No-Fault Case Law

The court considered the case of NL Quality Medical, P.C., who appealed an order of the Civil Court that granted GEICO Ins. Co.'s motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue was whether the proof submitted by the defendant was sufficient to give rise to a presumption that certain documents had been timely mailed and to demonstrate that the plaintiff had failed to comply with a condition precedent to coverage. The holding of the case was that the court modified the order by denying the branch of defendant's motion seeking summary judgment dismissing the second cause of action, as they found that an issue of fact exists as to whether the plaintiff is entitled to recover any additional reimbursement with respect to the services. Therefore, the branch of plaintiff's cross motion seeking summary judgment upon the second cause of action was properly denied.

The court considered the motion for summary judgment filed by the defendant, Nationwide Ins. Co., in a case brought by LVOV Acupuncture, P.C., as the assignee of Ozhan Tastaban, to recover first-party no-fault benefits. The main issue decided was whether the defendant had properly used the workers' compensation fee schedule to determine the amount owed to the plaintiff for the services in question. The court held that the defendant had fully paid the plaintiff for the services at issue, and that the affidavit executed by the defendant's certified medical coder established that the defendant had properly used the workers' compensation fee schedule. The court found that the plaintiff failed to rebut the defendant's showing, and affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered whether the defendant insurance company had properly used the workers' compensation fee schedule applicable to chiropractors to reimburse the plaintiff, a provider of acupuncture services, for the services rendered. The main issue decided was whether the plaintiff was entitled to recover the unpaid portion of claims for services billed under specific CPT codes. The holding of the case was that the Civil Court denied the branches of the plaintiff's motion seeking summary judgment for the unpaid portion of the claims and granted the branches of the defendant's cross motion seeking summary judgment dismissing those claims. The decision was affirmed by the court.

This case involved an appeal from a decision in a no-fault benefits action by a healthcare provider against an insurance company. The main issue at hand was whether the insurance company properly used the workers' compensation fee schedule applicable to chiropractors to reimburse the healthcare provider for acupuncture services rendered. The court found that the insurance company had provided sufficient evidence to show that it had fully paid the healthcare provider for the services at issue in accordance with the fee schedule for acupuncture services performed by chiropractors. As a result, the court affirmed the lower court's decision to grant the insurance company's motion for summary judgment and dismiss the portion of the healthcare provider's complaint seeking to recover the unpaid portion of the claims for services at issue.

The relevant facts the court considered were that Healing Art Acupuncture, P.C. sought to recover assigned first-party no-fault benefits and defendant, GEICO Ins. Co., argued that it had properly used the workers' compensation fee schedule applicable to chiropractors who render the same services as acupuncturists to reimburse plaintiff for the acupuncture services. The main issue decided was whether the defendant had properly used the fee schedule to reimburse the plaintiff for the acupuncture services. The holding was that the Civil Court denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. The order was affirmed by the Supreme Court, Appellate Term, Second Department.

The court considered the facts of an action by a provider to recover assigned first-party no-fault benefits, in which the defendant's motion for summary judgment dismissing the complaint was granted and the plaintiff's cross motion for summary judgment was denied. The main issue decided was whether the branch of defendant's motion seeking summary judgment dismissing the first cause of action should be denied. The holding of the court was that the order was modified by providing that the branch of defendant's motion seeking summary judgment dismissing the first cause of action is denied, and as modified, the order is affirmed, without costs.

The court considered the denial of a provider's motion for summary judgment and the granting of the defendant's cross motion for summary judgment in a case involving the recovery of assigned first-party no-fault benefits. The main issue decided was whether the defendant's affidavit and contemporaneous affidavits were sufficient to establish the proper mailing of denial of claim forms. The court held that the affidavit executed by the defendant's no-fault supervisor and the contemporaneous affidavits executed by the defendant's mailing officer were indeed sufficient to establish the proper mailing of the denial of claim forms. Therefore, the court affirmed the order, with costs.

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.