No-Fault Case Law

The relevant facts the court considered were that the plaintiff, BQE Acupuncture, P.C., sought to recover assigned first-party no-fault benefits from the defendant, GEICO Ins. Co. The main issue decided in this case was whether the defendant was entitled to summary judgment dismissing the complaint. The holding of the court was that the order denying the defendant's cross motion for summary judgment dismissing the complaint was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted. The decision was based on reasons stated in a similar case, Acupuncture Now, P.C., as Assignee of Lozano, Cleotilde v Global Liberty Ins., and the judges PESCE, P.J., ALIOTTA, and SIEGAL concurred with the decision.

The relevant facts considered by the court were that the plaintiff, Sovera Medical Supply Corp., was seeking to recover first-party no-fault benefits from the defendant, 21st Century Insurance Company. The defendant moved for summary judgment to dismiss the complaint, stating that there was a lack of medical necessity for the supplies in question. The plaintiff cross-moved for summary judgment, but both motions were denied by the Civil Court of the City of New York, Kings County. The main issue decided by the court was whether there was a lack of medical necessity for the supplies in question, as stated by the defendant. The court found that the peer review report submitted by the defendant sufficiently set forth a factual basis and medical rationale for the determination of a lack of medical necessity. The plaintiff's submission of an affidavit from a doctor failed to meaningfully address or rebut the conclusions set forth in the peer review report. The holding of the case was that the order of the Civil Court granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment was affirmed. The court concluded that there was a lack of medical necessity for the supplies in question, as supported by the peer review report, and therefore, the defendant was entitled to summary judgment dismissing the complaint.

The court considered the facts in a case where a provider was seeking to recover first-party no-fault benefits assigned to them. The main issue decided was whether the defendant's cross motion to hold the action in abeyance pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law should be granted. The holding of the court was that the defendant's defense that the assignor is eligible for workers' compensation benefits is subject to preclusion, as they failed to demonstrate that they had timely denied the plaintiff's claims on the ground that the assignor was injured in the course of his employment. As a result, the defendant's cross motion was properly denied and the order was affirmed.

The relevant facts considered by the court were that the plaintiff, GC Chiropractic, P.C., was seeking to recover first-party no-fault benefits from the defendant, Integon National Ins. Co. The defendant moved for summary judgment to dismiss the complaint on the grounds of lack of medical necessity, while the plaintiff argued that the defendant had failed to respond to discovery demands, and that those responses were necessary to oppose the motion. The court decided that the defendant was not entitled to summary judgment dismissing the complaint because the plaintiff had requested but not received the medical records relied upon by the defendant's peer reviewer in time to oppose the motion. As a result, the court reversed the order, denied the defendant's motion for summary judgment, and granted the plaintiff's cross motion to compel discovery.

The court considered the fact that Psychology YME, P.C. was seeking to recover assigned first-party no-fault benefits from Travelers Insurance. The main issue decided was whether defendant's motion for summary judgment dismissing the complaint should be granted based on plaintiff's failure to provide requested verification within 120 days of the initial verification request, and whether plaintiff's cross motion for summary judgment should be granted. The holding of the case was that defendant's motion for summary judgment dismissing the complaint was granted, and plaintiff's cross motion for summary judgment was denied. The court found that defendant's proof was sufficient to demonstrate that it had timely mailed initial and follow-up verification requests, had not received the requested verification, and had timely denied the claim on that ground, and that plaintiff failed to raise a triable issue of fact in opposition.

The court considered the denial of defendant's cross motion for summary judgment in a case involving a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's cross motion for summary judgment dismissing the complaint should be granted. The holding of the case was that the order denying the defendant's cross motion for summary judgment was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted. This decision was based on the reasons stated in a similar case, Acupuncture Now, P.C., as Assignee of Lozano, Cleotilde v Global Liberty Ins., which was decided herewith. The decision was concurred by all three judges.

The court considered the denial of claim forms that had been presumed to be timely mailed by the defendant, as well as the full payment made by the defendant to the plaintiff for services in accordance with workers' compensation fee schedules. The main issue decided was whether the defendant's cross motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was granted. The court found that the proof submitted by the defendant was sufficient to give rise to a presumption that the denial of claim forms had been timely mailed, and that the plaintiff had failed to raise a triable issue of fact in opposition. As a result, the court reversed the order and granted the defendant's cross motion for summary judgment dismissing the complaint.

The relevant facts that the court considered were that the plaintiff, Easy Care Acupuncture, P.C., was seeking to recover first-party no-fault benefits from the defendant, Ameriprise Ins. Co. The defendant had moved for summary judgment to dismiss part of the complaint, claiming that the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). The court decided that the defendant had established that the EUO scheduling letters had been timely mailed and that the plaintiff had indeed failed to appear for the scheduled EUOs. As a result, the court affirmed the order, granting the defendant's motion for summary judgment and dismissing the claims for certain amounts in the complaint. The main issue decided by the court was whether the defendant had proven that the plaintiff's assignor had failed to appear for scheduled examinations under oath, and if so, whether the plaintiff's claims for certain amounts should be dismissed. The holding of the case was that the court affirmed the order granting the defendant's motion for summary judgment, dismissing the claims in the complaint for specific amounts, as the plaintiff had failed to appear for the scheduled examinations under oath.

The court considered the fact that the plaintiff, Bronx Medical Diagnostic, P.C., was seeking to recover assigned first-party no-fault benefits, and the defendant, Hereford Insurance Co., had filed a cross-motion for summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor had failed to appear for scheduled examinations under oath. The main issues decided were whether the defendant had timely sought verification in the form of an examination under oath (EUO), and whether the defendant's cross-motion for summary judgment should be granted. The holding of the case was that the court reversed the order granting the defendant's cross-motion for summary judgment and denied the motion, stating that the defendant had failed to establish that it had timely sought verification in the form of an EUO, and had not demonstrated its entitlement to summary judgment based upon the plaintiff's failure to comply with a condition precedent to coverage.

The main issue in this case was whether the insurance company, Hartford Insurance Company, was liable to pay first-party no-fault benefits to KJC Chiropractic, P.C., as the assignee of the insured Gregory, Na-Quan. The insurance company had cancelled the policy for nonpayment of the premium before the accident occurred. The court considered whether the insurance company had sufficiently established the policy cancellation in accordance with Vehicle and Traffic Law, and whether the cancellation was effective. The court found that the insurance company had mailed the policy cancellation letter to the insured with a cancellation date that was effective prior to the accident, and had filed a copy of the notice of cancellation with the Department of Motor Vehicles within 30 days of the effective date of the cancellation. As a result, the court held that the cancellation was effective with respect to the insured and the insurance company was not liable to pay first-party no-fault benefits. Therefore, the court reversed the order and granted the insurance company's cross motion for summary judgment dismissing the complaint.