No-Fault Case Law
Gentlecare Ambulatory Anesthesia Servs.; Lyonel F. Paul, M.D. v GEICO Ins. Co. (2018 NY Slip Op 51773(U))
November 30, 2018
The main issue in this case was whether the insurance company, GEICO, was entitled to summary judgment dismissing the complaint by a medical provider, Gentlecare Ambulatory Anesthesia Services, for failing to appear for duly scheduled examinations under oath (EUOs) regarding assigned first-party no-fault benefits. The court found that the proof submitted by GEICO was sufficient to demonstrate that the denial of claim form had been timely mailed and that the medical provider had failed to appear for the EUOs. The court also stated that the insurer did not have to set forth objective reasons for requesting EUOs in order to establish its entitlement to summary judgment. Lastly, the court refused to consider the medical provider's remaining argument, as it was being raised for the first time on appeal, and affirmed the order granting GEICO's motion for summary judgment. The holding of the case was that GEICO was entitled to summary judgment dismissing the complaint.
Village Med. Supply, Inc. v Citiwide Auto Leasing Ins. Co. (2018 NY Slip Op 51772(U))
November 30, 2018
The court considered the fact that the plaintiff, a medical supply company, was seeking to recover first-party no-fault benefits as the assignee of an individual. The main issue decided was whether the defendant, an auto leasing insurance company, was entitled to summary judgment dismissing the complaint based on the assignor's failure to appear for independent medical examinations (IMEs). The court found that the proof submitted by the defendant was sufficient to establish the proper mailing of the IME scheduling letters and that the assignor had failed to appear for the IMEs. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
The holding of the case was that the defendant was entitled to summary judgment based on the assignor's failure to appear for the IMEs, and the court affirmed the order granting the defendant's motion for summary judgment.
Performance Plus Med., P.C. v American Tr. Ins. Co. (2018 NY Slip Op 51771(U))
November 30, 2018
The relevant facts considered by the court were that Performance Plus Medical, P.C. was seeking to recover assigned first-party no-fault benefits from American Transit Ins. Co. The main issue decided was whether defendant had issued an insurance policy covering the subject loss. 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, with costs of $25. The court found that the proof submitted by defendant was sufficient to demonstrate that it had not issued a policy covering the subject loss, and therefore, the order was affirmed.
Parisien v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51770(U))
November 30, 2018
The court considered the fact that the plaintiff was appealing from an order of the Civil Court which granted the defendant's motion for summary judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for duly scheduled examinations under oath. The main issue decided was whether the denial of the claim form had been timely mailed, and the court found that the defendant had established that it had been timely mailed. The holding of the court was that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed, with costs of $25.
Island Life Chiropractic Pain Care, PLLC v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51769(U))
November 30, 2018
The court considered the fact that the plaintiff, Island Life Chiropractic Pain Care, PLLC, was seeking to recover assigned first-party no-fault benefits from the defendant, State Farm Mutual Automobile Insurance Company. The main issue was whether the plaintiff failed to appear for duly scheduled examinations under oath, which was the ground on which the defendant had moved for summary judgment to dismiss the complaint. The court held that the order granting the defendant's motion for summary judgment to dismiss the complaint was affirmed, with the reasoning to be provided in a separate case decided with the same facts. The court found that the plaintiff had indeed failed to appear for the scheduled examinations under oath, and therefore, the defendant's motion for summary judgment was granted.
Acupuncture Now, P.C. v American Commerce Ins. Co. (2018 NY Slip Op 51768(U))
November 30, 2018
The court considered an order from the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment dismissing the complaint, based on the plaintiff's failure to appear for duly scheduled examinations under oath (EUOs). The main issue decided was whether the defendant's proof was sufficient to establish the plaintiff's nonappearance at the EUOs and whether the defendant was entitled to summary judgment dismissing the first cause of action based on the plaintiff's failure to appear for the EUOs. The holding was that the branch of defendant's motion seeking summary judgment dismissing the first cause of action is denied, as the initial EUO request had been sent more than 30 days after the defendant had received the claim underlying that cause of action, making the request a nullity. Therefore, the order was modified by providing that the branch of defendant's motion seeking summary judgment dismissing the first cause of action is denied.
First Am. Alliance, Inc. v Ameriprise Ins. Co. (2018 NY Slip Op 51765(U))
November 30, 2018
The court considered the denial of defendant's motion for summary judgment dismissing the complaint, as well as the exhaustion of available coverage defense. The main issue decided was whether the denial of the claims on the basis of an exhaustion of available coverage defense warranted summary judgment. The holding of the court was that the denial of the claims did not warrant summary judgment dismissing the complaint on the basis of an exhaustion of available coverage defense. Additionally, the court held that the branch of defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover on a bill for $630 is granted.
JCC Med., P.C. v American Tr. Ins. Co. (2018 NY Slip Op 51764(U))
November 30, 2018
The court considered the appeal from an order of the Civil Court of the City of New York, Kings County, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment. The main issue decided was whether the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs) as required by the insurance company. The court held that the affirmation submitted by the doctor who was to perform the scheduled IMEs was sufficient to establish that the plaintiff's assignor had indeed failed to appear for those IMEs. The court also declined to consider the plaintiff's remaining contention with respect to this defense, as the argument was being raised for the first time on appeal. Therefore, the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment was affirmed.
Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51763(U))
November 30, 2018
The Court considered the fact that defendant had moved for summary judgment dismissing the complaint of the provider to recover assigned first-party no-fault benefits, on the ground that the provider had failed to appear for duly scheduled examinations under oath (EUOs). The main issues decided were whether the insurer had twice duly demanded an EUO from the provider, whether the provider had twice failed to appear, and whether the insurer had issued a timely denial of the claims. The holding of the case was that the order, insofar as appealed from, was reversed and defendant's motion for summary judgment dismissing the complaint was granted.
Oriental Health Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51761(U))
November 30, 2018
The main issue in this case was whether the plaintiff, Oriental Health Acupuncture, P.C., was entitled to recover assigned first-party no-fault benefits from the defendant, 21st Century Insurance Company, after the defendant's motion for summary judgment dismissing the complaint was granted by the Civil Court. The court considered the fact that the plaintiff's assignor had failed to appear for examinations under oath (EUOs) and that the letters annexed to defendant's motion were delay letters which failed to toll defendant's time to pay or deny the claims. The court also reviewed the EUO scheduling letters mailed by the law firm retained by the defendant, and found no issue with their sufficiency. The holding of the court was that the order granting defendant's motion for summary judgment was affirmed, as the plaintiff had failed to provide any basis upon which to reverse the order.