No-Fault Case Law

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.

The court considered the fact that the defendant had scheduled examinations under oath (EUOs) for the plaintiff's assignor, but the assignor failed to appear for these scheduled EUOs. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted on the grounds that the plaintiff's assignor had failed to appear for the scheduled EUOs. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was granted, as the plaintiff failed to raise a triable issue of fact in opposition to the defendant's motion. Therefore, the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment.

The court considered the fact that Alleviation Medical Services, P.C. was seeking to recover first-party no-fault benefits. The main issues decided were that the defendant had provided sufficient proof that the independent medical examination (IME) scheduling letters were mailed properly and that the plaintiff's assignor had failed to appear for the scheduled IMEs. The court held that the defendant's motion for summary judgment dismissing the complaint was granted and the plaintiff's cross motion for summary judgment was denied. Therefore, the order was affirmed, and the defendant was awarded $25 in costs.

The relevant facts considered by the court were that Gentlecare Ambulatory Anesthesia Services was seeking to recover assigned first-party no-fault benefits from GEICO Ins. Co. The main issue decided was whether GEICO Ins. Co. had the right to summary judgment dismissing the complaint based on the provider's failure to appear for an examination under oath (EUO). The court held that the insurer must demonstrate, as a matter of law, that it had twice duly demanded an EUO from the provider, that the provider had twice failed to appear, and that the insurer had issued a timely denial of the claim. The court found that while the insurer made such a showing regarding the second cause of action, it did not demonstrate that it is not precluded from interposing its proffered defense with respect to the first cause of action. Therefore, the court granted summary judgment dismissing the second cause of action, but denied summary judgment dismissing the first cause of action.