No-Fault Case Law

The court considered a case in which Global Liberty Insurance Co. sought to vacate an award in favor of Dr. Mark S. McMahon, who was an assignee of Rudy Corniel. Global had only partially approved a payment for arthroscopic surgery performed on its insured, and McMahon sought payment for the balance. The lower arbitrator awarded the balance to McMahon, but did not consider a reference to the American Medical Association's CPT Assistant newsletter that Global relied on. The master arbitrator affirmed this decision, and the Supreme Court also denied Global's petition to vacate the award. The Appellate Division reversed this decision, holding that CPT Assistant, which is referenced in the Official New York Workers' Compensation Medical Fee Schedule, should have been considered in the arbitration process. Consequently, the matter was remanded for a new arbitration.

The court in this case considered whether defendant Sloan Tyrell failed to appear at properly noticed medical examinations, which would constitute a failure of a condition precedent to receiving insurance benefits for a motor vehicle accident. Plaintiff sought a declaration of noncoverage and an amendment to add additional defendants who allegedly provided the same claimant with services in connection with the same accident. The main issue decided was whether plaintiff provided the insured with proper notice of the location of the scheduled examinations. The court determined that plaintiff did not proffer sufficient evidence to establish prima facie that proper notice was provided and denied plaintiff's motion for summary judgment against defendants-respondents and a default judgment against the remaining defendants. However, the court granted the motion for leave to amend the complaint to add the proposed additional defendants, finding that permissive joinder was appropriate and leave to amend should have been freely granted.

The court considered the issue of whether the defendant insurance company was entitled to summary judgment dismissing the complaint filed by the plaintiff chiropractic care provider to recover assigned first-party no-fault benefits. The main issue decided was whether the insurance company was required to set forth objective reasons for requesting examinations under oath (EUOs) in order to establish its prima facie entitlement to summary judgment. The court held that the insurance company was not required to set forth objective reasons for requesting EUOs, as it only needed to demonstrate that it had duly demanded an EUO from the provider, that the provider failed to appear, and that the insurer issued a timely denial of the claim. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered a case in which Zen Acupuncture P.C. was appealing the denial of their cross-motion for summary judgment in a dispute with Allstate Insurance Company. The main issue decided was whether the proof submitted by Zen Acupuncture P.C. established that the claim had not been timely denied or that the denial of the claim was conclusory, vague, or without merit as a matter of law. The holding of the Court was that the denial of the cross-motion for summary judgment should be affirmed because the proof submitted failed to establish that the claim had not been timely denied or that the denial of the claim was without merit. Therefore, the order was affirmed and costs of $25 were imposed on the appellant.

The court considered a case in which a provider sought to recover assigned first-party no-fault benefits from an insurance company. The insurance company had moved for summary judgment, arguing that the provider had failed to appear for scheduled examinations under oath. The court also considered the provider's cross motion for summary judgment. The main issue decided was whether the provider's failure to appear for scheduled examinations under oath was a valid reason for the insurance company to deny the claim for no-fault benefits. The holding of the case was that the court affirmed the order granting the insurance company's motion for summary judgment and denying the provider's cross motion for summary judgment.

In this case, LMS Acupuncture, P.C. was appealing an order from the Civil Court of the City of New York, which granted State Farm Mutual Automotive Ins. Co.'s motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue in this case was whether plaintiff failed to appear for duly scheduled examinations under oath (EUOs). The court found that the proof submitted by the defendant was sufficient to demonstrate that the plaintiff had indeed failed to appear for the EUOs. The court also held that the defendant was not required to set forth objective reasons for requesting the EUOs in order to establish their entitlement to summary judgment. Therefore, the court affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment.

The court considered the fact that the plaintiff, Ksenia Pavlova, as the assignee of Murray, Eldica, was seeking to recover first-party no-fault benefits from Hartford Insurance Company. The main issue decided was whether the plaintiff had failed to appear for duly scheduled examinations under oath, and if so, whether this justified the granting of the defendant's motion for summary judgment dismissing the complaint. The holding of the case was that the order granting the defendant's motion for summary judgment was affirmed, as the plaintiff had indeed failed to appear for the scheduled examinations under oath, as required. Therefore, the plaintiff's appeal was denied, and the order of the Civil Court was affirmed.

The court considered the fact that the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, failed to appear for duly scheduled examinations under oath (EUOs) and that the denial of claim form at issue had been properly mailed. The main issue decided was whether the affirmation submitted by the defendant's attorney was sufficient to establish that the plaintiff had failed to appear for the EUOs, and whether the proof submitted by the defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim form had been properly mailed. The court held that the defendant's attorney's affirmation was sufficient to establish the plaintiff's failure to appear for the EUOs, and that the proof submitted by the defendant gave rise to a presumption that the denial of claim form had been properly mailed, thus affirming the lower court's decision to grant the defendant's motion for summary judgment dismissing the complaint and denying the plaintiff's cross motion for summary judgment.

The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits, and the defendant had denied the claims based on the plaintiff's assignor failing to appear for independent medical examinations (IMEs). The main issue decided was whether the plaintiff's assignor had failed to appear for the scheduled IMEs, and the holding of the court was that the defendant's cross motion seeking summary judgment to dismiss the claims based on the assignor's failure to appear for IMEs was granted. The court found that the affirmations and affidavits submitted by the defendant were sufficient to establish the assignor's failure to appear for the scheduled IMEs, and therefore granted the defendant's cross motion. The decision was made by the Supreme Court, Appellate Term, Second Department.

The appellant in this case, Solution Bridge, Inc., was seeking to recover assigned first-party no-fault benefits from the respondent, Nationwide Ins. The Civil Court granted the defendant's motion for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to provide requested verification. However, the appellant argued that the affidavit it submitted in opposition to the defendant's motion was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the defendant, creating a triable issue of fact. The appellate court reversed the order, finding that the affidavit was sufficient evidence and that there was a triable issue of fact as to whether the verification had been provided. As a result, the defendant's motion for summary judgment dismissing the complaint was denied and the order was reversed.