No-Fault Case Law

The relevant facts considered by the court were that the plaintiff sought to recover first-party no-fault benefits for medical supplies provided to an injured assignor, and that the defendant did not pay or deny the claims within 30 days. The main issue decided was whether the plaintiff was entitled to summary judgment, and the court held that the plaintiff had established its prima facie entitlement to summary judgment by showing that it had submitted complete proofs of claims to the defendant which the defendant did not pay or deny within 30 days. The holding of the case was that the plaintiff's motion for summary judgment was granted in the principal sum of $1,685.31, and the matter was remanded to the court below for a calculation of statutory interest and an assessment of attorney's fees.

The relevant facts considered by the court in S & M Supply v Kemper Auto & Home Ins. Co. were that the plaintiff sued to recover first-party no-fault benefits for medical supplies it provided to the 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 should be granted for the principal sum of $1,018.47, and the matter was remanded to the court below for a calculation of statutory interest and an assessment of attorney's fees. The court found that the plaintiff's moving papers established a prima facie case for summary judgment. Additionally, the defendant's submission in opposition to the plaintiff's motion did not set forth a factual basis and medical rationale for rejecting coverage on the ground that it was not medically necessary. Therefore, the court granted the plaintiff's motion and remanded the matter for further assessment.

The main issue in this case was whether or not a defendant who purchases an index number in Civil Court can recover that money either by making a motion or in a judgment issued at the end of the litigation. The Court considered the constitutionality of the current system and determined that it violates due process and equal protection rights of individuals. It was found that the system creates two classes of litigants: paying and non-paying customers, and this is a clear violation of the equal protection clause of the New York State Constitution. The Court also addressed the issue of whether the defendant is entitled to reimbursement and concluded that the defendant is entitled to be reimbursed for the expenses incurred in each action. The holding was that the defendant's motion in each action was granted to the extent that the plaintiff is directed to reimburse the defendant the sum of $45.00 in each of the actions, and the application for sanctions was dismissed.

The court considered an application made by State Farm Mutual Automobile Insurance Company to stay arbitration of respondent Colleen Dowling's underinsured motorist claim. The main issue decided was whether the application to stay arbitration was properly denied on the grounds that it was not made within 20 days after service of respondent's demand. The court held that the application to stay arbitration was properly denied and that it was not made within the required time frame. Respondent had notified the insurer of the accident immediately after it happened, and could not have known prior to the grant of summary judgment in the personal injury action that she had a viable underinsurance claim against the insurer. As such, the court held that the grant of summary judgment in the personal injury action marked the commencement of respondent's obligation to give written notice of claim "as soon as practicable".

The court considered a motion for summary judgment by plaintiffs seeking first-party no-fault benefits for medical services rendered to their assignor, as well as statutory interest and attorney's fees. The court also considered defendant's cross-motion for consolidation and summary judgment dismissing the complaint based on an affidavit submitted by one of the plaintiffs. The main issue decided was whether the affidavit submitted by Bella Safir was sufficient to establish entitlement to judgment as a matter of law. The holding of the court was that the affidavit submitted by Safir did not establish a prima facie showing of entitlement to judgment as a matter of law, and even if it did, the defendant raised a triable issue of fact as to fraud. As a result, the court affirmed the order denying both motions.

The main issues in this legal case were whether A.B. Medical Services PLLC, as the assignee of Kanzada McGreath, had the right to recover first-party no-fault benefits from State Farm Automobile Insurance Company. The court considered evidence provided by the plaintiff to establish that they submitted the necessary forms to prove "the fact and amount of loss sustained" and were entitled to the benefits. The court held that the plaintiff had established its entitlement to most of the benefits, for which defendant's failure to timely deny the claims precluded most defenses. However, the preclusion rule did not apply to a defense based on a claim of fraud, and the defendant provided proof that included significant discrepancies in the assignors' accounts and allegations of fraud in the medical services provided. Based on this evidence, the court held that there were triable issues as to whether the accident was deliberate, as well as the necessity of certain medical services, and therefore the plaintiff's motion for summary judgment was properly denied.

The court considered the case of Advanced Medical Rehabilitation, P.C. v Travelers Property Casualty Insurance Company and Travelers Indemnity Company, where the plaintiff sought to recover first party no-fault benefits provided to their assignor, David Briggs, pursuant to the No-Fault provision of his insurance policy. The main issue decided was whether the assignment of benefits form was admissible, and if the medical bills were admissible as evidence. The court held that both the assignment of benefits form and the medical bills were inadmissible as evidence. The court found that the assignment of benefits form was not a business record made in the regular course of business by a person with a business duty to report, and it was not properly authenticated or dated. Additionally, the court found that the witness was not qualified to testify as to the record-keeping practices of the entity that prepared and mailed the medical bills, and therefore, the plaintiff failed to prove the essential elements of their case. As a result, the court dismissed the action.

This case involved an action brought by three hospitals to recover unpaid no-fault benefits from the defendant insurance company, Progressive Casualty Insurance Company. The plaintiffs moved for summary judgment, which was granted by the Supreme Court for two of the five causes of action. The remaining three requested causes of action were dismissed. Progressive appealed, and the appeals court reversed the judgment, granting summary judgment to the defendant on two of the causes of action. The court held that the hospitals were not entitled to recover the unpaid benefits for these specific claims. The court also stated that analyzing if the claims were properly joined was not necessary, as this had not been raised in the lower court.

The relevant facts considered by the court included a motion for summary judgment by the plaintiffs to recover first-party no-fault benefits for medical services rendered to their assignor, as well as statutory interest and attorney's fees. The plaintiffs submitted an affidavit that was deemed insufficient to establish that the claim forms were properly completed, as it did not specify for which plaintiff the affiant was acting as the billing manager. The main issue decided was whether the affidavit provided sufficient evidence for the plaintiffs' entitlement to summary judgment. The court held that the affidavit was insufficient to establish that the claim forms were properly completed, and therefore the plaintiffs failed to make out their prima facie entitlement to summary judgment. The order denying the plaintiffs' motion for summary judgment was affirmed.

The court considered the fact that the plaintiff Hospital for Joint Diseases as assignee of its patient had alleged that the defendant no-fault insurer was liable for unpaid claims due to the plaintiff's patient. The main issue decided in this case was whether the defendant was liable under the no-fault provisions of the Insurance Law as the plaintiff alleged. The holding of the court was that the plaintiff's complaint was based on the defendant's failure to pay or deny the claims within 30 days of receipt, however, the defendant established that it previously issued timely denials for identical claims submitted by the plaintiff. Therefore, the defendant was properly granted summary judgment dismissing the complaint.