No-Fault Case Law

The court considered the appeal of an order from the Civil Court of the City of New York, Queens County, which granted the defendant's motion for summary judgment dismissing the complaint in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the action was premature because the provider had failed to provide requested verification. The holding of the court was that the order granting the defendant's motion for summary judgment was reversed, with the defendant's motion being denied. The court cited the reasons stated in a similar case, Renelique, as Assignee of Allen Haynes v Travelers Ins. Co., in support of its decision. The three presiding judges all concurred with this decision.

The court considered a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The insurance company had denied the claims based on the failure of the provider's assignors to appear for independent medical examinations. The main issue decided was whether the denial of the claims by the insurance company was justified due to the assignors' failure to attend the scheduled examinations. The holding was that the insurance company's motion for summary judgment dismissing the complaint was granted, reversing the Civil Court's decision. The court concluded that the insurance company was justified in denying the claims based on the assignors' failure to attend the scheduled medical examinations.

The court considered the fact that the defendant denied the claims at issue based on the plaintiff's assignor's failure to appear for independent medical examinations. However, the defendant failed to submit proof by someone with personal knowledge of the nonappearance of the plaintiff's assignor for the IMEs in question. As a result, the defendant failed to establish its prima facie entitlement to summary judgment. The main issue decided was whether the defendant had provided sufficient evidence to establish its entitlement to summary judgment. The holding of the case was that the order granting defendant's motion for summary judgment dismissing the complaint was reversed, and defendant's motion for summary judgment dismissing the complaint was denied.

The relevant facts the court considered in this case were that the plaintiff, Pierre Jean Jacques Renelique, was seeking to recover assigned first-party no-fault benefits from Travelers Insurance Company. The main issue decided by the court was whether the action was premature because the plaintiff had failed to provide requested verification. The court ultimately held that there was a triable issue of fact as to whether the action was premature, as the plaintiff had submitted an affidavit from the owner that gave rise to a presumption that the requested verification had been mailed to, and received by, the defendant. As a result, the court reversed the order granting summary judgment to the defendant and denied their motion to dismiss the complaint.

The relevant facts considered in this case were that an action was brought by a provider to recover assigned first-party no-fault benefits. The Civil Court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint on the basis that the action was premature due to the plaintiff's failure to provide requested verification. The main issue decided was whether the action was premature, and the holding of the case was that there was a triable issue of fact as to whether the action was premature, and as a result, the defendant's cross motion for summary judgment dismissing the complaint was denied.

The court considered an order of the Civil Court of the City of New York, Queens County, which granted defendant's motion for summary judgment dismissing the complaint brought by Omphil Care, Inc., as the assignee of FRANTZ MENARD, to recover first-party no-fault benefits from State Farm Mutual Automobile Ins. Co. The main issue decided was whether State Farm had timely and properly denied the claims at issue on the ground that the plaintiff had failed to comply with a condition precedent to coverage by not appearing for duly scheduled examinations under oath (EUOs). The court held that the defendant did have justification for its EUO requests, and therefore affirmed the order of the Civil Court, dismissing the complaint.

The main issues in this case were whether the defendant was entitled to summary judgment dismissing the complaint and whether the plaintiff was entitled to recover assigned first-party no-fault benefits. The court considered the defendant's motion for summary judgment or to compel the plaintiff's treating doctor to appear for examination before trial, as well as the plaintiff's cross-motion for summary judgment. The court held that with respect to all of the remaining claims, the sole issue for trial was the defendant's defense of lack of medical necessity. The court ultimately reversed the order, granted the defendant's motion seeking summary judgment dismissing the complaint, except for certain claims, and held that the defendant owed the plaintiff the additional sum sought for specific claims.

The court considered the facts of a lawsuit brought by New Quality Medical, P.C., as the assignee of Henry Munoz, against Allstate Insurance Company to recover assigned first-party no-fault benefits. Allstate Insurance Company had moved for summary judgment, arguing that they had timely and properly denied the claims due to the plaintiff's failure to appear for duly scheduled examinations under oath (EUOs). However, the plaintiff argued that Allstate had not established their failure to appear for the EUOs. The main issue decided was whether Allstate had submitted sufficient proof of the plaintiff's nonappearance for the EUOs. The court held that because Allstate failed to submit proof by someone with personal knowledge of the nonappearance of the plaintiff for the EUOs in question, Allstate's motion for summary judgment should have been denied. Therefore, the court reversed the order of the Civil Court and denied Allstate's motion for summary judgment dismissing the complaint.

The court considered the motion for summary judgment by the plaintiff to recover assigned first-party no-fault benefits, and the defendant's cross motion for summary judgment dismissing the complaint. The defendant alleged that the claim had been timely and properly denied based on the plaintiff's failure to appear at scheduled examinations under oath (EUOs). The Civil Court granted the plaintiff's motion and denied the defendant's cross motion, finding that the defendant had failed to sufficiently establish the plaintiff's failure to appear for EUOs. The main issue decided was whether the defendant had submitted enough proof of the plaintiff's failure to appear for the EUOs, and the court held that the defendant had failed to raise a triable issue of fact as to whether it had timely denied the plaintiff's claims, affirming the order with costs.

The court considered the motion for summary judgment made by defendant to dismiss the complaint on the ground of lack of medical necessity in an action by a provider to recover assigned first-party no-fault benefits. The court initially denied defendant's motion for summary judgment, as the affidavit of mail clerk demonstrated the existence of a triable issue of fact. Defendant then sought leave to renew their motion based on new facts and an affidavit explaining an inadvertent typographical error in the previous motion. The court held that the branch of defendant's motion seeking leave to renew was granted, and that upon renewal, the order denying the motion for summary judgment was vacated and defendant's prior motion was granted. This decision was based on the submission of evidence that the verification requests and denial of claim forms were timely mailed, and the submission of an affirmed peer review report providing a medical rationale for the determination that there was no medical necessity for the supplies furnished.