No-Fault Case Law

The court considered an action pursuant to Insurance Law § 5106 (c) for a de novo determination of the defendant's claims for no-fault insurance benefits due to a motor vehicle accident. The plaintiff appealed a master arbitrator's award of benefits to the defendant in the principal sum of $11,352.46, plus interest and attorney's fees. The plaintiff insurer claimed that the amount of the benefits sought by the defendant was not in accordance with the workers' compensation fee schedule and that the spinal fusion surgery performed on the claimant was not medically necessary. The main issue decided by the court was whether the plaintiff was obligated to pay the defendant no-fault benefits relating to the surgery, and whether the benefits sought by the defendant were in accordance with the workers' compensation fee schedule. The holding of the court was that the plaintiff had failed to demonstrate that the surgery performed on the claimant was not medically necessary, but the plaintiff had established its prima facie entitlement to judgment as a matter of law that the benefits sought by the defendant were not in accordance with the workers' compensation fee schedule. As such, the court modified the order by granting summary judgment to that effect.

The relevant facts in the case are that the defendant, an insurance company, filed a motion seeking an order to grant it summary judgment and dismissal of the action. The insurance company avers that it timely denied the plaintiff's claims for medical services under a no-fault insurance policy on grounds that the assignor failed to appear for two Independent Medical Examinations (IMEs). The plaintiff opposed the defendant's motion, asserting that the evidence presented by the defendant regarding the assignor’s appearance at the IMEs was conclusory. The main issue decided by the court was whether the defendant was entitled to summary judgment and dismissal of the action based on the plaintiff's failure to comply with the conditions precedent for payment of no-fault benefits. The court granted the defendant's motion in part and denied the plaintiff's cross-motion. The holding of the case was that the defendant was entitled to summary judgment based on the plaintiff's failure to comply with the technical requirements of the no-fault law, which are preconditions for payment to a medical provider.

The relevant facts the court considered were that the plaintiff, Gentlecare Ambulatory Anesthesia Services, was seeking to recover assigned first-party no-fault benefits from the defendant, GEICO Ins. Co. The defendant had moved for summary judgment dismissing the complaint on the basis that the plaintiff had failed to appear for duly scheduled examinations under oath. The main issue decided was whether the plaintiff's failure to appear for scheduled examinations under oath warranted the dismissal of their complaint. The court held that the plaintiff's failure to appear for the examinations under oath justified the granting of the defendant's motion for summary judgment, thus dismissing the complaint.

The court considered an appeal from an order of the Civil Court which granted the defendant's motion for summary judgment dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The court reversed the order, with $30 costs, and denied the defendant's motion for summary judgment dismissing the complaint. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was denied, and the order of the Civil Court was reversed.

The court considered the issue of whether defendant was entitled to summary judgment dismissing the complaint by a provider seeking to recover assigned first-party no-fault benefits, based on the plaintiff's failure to appear for duly scheduled examinations under oath (EUOs). The main issue was whether the defendant had established the timely and proper mailing of the EUO scheduling letters and denial of claim forms, as well as the plaintiff's failure to appear for the EUOs. The court held that, based on the reasons stated in another case, the defendant was entitled to summary judgment dismissing the complaint. Therefore, the defendant's motion for summary judgment was granted and the order denying the motion was reversed.

The court considered the motion for summary judgment by the defendant, who argued that the plaintiff had failed to appear for duly scheduled examinations under oath. The court found that the defendant had established the timely and proper mailing of the EUO scheduling letters and denial of claim forms, as well as the plaintiff's failure to appear for the EUOs. The main issue decided by the court was whether the defendant was entitled to summary judgment dismissing the complaint. The court held that the defendant was entitled to summary judgment, as they had met the necessary requirements to establish their prima facie case, and that there was no triable issue of fact raised by the discrepancy in the EUO request letter. Therefore, the court reversed the lower court's decision and granted the defendant's motion for summary judgment dismissing the complaint.

The case involved an appeal from an order that granted the defendant's motion for summary judgment dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs), and if the defendant had provided sufficient proof to demonstrate this failure. The court held that the proof submitted by the defendant was sufficient and gave rise to a presumption that the EUO scheduling letters and denial of claim form had been timely mailed. Therefore, the court affirmed the order, stating that the plaintiff had not provided any basis to disturb the Civil Court's decision.

The relevant facts the court considered were that Active Care Medical Supply Corp. was seeking to recover first-party no-fault benefits as an assignee of Thornton and Terry. The main issue decided was whether the provider, Active Care Medical Supply Corp., was entitled to recover assigned first-party no-fault benefits. The holding of the court was that the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed. The court referred to a similar case for the reasons behind their decision.

The court considered the appeal from an order of the Civil Court denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment in a case to recover first-party no-fault benefits. The main issue decided was whether the trial court erred in denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment. The holding of the case was that the decision of the lower court was affirmed, with the costs of $25, based on the reasons stated in a similar case. The court concurred with the decision to deny the plaintiff's motion for summary judgment and grant the defendant's cross motion for summary judgment.

The court considered the denial of the branches of plaintiff's motion seeking summary judgment on the first, second, fourth, and fifth causes of action, and the granting of the branches of defendant's cross motion seeking summary judgment dismissing those causes of action. The main issue decided was whether the provider was entitled to recover assigned first-party no-fault benefits. The holding of the case was that the branches of defendant's cross motion seeking summary judgment dismissing the first, second, fourth, and fifth causes of action were denied, and the order was affirmed, without costs.