No-Fault Case Law

The relevant facts of the case involved a provider suing to recover assigned first-party no-fault benefits. The only issues for trial were whether the services rendered were medically necessary and whether the plaintiff had properly billed in accordance with the workers' compensation fee schedule. At a nonjury trial, the plaintiff's attorney moved to preclude the defendant's expert witnesses on the grounds of untimely disclosure and that disclosure had been made by facsimile transmission, a method of notice which the plaintiff's counsel had previously rejected. The defense argued that there would be no prejudice to the plaintiff as a result of the testimony, and counsel advised the court that his witnesses were present to testify. The Civil Court granted the plaintiff's motion to preclude the witnesses and denied the defendant's motion, pursuant to CPLR 4404 (b), to set aside the decision. The main issue decided was whether the decision of the Civil Court should be set aside, and the matter should be remitted for a new trial limited to the issues of medical necessity and billing pursuant to the workers' compensation fee schedule. The holding of the case was that the order was reversed, defendant's motion to set aside the decision of the Civil Court was granted, and the matter was remitted to the Civil Court for a new trial limited to the issues of medical necessity and billing pursuant to the workers' compensation fee schedule.

The main issues decided in this case were whether the services rendered were medically necessary and whether the plaintiff had properly billed in accordance with the workers' compensation fee schedule. During a nonjury trial, the plaintiff's attorney moved to preclude the defendant's expert witnesses on the grounds of untimely disclosure and that it had been made by facsimile transmission, a method of notice which the plaintiff's counsel had previously rejected. The Civil Court granted the plaintiff's motion to preclude the witnesses, and later denied the defendant's motion, pursuant to CPLR 4404 (b), to set aside the decision. The Appellate Court reversed the order and held that the defendant's motion should have been granted. The matter was remitted to the Civil Court for a new trial limited to the issues of medical necessity and billing pursuant to the workers' compensation fee schedule.

The main issues considered in this case were whether the services rendered were medically necessary and if the plaintiff had properly billed in accordance with the workers' compensation fee schedule. The court found that defendant's service of expert witness notices at issue should have been more prompt, but there was no intentional or willful failure to disclose by the defendant, and there was no showing of prejudice by the opposing party. As a result, the Civil Court erred in precluding defendant's expert witnesses. The holding of the court was to reverse the order, grant defendant's motion to set aside the decision of the Civil Court, and remit the matter to the Civil Court for a new trial limited to the issues of medical necessity and billing pursuant to the workers' compensation fee schedule.

Plaintiff commenced an action to recover no-fault medical benefits on November 10, 2009, and defendant served plaintiff's attorney with a 90-day written demand pursuant to CPLR 3216 (b) (3) on August 5, 2016. On January 13, 2017, 158 days after receiving the demand, plaintiff filed a notice of trial. Defendant moved to dismiss the plaintiff's complaint pursuant to CPLR 3216, and plaintiff did not oppose the motion. The issue was whether the plaintiff had demonstrated a justifiable excuse for its delay and the existence of a meritorious cause of action. The holding was that since plaintiff failed to oppose defendant's motion and demonstrate any ground to deny it, defendant's motion to dismiss the complaint pursuant to CPLR 3216 was granted.

The court considered whether the complaint should have been dismissed pursuant to CPLR 3216 after the defendant filed a notice of trial 94 days following a 90-day demand. The main issue was whether plaintiff's delay was justifiable and whether there was a meritorious cause of action. The court reversed the lower court's order and granted the defendant's motion to dismiss, finding that the plaintiff had not taken any action within 90 days of receiving the demand and had not demonstrated any grounds to deny the motion. The failure to oppose the plaintiff's motion rendered the delay inexcusable. Thus, the court held that the plaintiff's complaint should be dismissed.

The court considered a case in which Charles Deng Acupuncture, P.C. was appealing the denial of their motion for summary judgment and the granting of the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had established with admissible evidence that Florida law applied to the case, limiting the amount available for no-fault reimbursement to $10,000, and whether the defendant had paid the full monetary limits of the policy at issue. The holding of the case was that the defendant failed to establish with admissible evidence that Florida law applied and that the payment log provided by the defendant did not constitute evidence in admissible form. This led to the denial of the defendant's cross motion for summary judgment, and the order was modified to reflect this decision. The court also determined that plaintiff's motion for summary judgment was properly denied, as the proof submitted by plaintiff failed to establish that the claims had not been timely denied.

The court considered the fact that the defendant failed to send a delay letter to the plaintiff as required by 11 NYCRR 65-3.6 (b) after sending a second examination under oath (EUO) scheduling letter to the plaintiff's assignor. As a result, the defendant failed to properly toll the time to pay or deny the plaintiff's claims, and was precluded from raising its defense that the plaintiff's assignor had failed to appear for scheduled EUOs. The main issue decided was whether the defendant had properly sent a delay letter to the plaintiff in accordance with the regulations. The holding of the case was that the judgment in favor of the plaintiff was affirmed, as the defendant failed to comply with the regulations regarding the sending of the delay letter.

The relevant facts considered by the court were that the plaintiff had moved for summary judgment in a case to recover assigned first-party no-fault benefits, and that the defendant had cross-moved for summary judgment to dismiss the complaint based on the plaintiff's failure to appear for scheduled examinations under oath. The main issues decided by the court were whether the plaintiff's motion for summary judgment should have been denied, and whether the defendant had failed to establish that a previous court order had a preclusive effect on the case. The holding of the case was that the plaintiff's motion for summary judgment should have been denied, and the matter was remitted to the Civil Court for a determination of the branch of defendant's cross motion seeking summary judgment dismissing the complaint on the ground that plaintiff's assignor had failed to satisfy a condition precedent to coverage.

The court considered the fact that the defendant had moved for summary judgment dismissing the complaint, arguing that the action was premature as plaintiff had failed to respond to timely requests for verification. The main issue decided was whether the action by the provider to recover assigned first-party no-fault benefits was premature due to the failure to respond to verification requests. The holding of the case was that the defendant had established the timely mailing of the initial and follow-up verification requests and that it had not received the requested verification. As a result, the 30-day period within which the defendant was required to pay or deny the claims did not begin to run, and the plaintiff's action was deemed premature. Therefore, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.

The main issue in the case of Matter of Country-Wide Insurance Company v Bay Needle Acupuncture, P.C. was whether the arbitration award should be affirmed regarding the refusal of the no-fault arbitrator to accept untimely opposition papers asserting a Mallela defense. The court held that the arbitration award was not irrational or incorrect as a matter of law, and therefore the master arbitrator did not exceed his power in affirming it. It was determined that the defense put forth by the petitioner was based on the guilty plea of Andrey Anikeyev, but there was no evidence that his actions could be imputed to respondent. The court also decided that respondent was entitled to reasonable attorneys' fees for this appeal, to be determined by Supreme Court. Ultimately, the judgment in favor of respondent was unanimously affirmed.