No-Fault Case Law

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.

The main issue decided in Majestic Acupuncture, P.C. v Interboro Mut. Ins. Co. was whether the court properly denied the defendant's motion to sever claims for services rendered to different assignors of the plaintiff. The defendant argued that the claims had arisen out of two different accidents and that multiple defenses had been interposed in the answer, and requested to sever the claims. However, the court held that the resolution of the claims for services rendered to the plaintiff's assignors did not involve different questions of fact and law. As a result, the court affirmed the order of the Civil Court, which denied the defendant's motion to sever the claims.

The court considered the facts of the case where Solution Bridge, Inc., as assignee of Castillo, Lilian, appealed an order from the Civil Court of the City of New York, Kings County, which granted the respondent, State Farm Mutual Automobile Ins. Co.'s motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue decided was whether the respondent had timely and properly denied the claim underlying the second cause of action based upon the plaintiff's failure to provide requested verification within 120 days of the initial verification request. The holding of the case was that there were triable issues of fact as to whether the claim underlying the first cause of action was timely submitted and as to whether plaintiff provided the requested verification as to the second cause of action. Therefore, the respondent's motion for summary judgment was denied, and the order was affirmed, without costs.

The main issue in this case was whether the provider, plaintiff, had failed to appear for scheduled examinations under oath (EUOs) and if this failure was grounds for dismissing the complaint. The court considered the evidence presented by the defendant showing the plaintiff's failure to appear for two scheduled EUOs. The court held that the defendant had sufficiently established the plaintiff's failure to appear for the scheduled EUOs, and therefore affirmed the order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint. The main holding of the case was that the plaintiff's failure to appear for the scheduled EUOs was grounds for dismissal of the complaint.

The main issues in this case were whether the plaintiff failed to appear for scheduled examinations under oath (EUOs) and whether the defendant sufficiently established the plaintiff's failure to appear for the EUOs. The court considered the argument that the plaintiff's remaining contention was not properly before the court, as it was being raised for the first time on appeal. The court ultimately held that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed, as the plaintiff had indeed failed to appear for two scheduled EUOs. The court declined to consider the plaintiff's remaining contention, as it was being raised for the first time on appeal.

The court considered the fact that the plaintiff, TAM Medical Supply Corp., was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant, Hereford Insurance Co., provided insurance coverage for the vehicle involved in the accident in question. The court held that defendant's affidavits were sufficient to demonstrate that plaintiff's claim did not arise out of a covered incident, and as plaintiff failed to raise a triable issue of fact, the Civil Court properly granted defendant's cross motion for summary judgment dismissing the complaint. Therefore, the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The main issue in this case was whether the defendant, Travelers Insurance Company, was entitled to summary judgment dismissing the complaint filed by the plaintiff, Ksenia Pavlova, D.O., as Assignee of Jan Cedana, to recover assigned first-party no-fault benefits. The defendant argued that the action was premature because the plaintiff had failed to provide verification which the defendant had requested. However, the plaintiff argued that the affidavit submitted in opposition to the defendant's motion was sufficient to give rise to a presumption that the requested verification had been mailed to, and received by, defendant. The court held that defendant had demonstrated, prima facie, that the action was premature, as they had timely mailed initial and follow-up requests for verification and had not received the requested verification. However, the affidavit submitted by plaintiff in opposition to defendant's motion was sufficient to create a triable issue of fact as to whether the action was premature. Therefore, the judgment was reversed, the order granting plaintiff's cross motion for summary judgment was vacated, and plaintiff's cross motion for summary judgment was denied.

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 whether the action was premature because the plaintiff had failed to provide requested verification. The court held that plaintiff's opposition to defendant's cross motion failed to raise a triable issue of fact, as the "affidavit" from plaintiff's owner was neither signed nor sworn to before a notary public. Consequently, the court affirmed the order, denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint.