No-Fault Case Law

The court considered a case where SS Medical Care, P.C. sued 21st Century Insurance Company to recover assigned first-party no-fault benefits for medical services provided after a motor vehicle accident. SS Medical had been granted summary judgment after 21st Century failed to oppose their motion, and a judgment was entered. 21st Century then filed a declaratory judgment action in Supreme Court against SS Medical and its assignor regarding the accident. 21st Century later moved in civil court to vacate the judgment and dismiss the complaint, stating they had been in the process of filing the declaratory judgment action at the time of their default. The main issue was whether a reasonable excuse was present for 21st Century's default in opposing SS Medical's motion for summary judgment. The court held that the excuse provided by 21st Century was not reasonable and, therefore, denied their motion.

The relevant facts considered by the court were that SS Medical Care, P.C. had sought to recover first-party no-fault benefits for medical services provided due to a motor vehicle accident, and had been granted summary judgment due to the lack of opposition from 21st Century Insurance Company. 21st Century subsequently commenced a declaratory judgment action in the Supreme Court, which later granted its motion to temporarily stay any lawsuits against 21st Century regarding the health care services in question. 21st Century then moved to stay the execution of the judgment in favor of SS Medical, vacate the judgment, and dismiss the complaint, claiming it had been in the process of filing the declaratory judgment action at the time of the original summary judgment. The main issue decided was whether 21st Century had a reasonable excuse for its default in opposing the original motion for summary judgment, and whether the judgment was valid in light of the subsequent declaratory judgment. The court held that 21st Century's excuse was insufficient, and the judgment in favor of SS Medical was valid.

The relevant facts considered by the court were that the plaintiff, Sure Way NY, Inc., had filed a lawsuit seeking to recover assigned first-party no-fault benefits from the defendant, Travelers Insurance Company. The defendant had filed a motion for summary judgment to dismiss the complaint on the grounds that the plaintiff had failed to appear for duly scheduled examinations under oath. The main issue decided by the court was whether the defendant was entitled to summary judgment based on the plaintiff's failure to appear for scheduled exams. The holding of the court was that the order granting the defendant's motion for summary judgment was reversed, and the defendant's motion was denied, with the plaintiff being awarded costs of $30. The court's decision was based on the reasoning stated in a related case, Zen Acupuncture, P.C., as Assignee of Figueroa Lizzette v Ameriprise Ins. Co.

The court considered the facts of Merrick Medical, P.C., as Assignee of Glenda Chin, bringing a action to recover assigned first-party no-fault benefits from A Central Insurance Company. A worker's compensation fee schedule was used to deny part of the claim, and the remaining claims were denied on the grounds of lack of medical necessity. The court ruled in favor of A Central Insurance Company and held that the remaining issues for trial were the reduction of plaintiff's claims in accordance with the workers' compensation fee schedule and medical necessity. The court ultimately granted A Central Insurance Company's motion for summary judgment to dismiss the complaint.

The court considered the failure of the plaintiff to appear for duly scheduled examinations under oath (EUOs) and the untimely denial of claims by the defendant. The main issue was whether the defendant was entitled to summary judgment dismissing the complaint based on the failure to appear for EUOs, and whether the plaintiff was entitled to summary judgment based on the untimely denial of claims. The holding was that the defendant failed to demonstrate it was entitled to summary judgment based on the failure to appear for EUOs, as the initial EUO request was sent more than 30 days after the defendant had received the claims at issue. The court also held that the plaintiff's cross motion for summary judgment should have been denied, as the proof submitted failed to establish that the claims had not been timely denied or that the defendant had issued timely denial of claim forms that were conclusory, vague, or without merit as a matter of law. Therefore, the order was modified to provide that the plaintiff's cross motion for summary judgment was denied.

The court considered a case in which Oriental Health Acupuncture, P.C., sought to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue decided was whether the amounts sought to be recovered were in excess of the workers' compensation fee schedule. The court held that the order granting the defendant's motion for summary judgment to dismiss the complaint and denying the plaintiff's cross motion for summary judgment was affirmed, with costs of $25. The court referred to a similar case, BQE Acupuncture, P.C., as Assignee of Carrington, Earnel v State Farm Mut. Auto. Ins. Co., in its reasoning for the decision.

The court considered the allegations of a provider seeking to recover assigned first-party no-fault benefits, and the defendant insurance company's motion for summary judgment to dismiss the complaint. The main issue decided was whether the amounts sought to be recovered by the plaintiff were in excess of the workers' compensation fee schedule, and whether the fee reductions made by the defendant in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors were proper. The court held that the insurer could use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services, and consequently affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross-motion for summary judgment.

The court considered an appeal from an order denying the defendant's motion for summary judgment in a case involving a provider seeking to recover assigned first-party no-fault benefits. The main issue was whether the defendant was entitled to summary judgment dismissing the complaint which sought to recover upon the unpaid portion of the plaintiff's claims. The court held that the order, insofar as appealed from, was reversed and the defendant's cross motion for summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff's claims was granted. The holding was based on the reasons stated in a similar case, Natural Therapy Acupuncture, P.C., as Assignee of Boodoo, Anselm Kevin v GEICO Ins. Co., decided herewith.

The relevant facts that the court considered in the case of Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. involved a provider seeking to recover first-party no-fault benefits that had been assigned to them. The main issue decided was whether the provider was entitled to recover the unpaid portion of their claims. The court held that the branch of the defendant's cross motion seeking summary judgment dismissing the unpaid portion of the plaintiff's claims was granted. This decision was based on the court's reasoning in a similar case, Natural Therapy Acupuncture, P.C., as Assignee of Boodoo, Anselm Kevin v GEICO Ins. Co., which was decided alongside this case. The decision was unanimous, with Justices Pesce, Aliotta, and Elliot concurring.

The court considered the fact that the plaintiff, Compas Medical, P.C., was seeking to recover first-party no-fault benefits as an assignee. The main issue was whether the plaintiff's assignor had failed to appear for duly scheduled examinations under oath (EUOs). The court held that the EUO scheduling letters had been timely mailed and that the plaintiff's assignor had indeed failed to appear for the scheduled EUOs. The court also found that the defendant had mailed the EUO scheduling letters to the address provided by the plaintiff. As a result, the court affirmed the order which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint.