No-Fault Case Law

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.

The relevant facts of the case include an action by a provider to recover assigned first-party no-fault benefits, resulting in a judgment entered in April 2016 due to the defendant's failure to appear or answer the complaint. The defendant then moved to vacate the default judgment citing an excusable default and a meritorious defense. The issue before the court was whether the defendant demonstrated a reasonable excuse for its default and a potentially meritorious defense to the action, as required by CPLR 5015 (a) (1). The court considered that the process server's affidavit provided evidence of proper service of process upon the defendant and ultimately denied the branch of the defendant's motion seeking to vacate the default judgment pursuant to CPLR 5015 (a) (1) due to the defendant's failure to establish a reasonable excuse for its default.

The court considered a proceeding brought by Kanter Physical Medicine & Rehab, P.C., as the assignee of an individual, to vacate a master arbitrator's award which upheld the award of an arbitrator, denying the petitioner's claims to recover assigned first-party no-fault benefits. The main issue was whether there was a rational basis for the determination of the master arbitrator upholding the arbitrator's award. The holding of the case was that the court found a rational basis for the determination of the master arbitrator upholding the arbitrator's award, and therefore the Civil Court properly denied the petition to vacate the master arbitrator's award. The order was modified to add a provision confirming the master arbitrator's award, as a special proceeding should terminate in a judgment, not an order.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the plaintiff's motion for leave to reargue its opposition to the defendant's prior motion to dismiss the complaint. The defendant's motion to dismiss the complaint pursuant to CPLR 3216 was granted based on the plaintiff's failure to comply with a 90-day notice. The main issue decided was whether the plaintiff should be granted leave to reargue its opposition to the defendant's motion to dismiss, and whether the defendant's motion to dismiss the complaint should be denied upon reargument. The holding of the court was that the order granting the defendant's motion to dismiss the complaint pursuant to CPLR 3216 was adhered to, affirming the order with modification, without costs.

The court considered a motion to dismiss a complaint by defendant GEICO Insurance, based on the plaintiff Faith Acupuncture, P.C.'s failure to comply with a 90-day notice in a no-fault benefits case. The Civil Court initially granted defendant's motion to dismiss, finding that plaintiff's claim of law office failure did not constitute a justifiable excuse. Plaintiff then moved for reargument, which was granted, resulting in an order denying defendant's motion to dismiss. The main issue decided was whether plaintiff's failure to comply with the 90-day notice warranted dismissal of the complaint. The holding of the case was that the order granting defendant's motion to dismiss the complaint pursuant to CPLR 3216 was adhered to, thereby affirming the decision to dismiss the complaint.

The relevant facts considered by the court were that the plaintiff, a medical provider, filed a summons and complaint to recover first-party no-fault benefits, but did not serve these documents on the defendant within the 120-day time period allotted by CPLR 306-b. The defendant moved to dismiss the complaint pursuant to CPLR 3211 (a) (8), and the plaintiff "cross-moved," pursuant to CPLR 306-b, for an extension of time to serve the summons and complaint upon the defendant and to deem the service on December 31, 2015 timely. The main issue decided by the court was whether the plaintiff's delayed service of the summons and complaint warranted dismissal of the complaint. The holding of the court was that the order granting the defendant's motion to dismiss the complaint and denying the plaintiff's "cross" motion for an extension of time to serve the documents was affirmed.