No-Fault Case Law

The court considered the motion to vacate a default judgment in favor of the plaintiff, Amaze Medical Supply Inc., against defendant Allstate Insurance Company. The main issue in the case was whether the defendant had established a reasonable excuse for defaulting and a meritorious defense to the action. The court held that in order to vacate a default judgment, the defendant must establish both a reasonable excuse for defaulting and a meritorious defense to the action. The court found that the defendant's employee's affidavit was insufficient to establish a reasonable excuse, as it failed to set forth supporting facts in evidentiary form, and that the defendant failed to establish a meritorious defense to the action. Therefore, the court reversed the order granting the defendant's motion to vacate the default judgment and denied the motion.

The main issue in this case was whether the plaintiff, Damadian MRI in Garden City, P.C., had established its entitlement to summary judgment in a lawsuit against Windsor Group Insurance for first-party no-fault benefits for medical services rendered to an assignor. The court considered whether the assignment made to the plaintiff by the assignor was valid, as the assignment form named the assignee merely as "Damadian MRI" and raised a question of fact as to whether plaintiff was the same entity named in the assignment. The court also addressed whether the defendant's notices for examinations under oath tolled the statutory period, as there was no provision in the no-fault regulations for such verification. The holding of the court was that the plaintiff failed to establish its prima facie entitlement to summary judgment and that its cross motion for summary judgment should have been denied. The court also reversed the judgment, vacated the order granting plaintiff's cross motion, and remanded the matter to the lower court for further proceedings.

Relevant facts considered by the court included a claim by a medical supply company for $2,998.04 in first-party no-fault insurance benefits. All but $780.96 of the claim was denied by the defendant insurer on the grounds that the supplier's prices exceeded the prevailing rates for medical equipment, and that certain items claimed were duplicative. The issue decided was whether the insurer was justified in denying the claim, and the court concluded that the insurer's denial was factually insufficient and that a portion of the claim was recoverable. The holding of the court was that partial summary judgment should have been granted in the amount of $2,598.04, and the matter was remanded to the court below for the calculation of statutory interest and an assessment of attorney's fees, and for all further proceedings on the remaining portion of the claim in accordance with the decision of the court.

In this legal case, Singh appealed the denial of his cross motion to dismiss a petition by his insurer, Nationwide Insurance Company, to permanently stay arbitration of his uninsured motorist claim. Singh had sent a certified letter to his insurer, enclosing an application for no-fault insurance benefits and a notice "with respect to uninsured and/or underinsured motorist benefits." Nationwide sent a letter of disclaimer 10 days later from its Woodbury office since Singh's claim was not notified to them as soon as possible. Singh cross-moved to dismiss the petition on the ground that the proceeding itself was not timely commenced, arguing that the 20-day preclusion was measured from the later demand for arbitration. The Supreme Court initially granted the petition to stay arbitration, holding that the proceeding was timely. However, this decision was reversed, and the court found that the evidence did not support the conclusion that Nationwide was misled into filing an untimely petition, and that Nationwide itself had never raised this issue. Therefore, the Supreme Court erred in denying Singh's cross motion to dismiss and in granting Nationwide's untimely petition to stay arbitration.

The main issue in this case was whether the insurer, New York Central Mutual Insurance Company, properly denied a claim for No-Fault benefits submitted by A.M Medical, P.C. Plaintiff argued that the denials were untimely and insufficient to raise a triable issue of fact, as they were based on an inadmissible "Low Impact Study." Defendant contended that the injuries did not arise from a covered accident and relied on a report prepared by a private consultant, which concluded that the speed of the assignor's vehicle was not sufficient to cause persistent injury. The court held that the defendant's denials were untimely and insufficient, as they were based on an inadmissible report and failed to establish that the accident was deliberate or part of an insurance fraud scheme. The plaintiff's motion for summary judgment was granted, and the plaintiff was given leave to enter judgment against the defendant in the sum of $7,562.00 plus statutory attorneys' fees and interest.

The court considered the fact that the plaintiff, a health care provider and assignee of no-fault benefits, submitted a claim to the defendant, the insurer of the assignor, to recover first party No Fault Law benefits. The defendant's denial of the claim was dated December 2, 2002, which was more than 30 days after the claim was received. The main issue decided was whether the defendant's late denial of the claim precluded them from asserting an affirmative defense. The holding of the case was that the defendant's late denial of the claim precluded them from asserting an affirmative defense, and the plaintiff's motion for summary judgment was granted in the amount of $1,758.40, plus interest and attorneys' fees.

The court considered an appeal from an order denying a motion for leave to reargue summary judgment on a first cause of action to recover no-fault benefits. The plaintiffs, Mount Sinai Hospital and others, appealed from the order, claiming that the Supreme Court had overlooked controlling law and sought leave to reargue the motion. The court held that the appeal was actually one for leave to reargue, not for leave to renew, and that the denial of reargument was not appealable. The appellants did not provide new facts or a change in the law that would alter the prior determination, so the motion for leave to reargue was not granted. Therefore, the appeal was dismissed, and the Supreme Court's order denying reargument was upheld.

The main issue in this case was whether Mary Immaculate Hospital and two other hospitals, as assignees of certain insurance claimants, were entitled to recover no-fault medical payments under certain insurance contracts. The defendant, Allstate Insurance Company, appealed from a judgment in favor of the hospitals, which had been granted summary judgment on their first, fourth, fifth, and seventh causes of action. The defendant argued that the evidence provided by the plaintiff hospitals did not show their entitlement to judgment as a matter of law. However, the court found that the hospitals had made a prima facie showing of their entitlement by providing evidentiary proof that the statutory billing forms had been mailed and received, and that payment of no-fault benefits was overdue. The court also found that the defendant's submissions in opposition were insufficient to raise an issue of fact as to whether it timely issued a partial denial of the claim or paid the claim asserted by the hospitals. Therefore, the judgment in favor of the plaintiff hospitals was affirmed.

The court considered the fact that the plaintiff, S & M Supply Inc., was suing to recover first-party no-fault benefits for medical supplies provided to an injured assignor. The main issue decided was whether the plaintiff's motion for summary judgment should be granted. The court held that the plaintiff's motion for summary judgment is granted for the principal sum of $1,018.47, and remanded the matter to the court below for a calculation of statutory interest and an assessment of attorney's fees. The court found that the defendant's submission of only a portion of an unsworn letter from its medical expert did not set forth a factual basis and medical rationale for the rejection of coverage on the ground that it was not medically necessary, and therefore, the plaintiff's motion should be granted.

The court considered an appeal from the denial of a motion for partial summary judgment in a case to recover first-party no-fault benefits. The main issue decided was whether the plaintiff had established a prima facie case for summary judgment by proving the fact and amount of the loss sustained. The court held that the denial of the claim on the ground that certain treatments were medically unnecessary was justified based on peer reviews and the results of an independent medical examination. The matter was remanded to the court for further proceedings on the claims.