement nunc pro tunc, but Continental refused. The issue was whether the delay in Taylor's application was the result of her fault or neglect and whether the settlement was reasonable, and the court ultimately decided that the delay in applying for judicial approval was inordinate, and the Supreme Court's grant of Taylor's application constituted an improvident exercise of discretion. Therefore, the order was reversed, and Taylor's application was denied.

The court considered an action to recover no-fault medical payments under insurance contracts, in which the defendant appealed from an order granting summary judgment on the causes of action to recover no-fault medical payments allegedly due to two hospitals. The main issue that was decided involved the timely submission of complete proof of claim for no-fault benefits, as required by Insurance Law § 5106 and 11 NYCRR 65.12. The court found that both of these plaintiffs demonstrated a showing of entitlement to judgment as evidence that their claims were neither denied nor paid within the required time period. However, in opposition, the defendant offered enough evidence to raise a factual issue, leading to the conclusion that summary judgment should not have been granted on those causes of action. Therefore, the parties' remaining contentions were either unnecessary to address or were without merit.

The court considered an appeal by the defendant insurance company from an order denying its motion for summary judgment in a case to recover first-party no-fault benefits. The main issue was whether the claim for benefits rendered on December 5, 2001 was submitted within 180 days as required by law. The court found that while the claim for benefits rendered on December 19, 2001 was timely submitted, the claim for benefits on December 5, 2001 was not received within 180 days, and the plaintiff failed to prove that it was mailed within the statutory time. Therefore, the court granted the defendant's motion for partial summary judgment, dismissing the claim as to $1,236.99 of the principal sum sought.

The main issues in this case were whether the plaintiff was entitled to recover first party benefits under No-Fault for transportation services provided to the plaintiff's assignor, and whether the defendant insurer's cross-motion for summary judgment should be entertained by the court. The court found that the plaintiff had failed to establish a prima facie case for entitlement to recover unpaid benefits under No-Fault, as the initial papers submitted were devoid of any assignment of benefits. The plaintiff's motion for summary judgment was denied, and the defendant's cross-motion for dismissal was also denied as premature due to a statutory stay. The court also ruled that the plaintiff's attempt to raise new issues in their cross-motion was improper and should not be entertained. The court found that the terms of the "so-ordered" stipulation between the parties were revived, with the only modification being an extension of time for the plaintiff to serve complete verified responses to the defendant's discovery demands.