No-Fault Case Law

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.

The court considered the defendant-insurer’s appeal from an order of the Civil Court of the City of New York, which denied, in part, its motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant-insurer made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely denied the plaintiff's first-party no-fault claims based on an affirmed independent examination report (IME) of its examining orthopedist. The holding of the court was that the defendant-insurer did make a prima facie showing of entitlement to judgment as a matter of law, and therefore, the motion for summary judgment was granted in its entirety, and the complaint was dismissed. The medical affirmation submitted by the plaintiff failed to raise a triable issue since it was not based on an examination of the assignor, nor did it meaningfully rebut the findings of the defendant's examining physician. Additionally, the assignor's subjective complaints of pain did not overcome the objective medical tests detailed in the IME report.

The court considered a case where Nova Chiropractic Services, P.C. as the assignee of Cynthia Guerrero, was seeking to recover first-party no-fault benefits from GEICO General Insurance Company. The main issue was the medical necessity of the services provided by the chiropractic services. The Civil Court precluded the testimony of defendant's expert witness and granted plaintiff's motion for a directed verdict. However, the Appellate Term, Second Department reversed the judgment and remitted the matter to the Civil Court for a new trial. The holding of the case was that the judgment in favor of the plaintiff was reversed, and a new trial was ordered.

The relevant facts the court considered were that Sharp View Diagnostic Imaging, P.C. was seeking to recover assigned first-party no-fault benefits from GEICO General Insurance Company. The main issue decided was the medical necessity of the services in question. The court precluded the testimony of defendant's expert witness and granted plaintiff's motion for a directed verdict, resulting in a judgment in favor of the plaintiff in the principal sum of $1,791.73. The holding of the case was that the judgment was reversed and the matter was remitted to the Civil Court for a new trial, in accordance with the decision in another related case.

In this case, Nova Chiropractic Services, P.C. sued GEICO General Insurance Company to recover assigned first-party no-fault benefits, with the sole issue being the medical necessity of the services provided. The Civil Court precluded the testimony of the defendant's expert witness and granted the plaintiff's motion for a directed verdict, awarding the plaintiff the principal sum of $873.96. On appeal, the Appellate Term, Second Department reversed the judgment and remitted the matter to the Civil Court for a new trial. The decision was made in light of a similar case involving the same parties, where issues related to the medical necessity of the services provided were considered. The Appellate Term held that a new trial was required in this case.

The court considered that plaintiff, Veraso Medical Supply Corp, was seeking to recover assigned first-party no-fault benefits and had filed a motion for summary judgment. However, the defendant, 21st Century Insurance Company, had filed a cross motion for summary judgment dismissing the complaint on the grounds that plaintiff's assignor had failed to appear for examinations under oath. The main issue decided was whether the defendant's cross motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was denied.

The court considered a case where Nova Chiropractic Services, P.C. was seeking to recover assigned first-party no-fault benefits from GEICO General Insurance Company. The main issue was the medical necessity of the services provided, and the Civil Court precluded the testimony of GEICO's expert witness, granting Nova Chiropractic's motion for a directed verdict. The judgment in favor of Nova Chiropractic in the amount of $2,184.94 was appealed by GEICO. The Appellate Term reversed the judgment and remitted the matter to the Civil Court for a new trial, citing a similar case as precedent. The holding of the case was that the judgment in favor of Nova Chiropractic was reversed and the matter was sent back for a new trial.

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 a patient who failed to appear for required examinations under oath. The main issue decided was whether the defendant insurance company could deny the claim based on the assignor's failure to attend the EUOs. The court held that the defendant's cross motion for summary judgment dismissing the complaint should have been denied as the defendant failed to demonstrate that it was not precluded from raising its defense. Additionally, the court found that the plaintiff failed to establish its entitlement to summary judgment, as it did not prove that the claim had not been timely denied, or that the denial of claim form issued by the defendant was conclusory, vague, or without merit as a matter of law. Therefore, the court modified the order by denying the defendant's cross motion for summary judgment.