No-Fault Case Law

The relevant facts considered by the court in this case were that the plaintiff, Neptune Medical Care, P.C., sought to recover first-party no-fault benefits, and the defendant, Praetorian Insurance Company, denied the claims on the grounds that the assignors of the plaintiff failed to appear for examinations under oath (EUOs) and independent medical examinations (IMEs). Both parties filed motions for summary judgment, and the Civil Court denied both motions, finding that the only triable issues were whether the EUO and IME scheduling letters had been timely and properly mailed. The main issue decided by the court was whether the defendant had timely and properly scheduled the EUOs and IMEs, and whether the plaintiff's assignors had failed to appear at duly scheduled appointments. The court held that the defendant failed to establish that the initial and follow-up letters scheduling the EUOs and IMEs had been timely mailed, and as a result, they failed to demonstrate that the appointments had been properly scheduled. Therefore, the defendant was not entitled to summary judgment dismissing the complaint, and the order was affirmed, with costs.

The main issue in the case was whether the plaintiff, Mag Medical, P.C., as the assignee of Nadezda Emelianova, was entitled to recover assigned first-party no-fault benefits from the defendant, Kemper Insurance Company. The defendant had filed a motion for summary judgment to dismiss the complaint, claiming that they had timely mailed the denial of claim forms and that there was a lack of medical necessity for the services at issue. In support of their motion, the defendant submitted an affirmed peer review report, but the plaintiff did not submit any medical evidence in opposition. The court ultimately reversed the order of the Civil Court, granting the defendant's motion for summary judgment and dismissing the complaint, as the plaintiff had failed to rebut the defendant's prima facie showing of lack of medical necessity.

The court considered the fact that the insurance company moved for summary judgment to dismiss the complaint on the grounds that the plaintiff failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the insurance company was entitled to summary judgment dismissing the complaint based on the failure of the plaintiff to appear for the EUOs. The holding of the court was that the insurance company was indeed entitled to summary judgment dismissing the complaint. The court found that the insurance company 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. Therefore, the only remaining issues for trial were the plaintiff's prima facie case and an issue of fact regarding a discrepancy in the EUO request letters.

The court considered whether a provider was entitled to recover assigned first-party no-fault benefits, and whether the defendant was entitled to summary judgment dismissing the complaint on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). 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 only remaining issues for trial were plaintiff's prima facie case and "an issue of fact regarding the discrepancy between the person stated to be the contact for defense counsel in the EUO request letters and the person signing the affirmation regarding plaintiff's failure to appear." The holding of the case was that the defendant was entitled to summary judgment dismissing the complaint, and the plaintiff's motion for summary judgment was granted.

The court considered the fact that the defendant, State Farm Mutual Automobile Insurance Co., moved for summary judgment to dismiss the complaint on the grounds that the plaintiff, Oleg's Acupuncture, P.C., had failed to appear for scheduled examinations under oath (EUOs). The Civil Court denied the motion, finding 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 was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to appear for the scheduled EUOs. The holding of the case was that, for the reasons stated in a similar case, 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.

The main issue in this case was whether the defendant, State Farm Mutual Automobile Insurance Co., was entitled to summary judgment dismissing the complaint brought by Oleg's Acupuncture, P.C., as Assignee of Storm Bowles, seeking to recover assigned first-party no-fault benefits. The defendant argued that the plaintiff failed to appear for duly scheduled examinations under oath (EUOs). The court found in favor of the defendant, holding that they were entitled to summary judgment dismissing the complaint based on the plaintiff's failure to appear for the EUOs. The court also found that the only remaining issues for trial were plaintiff's prima facie case and an issue of fact regarding the discrepancy between the person stated to be the contact for defense counsel in the EUO request letters and the person signing the affidavit regarding plaintiff's failure to appear. The decision was reversed, and the defendant's motion for summary judgment dismissing the complaint was granted.

The court considered the defendant's motion for summary judgment dismissing the complaint, which was based on the plaintiff's failure to appear for scheduled examinations under oath (EUOs) in a first-party no-fault benefits claim. The main issue decided was whether the defendant was entitled to summary judgment based on the plaintiff's failure to appear for the EUOs. The holding of the court was that the defendant was indeed entitled to summary judgment because they 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 also found that a discrepancy between the contact listed in the EUO request letter and the attorney signing the affirmation of nonappearance did not raise a triable issue of fact. Therefore, the defendant's motion for summary judgment dismissing the complaint was granted.

The court considered a motion for summary judgment by the defendant, who argued that the plaintiff failed to appear for scheduled examinations under oath (EUOs) and therefore should be denied first-party no-fault benefits. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to appear for the EUOs. The holding of the case was that the order denying the defendant's motion for summary judgment was reversed, with the court granting the defendant's motion for summary judgment dismissing the complaint. 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, and therefore was entitled to summary judgment in their favor.

The court considered the disagreement between Charles Deng Acupuncture, P.C. and State Farm Mutual Automobile Insurance Co. over the amount of payment for acupuncture services provided by Charles Deng. State Farm had paid based on the workers' compensation fee schedule for acupuncture services rendered by chiropractors, which Charles Deng argued was improper. The main issue decided was whether State Farm's fee reductions were proper under the workers' compensation fee schedule for acupuncture services performed by chiropractors. The holding of the court was that while the insurer could use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount a licensed acupuncturist is entitled to receive, State Farm was not entitled to summary judgment dismissing so much of Charles Deng's complaint as sought to recover $54.73 for an initial visit on February 5, 2014 and an additional $.63 for services rendered on February 27, 2014. The order was modified to deny the branches of the defendant's motion seeking summary judgment dismissing those parts of the complaint.

The relevant facts the court considered were that Bronx Chiropractic Care, P.C. was seeking to recover assigned first-party no-fault benefits from State Farm insurance. State Farm moved for summary judgment to dismiss the complaint on the grounds that Bronx Chiropractic Care had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether State Farm was entitled to summary judgment dismissing the complaint. The holding of the case was that the court reversed the order and granted State Farm's motion for summary judgment dismissing the complaint, as it was determined that State Farm had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, as well as the plaintiff's failure to appear for the EUOs. Therefore, the court found that Bronx Chiropractic Care had failed to meet its obligations and State Farm was entitled to summary judgment.