No-Fault Case Law

The relevant facts considered by the court in this case were that Compas Medical, P.C. sought to recover assigned first-party no-fault benefits from Farm Family Casualty Ins. Co. The main issues decided by the court were whether the claim forms had been properly mailed to the insurance company and whether the insurance company had failed to pay or deny the claims within the required time period. The holding of the case was that the branches of the insurance company's cross motion seeking summary judgment to dismiss the first and third causes of action were denied, and the order was affirmed, without costs. The court found that there was an issue of fact as to whether the insurance company's time to pay or deny the claims had begun to run, and that the insurance company failed to submit sufficient proof to dismiss the first and third causes of action.

The court considered a motion for summary judgment by the plaintiff to recover assigned first-party no-fault benefits and a cross-motion by the defendant to dismiss the complaint on the basis of fraudulent procurement of the insurance policy and that the amount sought to be recovered exceeded the amount permitted by the workers' compensation fee schedule. The main issue decided was whether the defendant had established its defense of fraudulent procurement of the insurance policy. The holding was that the branch of defendant's cross-motion seeking summary judgment dismissing the complaint on the ground of fraudulent procurement of the insurance policy was denied, and the matter was remitted to the Civil Court for a determination of the branch of defendant's cross-motion seeking summary judgment dismissing the complaint on the ground that the amount sought to be recovered exceeded the amount permitted by the workers' compensation fee schedule.

The relevant facts of the case included a provider seeking to recover assigned first-party no-fault benefits, and plaintiff's motion for summary judgment, and defendant's cross motion for summary judgment dismissing the complaint. The issues decided were whether the first cause of action was premature due to failure to provide requested verification, and whether the failure of plaintiff's assignor to appear for independent medical examinations and examinations under oath justified summary judgment dismissing the claims. The holding was that defendant's cross motion seeking summary judgment dismissing the first cause of action was denied due to a triable issue of fact as to whether the cause of action was premature, and defendant was entitled to summary judgment dismissing the second through sixth causes of action due to plaintiff's assignor failing to comply with a condition precedent to coverage.

The relevant facts the court considered were that GL Acupuncture, P.C. had moved for summary judgment to recover assigned first-party no-fault benefits, but Praetorian Ins. Co. had cross-moved for summary judgment dismissing the complaint, arguing that they had properly paid GL Acupuncture, P.C. for the services at issue in accordance with the workers' compensation fee schedule. The main issue decided was whether Praetorian Ins. Co. had properly paid GL Acupuncture, P.C. for the services at issue in accordance with the fee schedule. The court held that Praetorian Ins. Co. had established that they had timely mailed the denial of claim form and had fully paid GL Acupuncture, P.C. for the services at issue in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors, therefore affirming the order.

The court considered the plaintiff's motion for summary judgment and the defendant's cross-motion for summary judgment, as well as issues related to the timely mailing of independent medical examination (IME) and examination under oath (EUO) scheduling letters, the failure of plaintiff's assignor to appear for scheduled IMEs and EUOs, and the timely denial of claims by the defendant. The court also considered the issue of medical necessity of the services at issue in the plaintiff's seventh and eighth causes of action. The main issues decided were whether the defendant had demonstrated that the plaintiff's assignor failed to comply with a condition precedent to coverage, and whether there were triable issues of fact regarding the medical necessity of the services in the seventh and eighth causes of action. The holding was that the defendant was entitled to summary judgment dismissing the first through sixth causes of action, and that there were triable issues of fact regarding the medical necessity of the services in the seventh and eighth causes of action.

The court considered the fact that the plaintiff, Compas Medical, P.C., was seeking to recover first-party no-fault benefits on behalf of an assignor, and that the defendant, Praetorian Ins. Co., had denied the claims due to the assignor's failure to appear for independent medical examinations and examinations under oath. The main issues decided were whether the plaintiff was entitled to summary judgment and whether the defendant was entitled to summary judgment dismissing the complaint. The holding of the court was that the defendant was entitled to summary judgment dismissing the first through fifth, and seventh causes of action because the assignor had failed to comply with a condition precedent to coverage by not appearing for the scheduled examinations, and the defendant had timely denied the claims on that ground. The court affirmed the order in this regard.

The relevant facts considered in this case were that a medical supplier was seeking to recover first-party no-fault benefits as the assignee of an individual. The main issues decided were whether the defendant insurance company had timely mailed verification requests and if the plaintiff's second cause of action was premature. The holding of the case was that the defendant's motion for summary judgment was denied and the branch of the plaintiff's cross-motion seeking summary judgment upon the first cause of action was granted. This decision was based on the fact that the defendant did not timely deny the claim or seek verification, and therefore, the plaintiff was entitled to summary judgment.

The main issues in this case were whether the trial court erred in denying the defendant's motion for summary judgment seeking to dismiss a claim for $677.21 in first-party no-fault benefits. The defendant had argued that the plaintiff's assignor failed to appear for examinations under oath (EUOs), which was a condition precedent to the insurer's liability on the policy. The court held that the defendant did not need to demonstrate objective reasons for the requested EUOs as part of its prima facie showing of entitlement to judgment as a matter of law. The court reversed the trial court's decision and granted the defendant's motion for summary judgment, dismissing the claim for $677.21 in first-party no-fault benefits.

The relevant facts considered by the court were that Delta Diagnostic Radiology, P.C. was seeking to recover first-party no-fault benefits as an assignee of Philip Owusu-Afriyie. The main issue decided was whether the lower court erred in denying Delta Diagnostic's motion for summary judgment and granting Praetorian Ins. Co.'s cross motion for summary judgment dismissing the complaint. The holding of the court was that while Praetorian Ins. Co. was not entitled to summary judgment because they did not provide sufficient evidence that the assignor failed to appear for scheduled examinations, Delta Diagnostic also failed to demonstrate its prima facie entitlement to summary judgment as their affidavit did not establish that the claim at issue had not been timely denied. Therefore, the order was modified to provide that Praetorian's cross motion for summary judgment was denied.

The relevant facts in the case were that plaintiff Compas Medical, P.C. was seeking recovery of first-party no-fault benefits as the assignee of Masse Innocent. The defendant, American Transit Ins. Co., argued that the action should be stayed pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law, based on the assignor's alleged eligibility for workers' compensation benefits. The main issue decided was whether there was an issue as to whether the assignor had been acting in the course of his employment at the time of the accident, and therefore whether workers' compensation benefits might be available. The holding of the court was that the order denying plaintiff's motion for summary judgment was modified to hold the motion in abeyance pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law. The issue of whether the assignor was acting as an employee at the time of the accident had to be resolved by the Workers' Compensation Board, and therefore the court did not express views on the matter pending that determination.