No-Fault Case Law

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.

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.

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.

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.

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.

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.

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.

The main issue in this case was whether the insurance company was justified in denying claims for first-party no-fault benefits due to the plaintiff's failure to appear for scheduled examinations under oath (EUOs). The court considered the timing of the scheduling of the EUOs in relation to the receipt of the bills by the insurance company. The court ultimately held that once the initial letter scheduling the EUO was mailed to the plaintiff, the insurance company's time to pay or deny the claims applied, even for subsequent claim forms submitted by the plaintiff for the same assignor and accident. The court affirmed the order of the Civil Court, granting the insurance company's motion for summary judgment dismissing the complaint and denying the plaintiff's cross motion for summary judgment.

The relevant facts of the case were that the plaintiff, Ortho Passive Motion, Inc., was seeking to recover assigned first-party no-fault benefits from the defendant, Allstate Insurance Company. The defendant claimed, as an affirmative defense, that the insurance policy limits had been exhausted. The trial court noted that the parties had stipulated to the defendant's timely denial of the claim, and a judgment was entered in favor of the plaintiff. The defendant subsequently moved to modify the judgment on the grounds that the coverage limits of the insurance policy had been exhausted. The main issue decided by the court was whether the defendant had established an exhaustion of the coverage limits of the insurance policy at the time the claims at issue had been deemed complete. The court found that the defendant had failed to demonstrate that the policy had been exhausted at the relevant time, and therefore had not established a basis to modify the judgment. The holding of the case was that the order of the District Court denying the branch of defendant's motion seeking to modify the judgment was affirmed. This means that the judgment in favor of the plaintiff was upheld, and the defendant's motion to modify the judgment was denied.

The court considered the conflicting and contradictory submissions made by the defendant regarding the amount it paid on the claims and when, in a case seeking recovery of assigned first-party no-fault benefits. The main issue decided was whether the claims were timely and properly denied according to the applicable fee schedules. The court held that the case was not ripe for summary disposition due to the conflicting submissions creating triable issues, and affirmed the order of the lower court. The decision was made by the Appellate Term, First Department on November 29, 2018.