No-Fault Case Law

The court considered the appeal from an order of the Civil Court which granted the plaintiff's motion to compel discovery and denied the defendant's cross motion for summary judgment dismissing the complaint. The main issue was whether the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations, which would affect the outcome of the case. The court ultimately reversed the order, granted the defendant's cross motion for summary judgment dismissing the complaint, and denied the plaintiff's motion to compel discovery as moot. The holding of the case was in favor of the defendant, with the court ruling that the plaintiff's assignor's failure to appear for scheduled medical examinations warranted the dismissal of the complaint.

The relevant facts considered by the court were that Atlas Orthosurgery, P.C. was seeking to recover first-party no-fault benefits as the assignee of an individual named Jackxuell Delgado. The main issue decided was whether the defendant insurance company's motion for summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor failed to appear for independent medical examinations (IMEs) was valid, and whether the plaintiff's cross motion for summary judgment should be denied. The holding of the case was that the court affirmed the order to grant the defendant's motion for summary judgment and dismiss the complaint, as the proof submitted by the defendant was sufficient to establish the proper mailing of the IME scheduling letters. Therefore, the order was affirmed.

The relevant facts the court considered were that NICA Acupuncture, P.C., and other plaintiffs were seeking to recover assigned first-party no-fault benefits from American Independent Insurance Company. The main issue decided was whether the Civil Court should have denied the defendant's motion to dismiss and ordered jurisdictional discovery, pursuant to CPLR 3211 (d). The holding of the case was that the order to grant the defendant's motion to dismiss the complaint and deny the plaintiffs' cross motion seeking discovery pursuant to CPLR 3211 (d) was affirmed. The court found that the evidence provided by the plaintiffs did not constitute the "tangible evidence" necessary to substantiate their allegation that jurisdiction could exist, and therefore, they did not make a "sufficient start" to warrant discovery on the issue of personal jurisdiction over the defendant.

The relevant facts the court considered in this case were that the plaintiff, Body Acupuncture Care, P.C., had filed a motion for summary judgment to recover assigned first-party no-fault benefits, while the defendant, Erie Insurance Company of New York, had filed a cross-motion for summary judgment to dismiss the complaint on the grounds that the plaintiff had failed to appear for scheduled independent medical examinations (IMEs). The main issue decided was whether the plaintiff had failed to appear for the scheduled IMEs, and whether this failure warranted the dismissal of the complaint. The holding of the case was that the defendant had established that the IMEs had been scheduled and timely mailed to the plaintiff's assignor's address, the assignor had failed to appear at the scheduled IMEs, and the claims had been timely denied on that ground. Therefore, the defendant's cross motion for summary judgment dismissing the complaint was granted, and the plaintiff's motion for summary judgment was denied.

The court considered the appeal from an order of the Civil Court which granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue was whether the defendant's papers established, as a matter of law, that the denial of claim forms had been timely mailed, and if the defendant is entitled to summary judgment dismissing the complaint. The holding of the court was that while the defendant failed to demonstrate that it is not precluded from asserting its proffered defenses and is not entitled to summary judgment, the plaintiff also failed to establish that the claims at issue had not been timely denied or that the defendant had issued timely denials of claim that were conclusory, vague or without merit. Therefore, the court modified the order by providing that the defendant's motion for summary judgment dismissing the complaint is denied.

The main issue in this case was whether the Civil Court of the City of New York correctly granted the plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The relevant facts considered by the court included the plaintiff's motion for summary judgment, the subsequent judgment entered on December 12, 2017, and the appeal by the defendant. The holding of the case was that the judgment was reversed, and so much of the order entered May 10, 2017 as granted the plaintiff's motion for summary judgment was vacated, denying the plaintiff's motion for summary judgment.

The court considered the fact that Lida's Medical Supply, Inc. filed a motion for summary judgment in order to recover first-party no-fault benefits. The main issue decided was whether the proof submitted by Lida's Medical Supply, Inc. established that the claim had not been timely denied or that the insurer had issued a timely denial of claim form that was without merit as a matter of law. The holding of the court was that Lida's Medical Supply, Inc.'s motion for summary judgment should have been denied, as the proof submitted failed to establish that the claim had not been timely denied, or that the insurer had issued a timely denial of claim form that was without merit as a matter of law. Therefore, the judgment was reversed, and the motion for summary judgment was denied.

In New Horizon Surgical Center, LLC v Travelers Insurance Company, on October 18, 2019, the Second Department of the Appellate Term considered a denial of defendant's (Travelers Insurance Company) motion for summary judgment. They denied the motion for summary judgment, asserting that the provider (New Horizon Surgical Center, LLC) had failed to provide the requested verification for assigned first-party no-fault benefits. The proof defendant submitted was sufficient to demonstrate that defendant had not received the requested verification. The Court found that the defendant was not required to pay or deny plaintiff's claims upon receipt of a partial response to defendant's verification requests. The court reversed the order, concluding that defendant's motion for summary judgment dismissing the complaint should be granted.

The court considered the fact that the defendant had submitted an affidavit by a supervisor employed by Omnimed Evaluation Services, which had been retained by defendant to schedule independent medical examinations (IMEs) and that the assignor had failed to appear for the duly scheduled IMEs. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for duly scheduled IMEs. The holding of the case was that the defendant was entitled to summary judgment dismissing the complaint because they had timely denied the claims and the plaintiff had failed to raise a triable issue of fact in opposition to the defendant's cross motion. The court reversed the order denying the defendant's cross motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint.

The court considered the fact that the defendant had timely and properly denied the claims at issue based upon the plaintiff's assignor's failure to appear for independent medical examinations (IMEs). The main issue decided was whether the address to which the IME scheduling letters had been mailed was proper. The holding of the case was that the address to which the IME scheduling letters were mailed was proper, as it matched the one provided by the plaintiff's assignor on the assignor's sworn application for no-fault benefits (NF-2) and on the assignor's sworn notice of intention to make claim form which was submitted to the defendant. As a result, the defendant's cross motion for summary judgment dismissing the complaint was granted.