No-Fault Case Law

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.

The Court considered the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was that the defendant's proof established the proper mailing of the Independent Medical Examination (IME) scheduling letters and that the plaintiff's assignor had failed to appear for the scheduled IMEs. The holding of the case was that the order denying plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed. Therefore, the defendant was not liable to pay the first-party no-fault benefits to the plaintiff.

The court considered the fact that the plaintiff had failed to appear for duly scheduled examinations under oath and had not received initial EUO scheduling letters within 30 days of the claims. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint, and whether the plaintiff was entitled to summary judgment on certain claims. The holding of the case was that the order was modified to deny the branches of defendant's motion seeking summary judgment dismissing the claims for $348.80, $204.41, $148.69, and $91.42, as the initial EUO scheduling letters had been sent after 30 days and were therefore nullities. The court also found that the defendant had established the timely mailing of initial and follow-up EUO scheduling letters and denial of claim forms for the remaining claims, and that the plaintiff had failed to appear at an initial and follow-up EUO. Therefore, the Civil Court properly granted the branches of defendant's motion seeking summary judgment dismissing the remaining claims.

The medical provider, Main Street Medcare, P.C., brought a lawsuit against GEICO General Insurance Co. to recover assigned first-party no-fault benefits in the amount of $2,231.10. The sole issue in the nonjury trial was the medical necessity of the services provided by the medical provider. The Civil Court precluded the testimony of defendant's expert witness, who did not prepare the underlying peer review report, on the ground that such testimony would be hearsay, and granted the plaintiff's motion for a directed verdict. The Appellate Term reversed the judgment and remitted the matter to the Civil Court for a new trial, citing the reasoning in a similar case, North Am. Partners in Anesthesia, LLP, as Assignee of Jose Maravilla v GEICO Gen. Ins. Co. The holding was that the judgment in favor of the plaintiff was reversed, and the matter was remitted to the Civil Court for a new trial.

The court considered the fact that the plaintiff had commenced an action to recover first-party no-fault benefits and that the defendant was served with the complaint but failed to answer. The main issue decided was whether the defendant had established a reasonable excuse for its default in not answering the complaint. The holding of the case was that upon a review of the record, the court found no merit to the plaintiff's contention and affirmed the order granting the defendant's motion to vacate the default judgment and deeming the defendant's answer to be timely. Therefore, the defendant's excuse for its default was deemed reasonable and the order was affirmed.

The case involved Complete Chiropractic, P.C. as the respondent, and GEICO General Insurance Co. as the appellant in a dispute over first-party no-fault benefits. The main issue in the case was the medical necessity of the services in question. During the trial, the Civil Court precluded the testimony of the defendant's expert witness, who did not prepare the underlying peer review report, on the ground that such testimony would be hearsay, and granted the plaintiff's motion for a directed verdict. The Appellate Term, Second Department reversed the judgment and remitted the matter to the Civil Court for a new trial, citing a previous case with similar issues. The main issue decided in this case was whether the testimony of the defendant's expert witness, who did not prepare the underlying peer review report, should have been precluded as hearsay. The holding of the case was that the judgment in favor of the plaintiff was reversed, and the matter was remitted to the Civil Court for a new trial.

The case involved a dispute between North American Partners in Anesthesia, LLP, and GEICO General Insurance Co. over the medical necessity of services provided by the plaintiff. The Civil Court ruled in favor of the plaintiff, awarding them the principal sum of $243.09 after a nonjury trial. The main issue on appeal was the preclusion of the testimony of defendant's expert witness, who did not prepare the peer review report underlying the denial of no-fault benefits. The Appellate Term held that the expert witness should have been permitted to testify as to his opinion regarding the lack of medical necessity of the services at issue, limited to the basis for the denial as set forth in the peer review report. The judgment was reversed, and the matter was remitted to the Civil Court for a new trial.

The court considered the appeal of a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the provider's motion for summary judgment and the defendant's cross motion for summary judgment dismissing the complaint were granted or denied. The court held that the plaintiff's motion for summary judgment should have been denied, as the proof submitted failed to establish that the claim had not been timely denied or that the defendant had issued a timely denial of claim form. The defendant's cross motion was also properly denied as their papers failed to establish a lack of medical necessity. Therefore, the judgment was reversed, the portion of the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion for summary judgment was denied.