No-Fault Case Law

The relevant facts of the case involved a provider seeking to recover first-party no-fault benefits as an assignee, and the defendant's appeal from an order denying their motion seeking summary judgment dismissing the complaint. The main issue decided was whether the motion court had properly exercised its discretion in denying the defendant's motion after the plaintiff had failed to comply with two prior orders to produce its treating provider at a deposition. The court held that the trial court had broad discretion to oversee the discovery process and that the determination of the nature and degree of the penalty to be imposed for failing to comply with an order compelling disclosure lay within the discretion of the motion court. The order denying the defendant's motion was affirmed, without costs.

The court considered the fact that in this action by a provider to recover assigned first-party no-fault benefits, plaintiff's moving papers failed to establish that the defendant had failed to deny the claim within the requisite 30-day period or that the denial was conclusory, vague, or without merit. Defendant, in support of its cross motion, also failed to demonstrate that it is not precluded from asserting the defense of fraudulent procurement of the policy, as defendant failed to establish that it had timely denied plaintiff's claim. To the extent defendant also sought summary judgment on the ground of lack of coverage, a defense which is not subject to preclusion, defendant's proffered evidence was insufficient to establish, as a matter of law, that the assignor's alleged injuries did not arise from an insured incident. The main issue decided was whether plaintiff's motion for summary judgment should be denied and defendant's cross motion for summary judgment dismissing the complaint should be granted. The holding of the case was that defendant's cross motion for summary judgment dismissing the complaint is denied, and the order is affirmed.

The court considered the motion by the defendant to dismiss the complaint by a provider seeking first-party no-fault benefits, on the grounds that the claim was denied due to the plaintiff's assignor failing to appear for scheduled independent medical examinations (IMEs). The main issue decided was whether the defendant's motion to dismiss the complaint should be granted based on the assignor's failure to comply with the IMEs. The court held that the defendant's motion papers did not establish that the letters scheduling the IMEs had been timely mailed, and therefore failed to demonstrate that the IMEs had been properly scheduled. As a result, the court affirmed the order denying the defendant's motion for summary judgment dismissing the complaint.

The court considered the case of Delta Diagnostic Radiology, P.C. as Assignee of NOEL JUNIOR, appealing an order from the Civil Court of New York, which granted the defendant's motion for summary judgment and denied the plaintiff's cross motion for summary judgment. The main issue decided was whether the affidavits submitted by the defendant were sufficient to establish that the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The holding of the court was that since the assignor's appearance at an IME is a condition precedent to the insurer's liability on the policy, and in opposition to defendant's motion, the plaintiff did not raise a triable issue of fact, the order was affirmed.

The court considered the motion for summary judgment from the defendant, Hartford Insurance Company, in an action to recover assigned first-party no-fault benefits. The main issue was whether the defendant was the proper insurer for the claim. The defendant claimed it was not the proper insurer for the assignor's employer for no-fault claims, but the court found that the evidence provided was not sufficient to establish this for summary judgment. The court also denied the plaintiff's cross-motion for summary judgment and granted the plaintiff's motion to compel discovery, as the plaintiff contended that discovery was not complete. The holding of the case was that the defendant's motion for summary judgment was denied, the plaintiff's cross-motion for summary judgment was denied, and the plaintiff's motion to compel discovery was granted.

The relevant facts considered by the court were that the plaintiff, Big Apple Ortho Products, Inc., was seeking to recover first-party no-fault benefits that had been denied by the defendant, State Farm Mutual Automobile Ins. Co., on the basis that the accident in question occurred in Georgia and therefore was not covered by New York State no-fault law. The defendant provided an affidavit from a claims representative and a police report to support their argument. The main issue decided by the court was whether the accident fell under the coverage provided by New York State no-fault law, given the location of the accident and the residency of the individual involved. The holding of the court was that the defendant's motion for summary judgment was denied without prejudice, as the evidence presented was found to be inadmissible and did not establish whether the individual involved was a New York State resident or if he was covered by another policy providing the required coverage.

In the case of PR Medical, P.C. v Praetorian Insurance Company, the court considered whether the defendant's motion for summary judgment to dismiss the complaint and the plaintiff's cross-motion for summary judgment on their claims amounting to $2,005.25 should be granted. The main issue decided was whether the plaintiff's claims were overdue, as they were not "denied or paid" within the prescribed 30-day period. The holding of the court was that the defendant's motion for summary judgment was denied, the complaint reinstated, and the plaintiff's cross-motion for summary judgment in the principal amount of $2,005.25 was granted. The court found that the defendant failed to raise a triable issue as to whether it had timely denied the claims and that the claims at issue were not timely denied, therefore the defendant was precluded from asserting its defense of lack of medical necessity.

The court considered the fact that an automobile accident occurred in New York involving a vehicle insured by the defendant under a Florida automobile insurance policy. The defendant rescinded the policy retroactively based on a material misrepresentation in the insurance application. The main issue was whether the defendant had complied with the requirements of rescinding the policy under Florida law. The holding of the court was that the defendant had demonstrated, through documented evidence, that it had complied with the requirements for rescinding the policy under Florida law, and therefore, it was entitled to summary judgment to dismiss the complaint. The court reversed the lower court’s decision and granted the defendant’s motion for summary judgment, while denying the plaintiff’s cross motion for summary judgment.

The relevant facts that the court considered were that a medical provider was seeking to recover no-fault benefits for acupuncture services rendered to an assignor. The main issue was whether the acupuncture services were medically necessary. The court held that the services in question were, in fact, medically necessary, as the provider demonstrated, by a preponderance of the credible evidence, that the services at issue were medically necessary. The court also precluded the defendant from raising a defense that the assignor may have been eligible for workers' compensation benefits, as the defendant had not denied the claims based upon that eligibility. Therefore, the court affirmed the judgment in favor of the medical provider.

The court considered the motion for summary judgment by the plaintiff to recover assigned first-party no-fault benefits, as well as the cross motion for summary judgment by the defendant to dismiss the complaint. The main issue decided was whether the defendant had timely and properly paid the plaintiff's claims in accordance with the workers' compensation fee schedule. The holding of the court was that the defendant had fully paid the plaintiff for the services at issue in accordance with the fee schedule, as established by the affidavit of the defendant's no-fault examiner and the exhibits annexed in support of the cross motion. Consequently, the Civil Court properly granted the defendant's cross motion and denied the plaintiff's motion, and the order was affirmed.