No-Fault Case Law

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.

The court considered a motion for summary judgment in a case where a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company argued that the plaintiff's assignor had failed to appear for scheduled medical examinations. The main issue decided was whether the insurance company had established timely mailing of the denial of claim forms, and therefore whether they were entitled to summary judgment dismissing the complaint. The holding of the court was that the insurance company's motion for summary judgment was granted, and the complaint was dismissed, based on the same reasoning as a related case, Colin, as Assignee of Tyrell Sloan v Global Liberty Ins. Co. of NY.

The case involved an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment and denied the plaintiff's cross motion for summary judgment. The plaintiff, Solution Bridge, Inc., brought the action to recover assigned first-party no-fault benefits. The defendant, Nationwide Ins., argued that the action was premature due to the plaintiff's failure to provide requested verification and that the plaintiff had failed to appear for examinations under oath. The court held that while the defendant demonstrated that they had timely mailed initial and follow-up requests for verification, the affidavit submitted by the plaintiff in opposition to the defendant's motion was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the defendant. As a result, the court found a triable issue of fact as to whether the action was premature and modified the order to deny the defendant's motion for summary judgment dismissing the complaint.

The relevant facts of the case were that Advanced Orthopaedics, PLLC, as the assignee of Lisa Jones, appealed an order denying their petition to vacate a master arbitrator's award. The arbitrator had upheld the denial of Advanced Orthopaedics' claim to recover assigned first-party no-fault benefits. The main issue decided was whether there was evidentiary support, rationality, or a plausible basis for the master arbitrator's determination. The holding of the case was that the court affirmed the order to deny the petition to vacate the master arbitrator's award, but modified the order to include a provision confirming the master arbitrator's award as required by CPLR 7511(e).