No-Fault Case Law

The court considered that the plaintiff, Precise Physical Therapy Solutions, as assignee of Tazaya P., had submitted a medical bill to the defendant, State Farm Mutual Auto. Ins. Co., for treatment received by Tazaya P. after a car accident in an insured vehicle. The defendant denied the claim based on a belief that the alleged injury did not arise from an insured incident and because the assignor failed to sign the transcript of an examination under oath. The main issue decided was whether the defendant's motion for summary judgment to dismiss the plaintiff's complaint should be granted. The court held that the defendant's motion for summary judgment was denied in its entirety without opposition and without prejudice as it failed to provide sufficient evidence to rebut the presumption of coverage and that the motion to dismiss due to the assignor's failure to subscribe the transcript was premature and lacked evidence of an insurance contract term requiring the same.

The court considered a case where Longevity Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits from Nationwide Ins. The main issue was whether the plaintiff's assignor had failed to appear for duly scheduled examinations under oath, and whether the claims had been timely denied on that ground. The court found that defendant had established that the EUO scheduling letters had been timely mailed, that the assignor had failed to appear for the scheduled EUOs, and that the claims had been timely denied on that ground. Plaintiff failed to raise a triable issue of fact in opposition, and the court ultimately held in favor of the defendant, granting their motion for summary judgment dismissing the complaint.

The relevant facts considered by the court were that the plaintiff filed a lawsuit against the New York State Insurance Fund for failure to pay first party No-Fault benefits as a result of medical services rendered to an injured party. The main issue decided was whether the court had jurisdiction to hear the case, as the defendant argued that it should have been brought in the New York State Court of Claims. The holding of the case was that the court did not have jurisdiction, and therefore the plaintiff's motion for leave to reargue and renew the decision was denied. The court found that the new fact brought by the plaintiff, that the case was time-barred in the Court of Claims, did not change the outcome of the prior decision and therefore did not establish a basis for leave to renew.

The main issue in this case was whether the defendant had paid the limits of the policy in accordance with 11 NYCRR 65-3.15 in order to assert a defense of policy exhaustion. The court considered whether the defendant had made any payments under the policy and if the proof submitted was sufficient to establish the timely denial of claims. The court held that the defendant failed to demonstrate, as a matter of law, that it had made any payments under the policy, and therefore, its motion for summary judgment dismissing the complaint was denied. Additionally, the court held that the plaintiff's motion for summary judgment was properly denied, as the proof submitted by the plaintiff failed to establish that the claims had not been timely denied or that the defendant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law.

The main issue in this case was whether a provider could recover assigned first-party no-fault benefits when service of the summons was completed by mail, but there was no proof of acknowledgment of receipt of the summons and complaint by the defendant, thus failing to establish personal jurisdiction. The court held that when service of the summons in a Civil Court action is other than by personal delivery, service is complete upon the filing of proof of service. This involves an acknowledgment of receipt of the summons and complaint, as provided for in the CPLR 312-a. The record in this case failed to show that a signed acknowledgment of receipt was returned to the plaintiff, leading to a failure to acquire personal jurisdiction over the defendant. As a result, the court affirmed the order granting the defendant's motion to dismiss the complaint.

The relevant facts considered by the court included a dispute over whether the plaintiff obtained personal jurisdiction over the defendants in an action to recover assigned first-party no-fault benefits. The plaintiff alleged that the summons and complaint were served by mail pursuant to CPLR 312-a, but there was no acknowledgment of service in their papers. The defendants moved to dismiss the complaint on the ground that the plaintiff had failed to obtain personal jurisdiction over them, and the Civil Court denied the motion. The main issue decided was whether the plaintiff had acquired personal jurisdiction over the defendants, and the holding of the court was that the record failed to demonstrate that a signed acknowledgment of receipt was returned to the plaintiff, and thus they had failed to acquire personal jurisdiction over the defendants, resulting in the reversal of the lower court's decision and the granting of the defendants' motion to dismiss the complaint.

The court considered the fact that the defendant had moved for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs) and that the amounts plaintiff sought to recover upon the remaining claims exceeded the amount permitted by the workers' compensation fee schedule. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint on these grounds. The holding of the court was that the defendant's motion for summary judgment should have been granted, as they had sufficiently established that the IME scheduling letters had been timely mailed, the assignor had failed to appear for the scheduled IMEs, and the claim at issue was timely denied. Therefore, the branch of defendant's motion seeking summary judgment to dismiss the claim was granted.

The court considered a case where a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company moved for summary judgment to dismiss the complaint on several grounds, including failure of the plaintiff's assignor to appear for independent medical examinations, a portion of the claim being submitted more than 45 days after services were rendered, and that the amounts sought exceeded the amount permitted by the workers' compensation fee schedule. The court held that the insurance company had established that the assignor had failed to appear for the scheduled IMEs, and that the claim for services rendered on April 19, 2016 had been timely denied. The court also found that the claim for services rendered on December 28, 2015 had been submitted more than 45 days after the services had been rendered, and that the insurance company had fully paid the plaintiff for certain services in accordance with the workers' compensation fee schedule. Therefore, the court granted the insurance company's motion for summary judgment in part and modified the order to dismiss certain claims, but did not grant summary judgment with respect to claims under CPT code 90739.

The court considered the facts that defendant moved for summary judgment to dismiss the complaint seeking to recover $1,150 in first-party no-fault benefits, on the grounds that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs). The defendant submitted an affidavit demonstrating that scheduling letters had been properly mailed to the plaintiff's assignor, as well as affidavits from the chiropractors showing that the assignor had failed to appear for the scheduled IMEs. The court found that the plaintiff's opposition failed to demonstrate the existence of a triable issue of fact, as no issue was raised regarding the scheduling letters mailed to the assignor. The main issue decided by the court was whether the defendant had provided sufficient evidence that the plaintiff's assignor had failed to appear for the scheduled IMEs, and whether the plaintiff's opposition raised any triable issues of fact. The holding of the case was that the court reversed the lower court's decision and granted the defendant's motion for summary judgment to dismiss the complaint seeking to recover $1,150 in first-party no-fault benefits.

The court considered the issue of whether the defendant insurance company's motion for summary judgment dismissing the complaint regarding the failure of the plaintiff's assignor to appear for independent medical examinations (IMEs) should be granted. The defendant argued that the assignor had failed to appear for IMEs as required and that the address to which the IME scheduling letters had been mailed matched the one provided by the assignor on the application for no-fault benefits. The court found that the defendant had established timely mailing of the denial of claim forms and that the assignor had indeed failed to appear for the IMEs. The court reversed the lower court's decision and granted the defendant's motion for summary judgment dismissing the complaint. Therefore, the holding of the case was in favor of the defendant insurance company.