No-Fault Case Law

The relevant facts that the court considered in this case include the events leading up to the lawsuit, the actions of the parties involved, the communication between the State, Evanston Insurance, and Bruckel, and the timeliness of notice and disclaimer of coverage. The main issues decided by the court focused on whether Evanston Insurance's disclaimer of coverage for Bruckel was timely and, therefore, effective. The court also considered whether Evanston was notified in a timely manner about the lawsuit against Bruckel, and if the lack of cooperation by Bruckel in not forwarding legal papers to Evanston was a valid basis for the disclaimer of coverage. The holding of the case was that the motions by the defendants, the State of New York and P.S. Bruckel, Inc., were denied without prejudice to renewal upon a more complete record. The court found that there were disputed factual issues that could only be resolved by a jury, and that there were triable issues of fact as to the timeliness of Evanston's disclaimer of coverage and whether they acquired knowledge about the grounds for the disclaimer. Therefore, the case was not suitable for a summary judgment, and the issues would need to be resolved before any judgment could be made.

The court considered whether Civil Court erred in vacating a master arbitrator's award on the ground of misconduct. The relevant facts of the case are that the master arbitrator's response to the self-represented respondent's unsolicited communication did not rise to the level of misconduct so as to warrant vacatur of the arbitration award. The main issue decided was that the master arbitrator's measured response did not constitute misconduct and thus the Civil Court erred in vacating the master arbitrator's award. The holding was that the order of the Civil Court of New York County was reversed and the award of the master arbitrator was reinstated.

The court considered whether the assignor of the plaintiff qualified as an eligible injured person under the Florida insurance policy at issue, as the assignor was not a "family member" of the insured. The main issue decided was whether the assignor was a "family member" of the insured as defined in the insurance policy. The court held that the defendant sufficiently established that the assignor did not reside in the household of the Florida policyholder and thus was not a "family member" of the insured. As a result, the defendant's motion for summary judgment dismissing the complaint was properly granted, and the order was affirmed.

The court considered the denial of defendant's motion for summary judgment in a case where a provider was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment should be granted to dismiss the complaint. The court held that the order denying the defendant's motion for summary judgment was reversed, and the defendant's motion for summary judgment dismissing the complaint was granted. This decision was in line with a previous case, Sure Way, Inc., as Assignee of Dixin, Marla v Travelers Ins. Co., and the previous decision and order of the court was recalled and vacated.

The court considered the fact that CPM Med Supply, Inc. failed to provide verification requested by State Farm Fire and Casualty Insurance Company. The main issue was whether CPM Med Supply, Inc. was required to respond to the verification requests and if its failure to do so justified the dismissal of its complaint seeking to recover assigned first-party no-fault benefits. The court held that CPM Med Supply, Inc. was required to respond to the verification requests and failed to demonstrate a basis to disturb the order dismissing the complaint. The court affirmed with costs and noted that while defendant was entitled to dismissal of plaintiff's complaint with prejudice, as defendant did not cross-appeal, the order was affirmed.

The relevant facts considered were that the plaintiff, GL Acupuncture, P.C., sought to recover $178.58 for acupuncture services rendered by a licensed acupuncturist and defendant, Progressive Insurance Company, offered payment of only $54.74 for an office visit. At a nonjury trial, it was stipulated that plaintiff had established its prima facie case, that defendant had timely denied the claims at issue, and that defendant's witness was a certified coder. The defendant's coder explained how she had calculated the payments for the acupuncture services billed under specific CPT codes based on the chiropractic fee schedule, and she testified that the defendant was offering payment in the amount of $54.74 for an office visit billed under a specific CPT code. Plaintiff did not call a witness to rebut the coder's testimony. The main issue decided was whether the defendant had properly paid the claims billed under the specific CPT codes and the office visit. The holding of the case was that the defendant had established that it had fully paid plaintiff for the services billed under the specific CPT codes in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors, and that plaintiff had failed to rebut defendant's showing. Therefore, the judgment awarding the principal sum of $54.74 to the plaintiff was affirmed.

The court considered the testimony of the defendant's witness, who was a certified medical coder, who stated that the workers' compensation chiropractic fee schedule was applied to determine payment for services by a licensed acupuncturist. The main issue at trial was whether the defendant had properly paid the bill in accordance with the workers' compensation fee schedule. The holding of the case was that the court found that the defendant had correctly applied the fee schedule codes and had fully paid the plaintiff for the services billed in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. Therefore, the judgment was affirmed, with the defendant being required to pay $25 in costs.

The court considered the denial of claim forms for medical services provided from March 1, 2010 through September 22, 2010, which had been denied on the ground of lack of medical necessity. The defendant moved for summary judgment dismissing the complaint. The main issue decided was whether the proof submitted by the defendant was sufficient to give rise to a presumption that the denial of claim forms at issue had been timely mailed. The court held that the proof submitted by the defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim forms had been timely mailed. The order, insofar as appealed from, granting the branches of defendant's motion seeking summary judgment dismissing seven claims for services provided from March 1, 2010 through September 22, 2010, which had been denied on the ground of lack of medical necessity, was affirmed.

The relevant facts in this case are that plaintiff filed an action to recover no-fault benefits on behalf of an assignor in 2013, and a judgment was awarded in 2018. The case was then assigned to the court to determine plaintiff's claim for attorneys' fees. The main issue decided was the allocation of attorneys' fees in a case where the insurer designated its defense as a policy issue, and the courtroom appearances and preparation work spent by the attorney. The holding of the case was that the plaintiff was awarded a total of $695 for attorneys' fees, based on the hours spent in court appearances and trial preparation. The court found that the failure to maintain contemporaneous time records and a lack of evidence on the number of cases handled by the attorney limited the amount of time awarded for the work performed.

The court considered the background of the case, which involved an action by PDG Psychological P.C. seeking to recover no-fault insurance benefits for services rendered to an assignor involved in a car accident. The main issues decided included a motion for summary judgment by the plaintiff, and a cross-motion to dismiss by the defendant for failure to provide discovery. The court also considered the issue of the defendant's motion to reargue a previous decision, and the decision on whether to stay the accrual of no-fault interest. The holding of the case was that the defendant's motion to dismiss was denied, motion to strike was granted, motion to compel was granted, and motion to stay interest was denied. In summary, the court decided in favor of the defendant on the motion to strike and motion to compel, and against the defendant on the motion to stay interest. The case involved a dispute over insurance benefits, and the court's decision addressed issues related to discovery and the accrual of interest.