No-Fault Case Law

The case involved a dispute over the payment of no-fault benefits for medical supplies provided to an individual injured in a motor vehicle accident. The defendant insurer, Kemper, had sought a declaration in a separate action that they were not obligated to pay for any claims for benefits stemming from the accident, which was granted by the Supreme Court. The plaintiff, TAM Medical Supply Corp., then moved in the Civil Court for summary judgment, while Kemper cross-moved to dismiss the complaint on the basis that the Supreme Court's order granted them summary judgment. The Civil Court denied TAM's motion and granted Kemper's cross motion, leading to the dismissal of the complaint. The Appellate Term affirmed the judgment, holding that TAM's action in the Civil Court was barred by the doctrine of res judicata due to the findings of fact and determination of the merits made by the Supreme Court in granting summary judgment to Kemper.

The relevant facts of the case were that Bronx Acupuncture Therapy, P.C. commenced an action in Civil Court to recover $727.36 from Hereford Ins. Co. for unpaid healthcare services rendered to Dulce Baez. Hereford had denied payment due to lack of information submitted about the nature, extent, and need of the service. The main issue of the case was whether Hereford was right to have denied the payment based on lack of sufficient information. In a unanimous decision, the court held that Hereford's denial of payment was without merit as a matter of law. An unlisted modality like moxibustion must be justified by report, but the insurer has the burden of requesting additional verification first, which Hereford had failed to do. Therefore, summary judgment in favor of Bronx Acupuncture Therapy, P.C. was proper.

The court considered the case of Lida's Medical Supply, Inc. as the assignee of George Cortwright, who was seeking to recover first-party no-fault benefits from Park Insurance Company. The main issue decided was whether the defendant's motion for summary judgment, which sought to dismiss the complaint on the grounds that Cortwright had failed to appear for scheduled independent medical examinations, should be granted. The court held that for the same reasons stated in another case, Alleviation Med. Servs., P.C., as Assignee of Hill, Laquan v. Citiwide Auto Leasing, the defendant's motion for summary judgment should be granted. Therefore, the court reversed the order that denied the defendant's motion and granted summary judgment in favor of the defendant.

The main issue in this case was whether the defendant's motion for summary judgment to dismiss the complaint should be granted. The court considered the fact that the plaintiff, as an assignee of a provider, was seeking to recover first-party no-fault benefits, and that the defendant had appealed from an order of the Civil Court denying its motion which had sought summary judgment on the ground that the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The court ultimately held that the defendant's motion for summary judgment should be granted, reversing the lower court's decision and ruling in favor of the defendant. Therefore, the complaint was dismissed in favor of the defendant.

The relevant facts considered by the court included a provider seeking to recover first-party no-fault benefits and an order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint. The main issue decided in the case was whether the insured vehicle had been involved in the alleged accident in question. The holding of the case was that the order granting defendant's motion for summary judgment was affirmed, as the court found that the insured vehicle had not been involved in the accident, and denied the plaintiff's cross motion for summary judgment.

The court considered an appeal from an order of the Civil Court that denied the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the plaintiff had failed to appear for duly scheduled examinations under oath and if this constituted grounds for dismissing the complaint. The holding of the court was that the order denying the defendant's motion was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted. This decision was based on the reasoning provided in a similar case, Right Aid Med. Supply Corp., as Assignee of Kusi Comfort v Ameriprise Auto & Home. The appellate court judges all concurred with this decision.

The court considered whether additional verification requested by the insurance company remained outstanding. The main issue in the trial was whether the requested verification that was mailed to the plaintiff remained outstanding. The judgment was reversed and the matter was remitted to the Civil Court for a new trial on the issue of whether the requested verification remains outstanding. The court specifically stated that the requests were mailed, and the finding that they were timely mailed was implicit in the court's order. So, the main legal issue in this case was whether the requested verification remained outstanding, and the holding of the court was that the matter needed to be remitted to the Civil Court for a new trial to address this issue.

The court considered the fact that the defendant's motion for summary judgment dismissing the complaint was granted on the grounds that the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs) and that the plaintiff's cross motion for summary judgment was denied. The main issue decided was whether the defendant had established that its time to pay or deny the claims at issue was tolled, and whether the delay letters submitted were sufficient to toll the defendant's time to pay or deny the claims. The holding of the case was that the order granting the defendant's motion for summary judgment was affirmed, as the plaintiff's contention that the defendant failed to established that its time to pay or deny the claims was tolled was found to lack merit and the remaining contention was not properly before the court. Ultimately, the court held that the plaintiff failed to establish the defendant's time to pay or deny the claims was tolled, and as such, the order granting the defendant's motion for summary judgment was affirmed.

The court considered whether a provider could recover first-party no-fault benefits when the assignor failed to appear for duly scheduled examinations under oath. The main issue was whether the provider, Nica Acupuncture, P.C., could recover assigned first-party no-fault benefits after its assignor, Maxim Savelyev, failed to appear for scheduled examinations under oath. The court held that the provider could not recover the benefits and affirmed the lower court's order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment. The court's decision was based on the same reasoning as another case, Ocean One Physical Therapy, P.C. v 21st Century Centennial Ins. Co., which was decided at the same time.

The court considered the fact that NL Quality Medical, P.C. was seeking to recover assigned first-party no-fault benefits and that the complaint was dismissed on the grounds that the assignor had failed to appear for scheduled examinations under oath. The main issue decided was whether the provider could recover assigned first-party no-fault benefits when the assignor failed to appear for scheduled examinations under oath. The holding of the court was that the order granting the defendant's motion for summary judgment and dismissing the complaint was affirmed, and the plaintiff's cross-motion for summary judgment was denied. The court's decision was based on the reasoning stated in a similar case, Ocean One Physical Therapy, P.C., as Assignee of Maxim Savelyev v 21st Century Centennial Ins. Co., and the decision was made by P.J. Pesce, and Judges Weston and Aliotta.