No-Fault Case Law

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.

The court considered the conflicting affidavits from the claims adjuster and the application for no-fault benefits to determine if the EUO letters were timely mailed. They also considered the issue of why the claimant, Akeem Evans, left the EUO after his counsel announced he would no longer represent him. The main issue decided was whether Global Liberty Insurance Co. owed no-fault coverage to health care provider SML Acupuncture, P.C. The court ultimately held that Global's motion for summary judgment was denied because they failed to provide sufficient evidence to prove that the EUO letters were timely mailed and because issues of fact arose as to why Evans left the EUO. The court also found that SML's contention that Global failed to provide proper notice for the delay of the claim was unpreserved, and their argument for attorneys' fees was unavailing.

The relevant facts considered by the court were that ZZ Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from American Independent Ins. Co. The main issue decided was whether the defendant's motion to dismiss the complaint should be granted pursuant to CPLR 3211 (a) (8). The holding of the case was that, for the reasons stated in another case (Pierre J. Renelique, M.D., P.C., as Assignee of Vernizier, Jean Willy v American Ind. Ins. Co.), the order denying the defendant's motion to dismiss the complaint was reversed and the motion to dismiss the complaint was granted. Therefore, the defendant's motion to dismiss the complaint was ultimately granted.

The court considered an appeal from an order of the Civil Court which denied the defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover for services rendered to assignors Paola Dossa and Omar Morrison. The main issue decided was whether the action was premature because the plaintiff had failed to provide requested verification of the services rendered. The court held that the defendant had demonstrated that it had timely mailed initial and follow-up requests for verification and had not received the requested verification, thus showing that the complaint seeking to recover for services rendered to Paola Dossa and Omar Morrison was premature. As the plaintiff failed to raise a triable issue of fact in opposition to the defendant's motion, the branches of the defendant's motion seeking summary judgment were granted.