No-Fault Case Law

The court considered a case in which a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance company's motion for summary judgment dismissing the complaint should be granted, and whether the provider's cross motion for summary judgment should be denied. The court held that the insurance company's motion for summary judgment dismissing the complaint should be denied, as the company failed to establish that the denial of claim forms had been timely mailed. However, the court also held that the provider's cross motion for summary judgment should be denied, as the provider failed to establish that the claims at issue had not been timely denied, or that the insurance company had issued timely denials of claim that were conclusory, vague or without merit as a matter of law.

The court considered an appeal from an order of the Civil Court of New York denying the provider's motion for summary judgment seeking to recover assigned first-party no-fault benefits. The court also granted the defendant's cross motion for summary judgment seeking to dismiss that cause of action. The main issue decided was whether the plaintiff was entitled to summary judgment to recover no-fault benefits, and if the defendant was entitled to summary judgment dismissing the cause of action. The holding of the case was that the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment was affirmed. Therefore, the plaintiff was not entitled to recover assigned first-party no-fault benefits and the defendant was entitled to dismiss the cause of action.

The main issue in the case was whether the provider was entitled to recover assigned first-party no-fault benefits from the insurance company. The court considered the denial of the plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment. The court affirmed the lower court's decision to deny the plaintiff's motion and grant the defendant's cross motion, dismissing the complaint. The holding of the case was that the insurance company was not obligated to provide no-fault benefits to the provider, and therefore the lower court's decision was affirmed.

The court considered the denial of the defendant's motion for summary judgment in a case brought by a medical provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment should be granted or denied. The holding of the case was that the order denying the defendant's motion for summary judgment was affirmed, with the court concurring. The specific reasons for the decision were not provided in the summary.

The case involved a dispute between Gentlecare Ambulatory Anesthesia Services and GEICO Insurance Company regarding the failure of Gentlecare to appear for scheduled examinations under oath (EUOs) as part of a claim for first-party no-fault benefits. The Civil Court denied Gentlecare's motion for summary judgment and granted GEICO's cross-motion for summary judgment dismissing the complaint. The main issue decided was whether GEICO's proof was sufficient to demonstrate that Gentlecare had failed to appear for the EUOs and whether GEICO was required to set forth objective reasons for requesting the EUOs. The court held that the proof submitted by GEICO was sufficient to establish that Gentlecare had failed to appear for the EUOs and that GEICO was not required to set forth objective reasons for requesting the EUOs in order to establish its entitlement to summary judgment. As a result, the court affirmed the order, with $25 costs.

The main issue in this case was whether the defendant, GEICO Ins. Co., had properly used the workers' compensation fee schedule applicable to chiropractors to reimburse the plaintiff, BQE Acupuncture, P.C., for the acupuncture services it had rendered. The court considered the evidence presented by both parties and determined that the defendant had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The court found that the defendant had established its entitlement to judgment as a matter of law and granted the defendant's motion for summary judgment, dismissing the complaint. The court also noted that one of the plaintiff's contentions was not properly before the court as it was being raised for the first time on appeal and declined to consider it. Therefore, the court affirmed the order in favor of the defendant, GEICO Ins. Co.

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 American Transit Insurance Company. American Transit had mailed examination under oath (EUO) scheduling letters to Active Care, but Active Care failed to appear for the scheduled EUOs. American Transit was granted summary judgment dismissing the first and third causes of action by the Civil Court. The main issue decided was whether American Transit had established that the EUO scheduling letters had been timely mailed and whether Active Care had failed to appear for the scheduled EUOs. The holding of the case was that the court affirmed the order granting American Transit's motion, as they had shown that the EUO scheduling letters were timely mailed and that Active Care had failed to appear for the scheduled EUOs.

The relevant facts in this case involved a dispute between Chapa Products Corp., as Assignee of Isabel Corniel, and 21st Century Insurance Company. Chapa Products Corp. sought to recover assigned first-party no-fault benefits, but the defendant argued that the plaintiff had not timely submitted the claim underlying the first cause of action and had failed to provide requested verification as to the claim underlying the second cause of action. The main issue decided by the court was whether the plaintiff had timely submitted the claims and verification as required, and whether the defendant had received the verification at issue. The holding of the court was that while the defendant had demonstrated that the claim underlying the first cause of action had not been timely submitted and that the defendant had not received the verification at issue, the proof submitted by the plaintiff was sufficient to give rise to a presumption that the claim form and verification had been timely mailed. Therefore, on this record, neither party was entitled to summary judgment.

The relevant facts the court considered in this case were that Solution Bridge, Inc. was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. State Farm moved for summary judgment dismissing the first cause of action on the grounds that Solution Bridge failed to provide requested verification. The main issue decided was whether Solution Bridge provided sufficient evidence to show that the requested verification had been mailed to, and received by, State Farm. The holding of the case was that the affidavit submitted by Solution Bridge was sufficient to give rise to a presumption that the verification had been provided, creating a triable issue of fact. Therefore, the court reversed the order and denied State Farm's motion for summary judgment.

The court considered the circumstances underlying the action, in which the plaintiff sought to recover a balance of $10,906.14, which was claimed due as a loss of earnings for attendance at an examination under oath in the context of a first-party no-fault insurance claim. The issue decided was whether the additional $2,604,942 claimed by the plaintiff could be rightfully considered in the formula for calculation of lost earnings pursuant to 11 NYCRR 65-3.5 (e). The court held that while there is no disagreement about the formula used to determine the loss of earnings incurred as a result of the plaintiff's appearance at the examination under oath, the focus should be on the actual monetary loss incurred, and the parties failed to provide evidence of why the plaintiff's unavailability for an undisclosed number of hours on that date caused earnings loss. Therefore, both the defendant's motion and plaintiff's cross motion for summary judgment were denied.