No-Fault Case Law

The court considered the fact that the defendant's motion for summary judgment dismissing the complaint was denied by the Civil Court. The main issue decided was whether the plaintiff's assignor failed to appear for duly scheduled independent medical examinations (IMEs) and examinations under oath (EUOs). The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was granted, as the defendant established that the assignor failed to appear on the scheduled dates for IMEs, and that the claims had been timely denied on that ground. The court found that the plaintiff failed to raise a triable issue of fact in opposition to the defendant's motion, and therefore, the defendant was entitled to summary judgment dismissing the complaint.

The main issues in this case were whether the plaintiff had failed to comply with a condition precedent to coverage by not appearing for scheduled independent medical examinations (IMEs) and whether the defendant had timely denied the plaintiff's claims. The court considered an affidavit from the general manager of Empire Stat Med Review, P.C. to determine if the IME scheduling letters had been timely mailed and if the assignor failed to appear for the IMEs. The court also examined if the defendant had timely denied the remaining claims at issue after the plaintiff allegedly failed to appear for examinations under oath (EUOs). The holding of the court was that the defendant's cross motion to seek summary judgment dismissing the claim for services rendered from May 19, 2016 through May 25, 2016 was granted, as there was sufficient evidence that the assignor failed to comply with a condition precedent to coverage. However, the defendant was not entitled to summary judgment upon the branch of its cross motion seeking summary judgment dismissing the remaining portion of the complaint due to lack of evidence that it was not precluded from raising this defense.

The court considered the defendant's motion for summary judgment in an action by a provider to recover assigned first-party no-fault benefits. The motion sought to dismiss the complaint in relation to claims for services rendered to specific individuals. The Civil Court granted the defendant's motion, and the plaintiff did not submit any papers in opposition to the motion, nor were the substance of the plaintiff's arguments, if any, made at oral argument, included in the order. As a result, the Court of Appeals could not review the decision on direct appeal. The remedy for the plaintiff, if so advised, was to move in the Civil Court to vacate the order. Therefore, the appeal was dismissed.

The court considered the affidavits of an employee of a company retained to schedule independent medical examinations (IMEs), as well as an affidavit from the medical provider who was to perform the IMEs, and an affidavit executed by defendant's claims examiner. The main issue was whether the IME scheduling letters had been timely mailed, and whether the plaintiff's assignor had failed to appear for the duly scheduled IMEs. The court held that the affidavits established that the IME scheduling letters had been timely mailed, and that the plaintiff's assignor had failed to appear for those IMEs. As a result, the court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint.

The relevant facts that the court considered were that Domny Medical Services, P.C. was seeking to recover assigned first-party no-fault benefits, and the defendant, Travelers Insurance Company, had moved for summary judgment to dismiss the complaint, which was granted. The court also considered that plaintiff's cross motion for summary judgment was denied. The main issue decided was whether the record was sufficient to establish the proper mailing of the examination under oath scheduling letters to plaintiff's assignor and the denial of claim forms to plaintiff. The holding of the case was that the order granting defendant's motion for summary judgment and dismissing the complaint, while denying plaintiff's cross motion for summary judgment, was affirmed.

The relevant facts considered by the court in First Care Med. Equip., LLC v. Kemper Ins. Co. involved a medical equipment provider seeking to recover assigned first-party no-fault benefits. The main issue was whether the provider was entitled to summary judgment upon the first cause of action, as defendant insurance company argued that the supplies furnished were not medically necessary. The court ultimately held that the provider failed to establish its entitlement to summary judgment, as it did not prove that the defendant failed to timely deny the claim or that the denial of claim form was conclusory, vague, or without merit as a matter of law. The judgment awarding the provider the principal sum of $2,523.37 was reversed, and the branch of the provider's motion seeking summary judgment upon the first cause of action was denied. Thus, the defendant insurance company was not required to pay the requested benefits.

The court considered a case involving a motion for leave to enter a judgment upon defendant's failure to appear or answer the complaint, and a cross motion to open the default and compel the plaintiff to accept the late answer. The main issue decided was whether the defendant had a reasonable excuse for the default and the existence of a potentially meritorious defense to the action. The holding of the case was that the defendant failed to meet its burden of demonstrating a reasonable excuse for its default, and therefore, the motion for leave to enter a default judgment was granted and the cross motion to open its default in answering and to compel plaintiff to accept the late answer was denied.

The court considered a case where ESA Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits from Nationwide Affinity Ins. Co. of America. The main issue decided was whether the defendant had sufficient proof to establish that the initial and follow-up letters scheduling an examination under oath (EUO) had been timely mailed to plaintiff's assignor and whether the plaintiff's assignor had failed to appear for the scheduled EUOs. The court held that the proof submitted by the defendant was sufficient to establish that the letters had been timely mailed to the plaintiff's assignor and that the assignor had failed to appear for the scheduled EUOs. The court also rejected the plaintiff's argument that the affidavit submitted by the defendant did not comply with Alabama law, as it had an embossed notarial seal affixed to it. Therefore, the court affirmed the order, granting the defendant's motion for summary judgment and dismissing the complaint, while denying the plaintiff's cross motion for summary judgment.

The relevant facts the court considered were that the defendant had not received the claim forms underlying certain causes of action and that the plaintiff had failed to appear for duly scheduled examinations under oath. The main issues decided were whether there was a triable issue of fact as to whether the claims were timely submitted to the defendant, and whether the defendant was entitled to summary judgment dismissing the fourth and fifth causes of action based on the plaintiff's failure to appear for the examinations under oath. The holding of the case was that there was a triable issue of fact as to whether the claims were timely submitted to the defendant, and that the defendant was not entitled to summary judgment dismissing the fourth through ninth causes of action. Therefore, the order was modified to deny the branches of the defendant's motion seeking summary judgment dismissing the second through ninth causes of action.

The court considered that the defendant insurance company had sent letters scheduling examinations under oath (EUOs) to the plaintiff's assignor, which the plaintiff's assignor had failed to appear at. The insurance company had also timely denied the claims on these grounds. The main issue decided was whether the insurance company was entitled to summary judgment dismissing the complaint due to the assignor's failure to appear for the scheduled EUOs. The holding of the court was that the insurance company had established that the EUOs had been scheduled and that the assignor had failed to appear, and as the plaintiff had failed to raise a triable issue of fact in opposition, the insurance company was entitled to summary judgment dismissing the complaint. Therefore, the judgment was reversed, the order from 2018 was vacated, the insurance company's motion for summary judgment was granted, and the plaintiff's cross-motion was denied.