No-Fault Case Law

The court considered a case in which TAM Medical Supply Corp. appealed an order granting New York Central Mutual Fire Insurance Company's motion for summary judgment dismissing the complaint. The main issue decided was whether the action was premature due to the plaintiff's failure to provide requested verification for a no-fault benefits claim. The court held that there was a triable issue of fact as to whether the action was premature, as the plaintiff's affidavit gave rise to a presumption that the requested verification had been mailed to and received by the defendant. Therefore, the order granting the defendant's motion for summary judgment was reversed and the motion was denied.

The relevant facts considered in this case involve an action by a provider to recover assigned first-party no-fault benefits. The court considered whether the defendant had timely and properly denied the claim based on the plaintiff's failure to provide requested verification within 120 days of the initial verification request. The main issue decided was whether the defendant had received the requested verification, as well as whether the affidavit submitted by the plaintiff 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 the defendant. The holding of the case was that there was a triable issue of fact as to whether the plaintiff provided the requested verification, and as a result, the court reversed the order and denied the defendant's motion for summary judgment dismissing the complaint.

The court considered an appeal from an order of the Civil Court which granted the defendant's motion for summary judgment dismissing the complaint in this action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's proof sufficiently established proper mailing of the denials and verification requests and if the plaintiff had failed to appear for the scheduled examinations under oath (EUOs). The court held that the defendant's proof did establish proper mailing of the denials and verification requests and that the plaintiff had failed to appear for the scheduled EUOs, therefore affirming the order granting summary judgment in favor of the defendant.

The court considered the fact that the plaintiff, an assignee of a provider, was seeking to recover first-party no-fault benefits from the defendant insurance company. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to appear for duly scheduled examinations under oath should be granted. The court held that the order granting the defendant's motion for summary judgment was affirmed, with $25 costs, based on the plaintiff's failure to appear for the examinations under oath. The court referenced a similar case, Laga, as Assignee of Mondestin, Liliane v Lancer Ins. Co., in which the same decision was made, in support of their holding.

The court considered the fact that the plaintiff, T & S Medical Supply Corp., was seeking to recover assigned first-party no-fault benefits. The main issue that was decided was whether the defendant, State Farm Mutual Automobile Ins. Co., properly tolled its time to pay or deny the claim at issue through its initial and follow-up EUO (examinations under oath) scheduling letters. The court ultimately held that the defendant did properly toll its time to pay or deny the claim, and affirmed the order granting the defendant's motion for summary judgment dismissing the complaint. Therefore, the plaintiff's appeal was unsuccessful and the order to dismiss the complaint was affirmed by the court.

The main issue in this case was whether the plaintiff, Compas Medical, P.C., was entitled to recover assigned first-party no-fault benefits from the defendant, American Transit Ins. Co. The court considered whether there were triable issues of fact with respect to the causes of action brought by the plaintiff, specifically the second through seventh causes of action. The court ultimately held that there were triable issues of fact with respect to the causes of action, and the branches of defendant's cross motion seeking summary judgment dismissing the third through seventh causes of action were denied. The court also determined that plaintiff had not established its prima facie entitlement to summary judgment on the sixth and seventh causes of action, as the proof submitted failed to establish that the claims had not been timely denied or that defendant had issued timely denial of claim forms. Therefore, the branches of defendant's cross motion seeking summary judgment dismissing the third through seventh causes of action were denied.

The case involved an appeal from the Civil Court of the City of New York, where TAM Medical Supply Corp. was seeking to recover first-party no-fault benefits as an assignee of Wilman Martinez. 21st Century Insurance Company had moved for summary judgment to dismiss the complaint on the ground of lack of medical necessity. The main issue before the court was whether the denial of claim forms had been properly mailed, with the defendant arguing that they had established proper mailing of the forms. The court found that the proof submitted by the defendant was sufficient to establish that the denial of claim forms had been properly mailed, and therefore affirmed the order granting the branch of the defendant's motion seeking summary judgment dismissing the second cause of action. The court also found, pursuant to CPLR 3212 (g), that the defendant had established proper mailing of the denial of the claim form underlying the first cause of action.

The court considered an appeal from an order of the Civil Court denying a provider's motion for summary judgment to recover first-party no-fault benefits. The court also looked at a cross motion seeking summary judgment by the defendant to dismiss some of the claims based on the workers' compensation fee schedule. The main issue decided was whether the denial of claim forms were properly mailed by the defendant, and whether the defendant's application of the workers' compensation fee schedule was valid. The holding of the case was that the defendant had established the timely denials of the claims underlying that portion of the complaint, and the court affirmed the order in favor of the defendant.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment dismissing the complaint. The main issue decided in this case was whether the defendant's proof was sufficient to demonstrate that the plaintiff's assignor had failed to appear for examinations under oath (EUOs), a requirement for recovery of assigned first-party no-fault benefits. The court held that the proof submitted by the defendant was indeed sufficient to demonstrate the assignor's failure to appear for the EUOs, and therefore affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The Court considered the facts surrounding a provider's attempt to recover assigned first-party no-fault benefits, specifically focusing on the timeliness of the submission of the claim. The main issue decided was whether the plaintiff had timely submitted the claim, as the defendant argued that the complaint should be dismissed based on the untimeliness of the submission. The holding of the case was that the Civil Court properly found that there was a triable issue of fact as to whether the plaintiff had timely submitted the claim at issue, and therefore the branch of defendant's cross motion seeking summary judgment dismissing the complaint was denied. The order was affirmed by the Appellate Term, Second Department.