No-Fault Case Law

The court considered the denial of defendant's motion for summary judgment in a case where a provider was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment should be granted to dismiss the complaint. The court held that the order denying the defendant's motion for summary judgment was reversed, and the defendant's motion for summary judgment dismissing the complaint was granted. This decision was in line with a previous case, Sure Way, Inc., as Assignee of Dixin, Marla v Travelers Ins. Co., and the previous decision and order of the court was recalled and vacated.

The court considered the fact that CPM Med Supply, Inc. failed to provide verification requested by State Farm Fire and Casualty Insurance Company. The main issue was whether CPM Med Supply, Inc. was required to respond to the verification requests and if its failure to do so justified the dismissal of its complaint seeking to recover assigned first-party no-fault benefits. The court held that CPM Med Supply, Inc. was required to respond to the verification requests and failed to demonstrate a basis to disturb the order dismissing the complaint. The court affirmed with costs and noted that while defendant was entitled to dismissal of plaintiff's complaint with prejudice, as defendant did not cross-appeal, the order was affirmed.

The relevant facts considered were that the plaintiff, GL Acupuncture, P.C., sought to recover $178.58 for acupuncture services rendered by a licensed acupuncturist and defendant, Progressive Insurance Company, offered payment of only $54.74 for an office visit. At a nonjury trial, it was stipulated that plaintiff had established its prima facie case, that defendant had timely denied the claims at issue, and that defendant's witness was a certified coder. The defendant's coder explained how she had calculated the payments for the acupuncture services billed under specific CPT codes based on the chiropractic fee schedule, and she testified that the defendant was offering payment in the amount of $54.74 for an office visit billed under a specific CPT code. Plaintiff did not call a witness to rebut the coder's testimony. The main issue decided was whether the defendant had properly paid the claims billed under the specific CPT codes and the office visit. The holding of the case was that the defendant had established that it had fully paid plaintiff for the services billed under the specific CPT codes in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors, and that plaintiff had failed to rebut defendant's showing. Therefore, the judgment awarding the principal sum of $54.74 to the plaintiff was affirmed.

The court considered the testimony of the defendant's witness, who was a certified medical coder, who stated that the workers' compensation chiropractic fee schedule was applied to determine payment for services by a licensed acupuncturist. The main issue at trial was whether the defendant had properly paid the bill in accordance with the workers' compensation fee schedule. The holding of the case was that the court found that the defendant had correctly applied the fee schedule codes and had fully paid the plaintiff for the services billed in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. Therefore, the judgment was affirmed, with the defendant being required to pay $25 in costs.

The court considered the denial of claim forms for medical services provided from March 1, 2010 through September 22, 2010, which had been denied on the ground of lack of medical necessity. The defendant moved for summary judgment dismissing the complaint. The main issue decided was whether the proof submitted by the defendant was sufficient to give rise to a presumption that the denial of claim forms at issue had been timely mailed. The court held that the proof submitted by the defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim forms had been timely mailed. The order, insofar as appealed from, granting the branches of defendant's motion seeking summary judgment dismissing seven claims for services provided from March 1, 2010 through September 22, 2010, which had been denied on the ground of lack of medical necessity, was affirmed.

The relevant facts in this case are that plaintiff filed an action to recover no-fault benefits on behalf of an assignor in 2013, and a judgment was awarded in 2018. The case was then assigned to the court to determine plaintiff's claim for attorneys' fees. The main issue decided was the allocation of attorneys' fees in a case where the insurer designated its defense as a policy issue, and the courtroom appearances and preparation work spent by the attorney. The holding of the case was that the plaintiff was awarded a total of $695 for attorneys' fees, based on the hours spent in court appearances and trial preparation. The court found that the failure to maintain contemporaneous time records and a lack of evidence on the number of cases handled by the attorney limited the amount of time awarded for the work performed.

The court considered the background of the case, which involved an action by PDG Psychological P.C. seeking to recover no-fault insurance benefits for services rendered to an assignor involved in a car accident. The main issues decided included a motion for summary judgment by the plaintiff, and a cross-motion to dismiss by the defendant for failure to provide discovery. The court also considered the issue of the defendant's motion to reargue a previous decision, and the decision on whether to stay the accrual of no-fault interest. The holding of the case was that the defendant's motion to dismiss was denied, motion to strike was granted, motion to compel was granted, and motion to stay interest was denied. In summary, the court decided in favor of the defendant on the motion to strike and motion to compel, and against the defendant on the motion to stay interest. The case involved a dispute over insurance benefits, and the court's decision addressed issues related to discovery and the accrual of interest.

The court considered the relevant facts involving an action in which the respondent brought suit to avoid payment of certain no-fault claims submitted by the appellant based on the appellant's failure to follow conditions precedent to coverage or to verify its claims. The issue before the court was whether the defaulting appellant, which did not answer or appear in response to the suit after being served through the Secretary of State, could vacate the default judgment and defend the action, and whether the appellant demonstrated a reasonable excuse for the default and a potentially meritorious defense to the action. The court held that the defaulting appellant, having failed to substantiate that it did not have actual notice of the action in time to defend, did not have a reasonable excuse for the default pursuant to CPLR 5015 (a) (1), and the motion pursuant to CPLR 5015 (a) (1) was untimely. Thus, the court affirmed the lower court's denial of the appellant's motion to vacate the judgment.

The main issue before the court was whether to vacate an order of administrative dismissal under CPLR 3215(c) and enter a default judgment against Defendant for failure to respond to an action seeking reimbursement for medical services provided under the No-Fault system. Plaintiff had failed to serve the summons and complaint on Defendant until over two years after the statutory 120-day service period had expired, and also failed to move for an extension of time to effectuate service. Plaintiff argued that the court's failure to give notice of the impending administrative dismissal deprived them of an opportunity to be heard. The court held that the dismissal was proper under CPLR 3215(c) as the case lay dormant in the court system without a default judgment against Defendant for over three years, and that Plaintiff's vague excuses for the procedural defects, including law office failure due to a new case management and computer system, were not valid reasons to vacate the dismissal. The holding of the case was that Plaintiff's motion to vacate the order of administrative dismissal pursuant to CPLR 3215(c) was denied, and the complaint was dismissed with prejudice.

The court considered the denial of a motion by the defendant to dismiss the complaint, or in the alternative, to compel the plaintiff to produce its owner for an examination before trial, and the granting of the plaintiff's cross motion for summary judgment. The main issue decided was whether the defendant's argument for dismissal based on plaintiff's reimbursement pursuant to a fee schedule of a practitioner provider option (PPO) agreement, and the failure to name Multiplan as a necessary party, was valid. The holding was that the branch of the defendant's motion seeking to compel the plaintiff to produce its owner for an examination before trial was granted, and the plaintiff's cross motion for summary judgment was denied. The court also found that the plaintiff failed to establish its prima facie entitlement to summary judgment, as the evidence did not prove that the claims in question had not been timely denied, or that the defendant had issued timely denial of claim forms that were without merit as a matter of law.