No-Fault Case Law

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.

The court considered a case where Atlantic Chiropractic, P.C., as assignee of Wilfredo Cueto, sought to recover assigned first-party no-fault benefits from Global Liberty Insurance Company. The main issue decided was whether the fees charged by the plaintiff exceeded the amounts permitted by the workers' compensation fee schedule. The court held that the defendant's motion for summary judgment dismissing the complaint was denied, and the only remaining issue for trial was the defendant's defense that the amounts sought exceeded the amounts permitted by the workers' compensation fee schedule. The court affirmed the order, holding that the defendant's motion papers failed to establish, as a matter of law, that the fees charged by the plaintiff exceeded the amounts permitted by the workers' compensation fee schedule.

The court considered the fact that a provider was seeking to recover first-party no-fault benefits and that the defendant had moved for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the defendant's proof sufficiently established that the plaintiff's assignor had indeed failed to appear for the scheduled EUOs. The holding of the court was that the defendant's proof was sufficient and therefore the order granting the defendant's motion for summary judgment and dismissing the complaint was affirmed.

The court considered the fact that the plaintiff, a medical provider, had failed to appear for duly scheduled examinations under oath. The main issue decided was whether the plaintiff's failure to appear for scheduled examinations under oath warranted the dismissal of the complaint. The court held that the defendant's motion for summary judgment dismissing the complaint should be granted, reversing the order of the Civil Court. This decision was based on the fact that the plaintiff had failed to appear for scheduled examinations under oath, and in line with a similar decision in a related case.

The relevant facts in this case involved a provider 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 the grounds that the provider failed to appear for scheduled examinations under oath (EUOs). The insurance company's affidavit established that the EUO scheduling letters and denial of claim forms had been timely mailed, and their attorney's affirmation demonstrated that the provider failed to appear on the scheduled dates. The main issue decided was whether the insurance company had demonstrated its prima facie entitlement to summary judgment. The court held that the insurance company had met its burden, as the provider failed to raise a triable issue of fact in opposition to the motion. Therefore, the court reversed the order and granted the insurance company's motion for summary judgment dismissing the complaint.

The court considered an order denying the defendant's motion for summary judgment in a case where a provider was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the insurance policy in question was procured by making a material misrepresentation as to the ownership and use of the vehicle in question. The court held that the insurer failed to establish as a matter of law that it would not have issued the policy in question if the correct information had been disclosed in the application, and therefore did not demonstrate that the misrepresentation by the plaintiff's assignor was material. As a result, the order denying the defendant's motion for summary judgment was affirmed by the court.

The court considered the fact that the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, appealed from an order of the Civil Court granting the defendant's motion for summary judgment. The defendant had argued that the plaintiff's assignor had failed to appear for scheduled examinations under oath. The main issue decided was whether the defendant had established, as a matter of law, that the assignor had failed to appear for the examinations, and whether this failure relieved the insurer of liability. The holding of the court was that the defendant had indeed established that the assignor had failed to appear for the examinations, which was a condition precedent to the insurer's liability on the policy. Therefore, the order granting the defendant's motion for summary judgment was affirmed.

The court considered the fact that the defendant had scheduled EUOs (Examinations Under Oath) in accordance with their standard office practices and procedures, but the plaintiff failed to appear for these scheduled EUOs. As a result, the defendant had denied the plaintiff's claim for services rendered on the basis of the plaintiff's failure to appear for the EUOs. The main issue before the court was whether the defendant was entitled to summary judgment dismissing the complaint on these grounds. The holding of the case was that the defendant had established its prima facie entitlement to summary judgment dismissing the complaint, and the plaintiff failed to raise a triable issue of fact in opposition to the defendant's showing. Therefore, the judgment was reversed, and the order granting the plaintiff's cross-motion for summary judgment was vacated.