No-Fault Case Law

The court considered an appeal from an order of the Civil Court of the City of New York involving a case in which Natural Therapy Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from GEICO Ins. Co. The main issue decided was whether the branch of the defendant's cross motion seeking summary judgment dismissing the complaint, insofar as it sought to recover upon the unpaid portion of plaintiff's claims, should be granted. The holding of the court was that the order of the Civil Court, insofar as it was appealed from, was reversed, and the branch of the defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of the plaintiff's claims was granted. The decision was made on August 2, 2019, and was decided by the Appellate Term, Second Department.

The court considered the appellant's motion for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to appear for scheduled examinations under oath (EUOs). The court also considered the plaintiff's cross motion for summary judgment. The main issue decided was whether the appellant had issued timely EUO notices and whether the plaintiff had failed to appear for scheduled EUOs. The court held that the follow-up requests for verification from the appellant were actually delay letters, as they did not specify the time and place the EUOs would take place, and therefore the appellant failed to establish that it had issued timely EUO notices with respect to the claims underlying the first and second causes of action. However, the court found that the proper EUO scheduling letters had been timely mailed with respect to the third cause of action, and the appellant's time to pay or deny this claim was tolled, and therefore the branch of the appellant's motion seeking summary judgment dismissing the third cause of action should have been granted. The court also held that the plaintiff's cross motion for summary judgment should have been denied as the proof submitted by plaintiff failed to establish that the claims underlying the first and second causes of action had not been timely denied, and that the appellant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law. Therefore, the judgment was reversed, and the branch of the defendant's motion seeking summary judgment dismissing the third cause of action was granted, and the plaintiff's cross motion was denied.

The court considered a case in which Natural Therapy Acupuncture, as assignee of Boodoo, Anselm Kevin, sought to recover unpaid first-party no-fault benefits from GEICO Ins. Co. Plaintiff moved for summary judgment, while defendant cross-moved for summary judgment to dismiss the complaint on the basis that it had fully paid for the services at issue rendered prior to April 1, 2013. The main issue decided was whether defendant demonstrated that it had timely denied the claims at issue and properly used the workers' compensation fee schedule to determine the amount plaintiff was entitled to receive for the services in question. The holding of the court was that the branch of defendant's cross motion seeking summary judgment to dismiss the unpaid portion of plaintiff's claims should have been granted, reversing the lower court's decision.

The main issue in this case was whether the insured vehicle had been involved in the alleged accident in question. The court granted the defendant's motion for summary judgment dismissing the complaint, as the insured testified in an examination under oath (EUO) that she had been parking her vehicle at the time of the alleged accident, and no accident had occurred. The EUO testimony and supporting affidavit were deemed sufficient to demonstrate that the alleged injury did not arise out of an insured incident, and plaintiff failed to raise a triable issue of fact in opposition to defendant's motion. Therefore, the court affirmed the order granting summary judgment in favor of the defendant.

The Court considered the fact that American Transit Insurance Company and Hereford Insurance Company were involved in a proceeding pursuant to CPLR article 75 to confirm an arbitration award for a motor vehicle accident that occurred on May 15, 2015. Hereford sought to recover $50,000 from ATIC, and the arbitrator awarded Hereford the sum of $50,000. ATIC opposed the petition, but the Supreme Court granted the petition to confirm the award, determining that there was no basis to vacate the arbitrator's award. ATIC appealed, arguing that the arbitrator's determination was arbitrary and capricious, but the Court found that the arbitrator's award was supported by a reasonable hypothesis and was not contrary to what could be fairly described as settled law. The main issue decided by the Court was whether the arbitrator's determination to award Hereford the sum of $50,000 for benefits paid to the injured party was arbitrary and capricious. The holding of the case was that the Supreme Court's determination to grant the petition to confirm the arbitration award was affirmed.

The relevant facts of this case include the fact that the Parkway Hospital, Inc., as assignee of David Elascano, brought an action against Integon National Insurance Company. The case involved a challenge by the defendant of the medical necessity of the services provided. A nonjury trial was held and the defendant's expert testified that the services were not medically necessary nor causally related to the assignor's motor vehicle accident. The Civil Court found that the defendant's witness was not credible and awarded judgment to the plaintiff in the amount of $17,388.68. The main issue is whether the insurer had rebutted the presumption of medical necessity which attaches to a claim form in a no-fault trial involving a defense of lack of medical necessity. The holding of the case was that the record supports the determination of the Civil Court, based upon its assessment of the credibility of defendant's expert witness and the proof adduced at trial, that the defendant failed to demonstrate that the services rendered were not medically necessary. Consequently, the judgment of the Civil Court was affirmed.

The relevant facts considered by the court were that Active Care Medical Supply Corp. was seeking to recover assigned first-party no-fault benefits from Erie Insurance Company of New York. The main issue decided by the court was whether the denial of claim forms had been timely mailed and whether there was a lack of medical necessity for the services at issue. The court reversed the judgment, vacated the order entered on February 15, 2014, denied plaintiff's motion for summary judgment, and granted defendant's cross motion for summary judgment dismissing the complaint. The holding of the case was that the denial of claim forms had been timely mailed and there was a lack of medical necessity for the services at issue. Therefore, plaintiff's motion for summary judgment was denied and defendant's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts of this case were that Right Aid Medical Supply Corp. was seeking to recover assigned first-party no-fault benefits from Travelers Insurance Company. The main issue that was decided in this case was whether the verification requested by Travelers Insurance Company had been provided, as this was the sole issue for trial. The Civil Court found that Travelers Insurance Company had not received the requested verification and dismissed the complaint. The holding of the case was that the testimony provided by the 27-year employee of Travelers Insurance Company was sufficient to establish that they had not received the requested verification, and therefore the judgment to dismiss the complaint was affirmed.

The main issue in the case was whether the defendant had properly notified the plaintiff's assignor of independent medical examinations (IMEs) in a no-fault benefits case. The court considered that the IME scheduling letters were mailed to the assignor's address without using an apartment number, but the address matched the one provided by the plaintiff on their bill and by the assignor on the application for no-fault benefits. The court held that the plaintiff did not demonstrate that the defendant did not give the assignor proper notice of the IMEs, and affirmed the lower court's order granting the defendant's motion for summary judgment dismissing the complaint. The case was decided by the Supreme Court, Appellate Term, Second Department, and the decision was entered on July 19, 2019.

The main issue decided in this case was whether certain letters from the defendant insurance company constituted delay letters and failed to toll the time to pay or deny the claims made by the provider. The court considered the sufficiency of the examination under oath (EUO) scheduling letters and the timely mailing of the denial of claim forms. The court found that the examination under oath (EUO) scheduling letters were timely mailed and the affidavits submitted by the defendant sufficiently established the timely mailing of the denial of claim forms. As a result, the court affirmed the order that denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint.