No-Fault Case Law

The court considered the facts of an action by a provider to recover assigned first-party no-fault benefits. Plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court denied plaintiff's motion and granted defendant's cross motion, finding that plaintiff's assignor was not entitled to receive no-fault benefits from defendant because the assignor had been injured while driving a vehicle insured by a different insurer. The main issue decided was whether defendant was entitled to summary judgment dismissing the complaint. The court held that defendant's cross motion for summary judgment dismissing the complaint should have been denied because the evidence presented was insufficient to establish, as a matter of law, that defendant did not insure the vehicle in which plaintiff's assignor was riding when the accident occurred. The court also held that plaintiff failed to establish as a matter of law that there was coverage by defendant of plaintiff's assignor's claims. Therefore, the order was modified to provide that defendant's cross motion for summary judgment dismissing the complaint is denied.

The main issue in this case was whether plaintiff T & J Chiropractic, P.C. was entitled to recover assigned first-party no-fault benefits from defendant American Transit Ins. Co. Plaintiff had moved for summary judgment, while defendant cross-moved for summary judgment dismissing the complaint on the grounds that plaintiff had failed to provide requested verification. The court considered the affidavits submitted by both parties, with defendant demonstrating prima facie that it had not received the requested verification, and plaintiff's owner submitting an affidavit to give rise to a presumption that the verification had been mailed to and received by defendant. The court held that there was a triable issue of fact as to whether the action was premature, and thus modified the order by providing that defendant's cross motion for summary judgment dismissing the complaint was denied. Therefore, the court affirmed the order, with the modification, without costs.

The main issue in the case was whether the insurance company had properly denied the claims on the grounds that the plaintiff's assignor had failed to appear for scheduled IMEs. The court considered the evidence submitted by the defendant to show that the IME scheduling letters and denial of claim forms had been timely mailed, as well as proof that the plaintiff's assignor had not appeared for the scheduled IMEs. The court found that the insurance company had demonstrated that the assignor had failed to comply with a condition precedent to coverage, and as the plaintiff failed to raise a triable issue of fact in opposition, the defendant's cross motion was properly granted. Therefore, the court held that the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The court considered the fact that Compas Medical, P.C. had moved for summary judgment to recover first-party no-fault benefits, but defendant American Transit Ins. Co. had cross-moved for summary judgment to dismiss the complaint. The main issue decided was whether plaintiff's assignor had failed to comply with a condition precedent to coverage by not appearing for examinations under oath (EUOs) and independent medical examinations (IMEs). The court held that defendant had timely mailed the EUO scheduling letters and that plaintiff's assignor had failed to appear for the duly scheduled EUOs, which demonstrated non-compliance with a condition precedent to coverage. As a result, the court affirmed the order denying plaintiff's motion for summary judgment and granted the branches of defendant's cross motion seeking summary judgment dismissing the claims in question.

The court considered the appeal of an order from the Civil Court of the City of New York, Kings County, which denied the plaintiff's motion for summary judgment and granted partial summary judgment to the defendant. The main issue decided was whether the defendant's defense based on the workers' compensation fee schedule was appropriate. The holding of the court was that while the court has the power to award summary judgment to a nonmoving party, in this case, the issue of medical necessity was not the subject of the plaintiff's motion for summary judgment. Thus, the court modified the order by striking the provision granting partial summary judgment to the defendant and affirmed the order without costs.

The relevant facts the court considered were that the defendant, an insurance company, had denied a claim for first-party no-fault benefits based on the plaintiff's assignor's failure to appear at examinations under oath (EUOs). The main issue decided was whether there was an issue of fact as to whether the plaintiff's assignor had failed to appear for the scheduled EUOs. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was granted, as the defendant had sufficiently established that the assignor had failed to comply with a condition precedent to coverage and that the claim had been timely denied on that ground. As a result, the court reversed the lower court's decision and granted the defendant's motion for summary judgment.

The relevant facts considered by the court in this case included a dispute over first-party no-fault benefits between Compas Medical, P.C., as an assignee of Jean Guillaume, and Praetorian Ins. Co. Both parties moved for summary judgment, with Compas Medical seeking to recover assigned benefits and Praetorian seeking to dismiss the complaint. The court examined whether the IME and EUO scheduling letters had been timely mailed, and whether the assignor had failed to appear for the scheduled IMEs and EUOs. The main issues decided were that Praetorian was entitled to summary judgment dismissing the first, second, and fourth through eighth causes of action due to the assignor's failure to comply with a condition precedent to coverage. However, the court held that Compas Medical was entitled to summary judgment upon its third cause of action, as the claim at issue was not denied within 30 days of its receipt and Praetorian did not demonstrate that the 30-day claim determination period had been tolled. As a result, the court remitted the matter to the Civil Court for the calculation of statutory interest and an assessment of attorney's fees with respect to this cause of action.

The court considered that the complaint was brought by the plaintiff, seeking no fault benefits under an insurance policy issued by the defendant to D & M Collision, Inc., following an accident involving a vehicle owned by D & M. The defendant moved for summary judgment dismissing the complaint, arguing that the vehicle involved in the accident was not owned by D & M and thus not covered by the policy. The main issue decided was whether the vehicle in question was owned by D & M at the time of the accident and therefore covered by the insurance policy. The court held that there is a factual issue as to whether D & M owned the vehicle and therefore the denial of the defendant's motion for summary judgment was affirmed. The court cited evidence that the vehicle was bought with D & M's dealer credentials, D & M had title to the vehicle and its dealer plates were on the vehicle at the time of the accident to support its decision.

The relevant facts that the court considered in this case were that Great Health Care Chiropractic, P.C. sought to recover no-fault benefits from Travelers Insurance Company, but defendant had denied the claim on the grounds that the plaintiff had failed to appear at scheduled examinations under oath (EUOs). The main issue decided by the court was whether the denial of the claim was valid based on the plaintiff's failure to comply with the EUO requirement. The holding of the court was that the denial of the claim was not valid because the defendant had failed to schedule the EUOs within the required time frame, and therefore had not demonstrated that the denial of the claim was based on a failure to comply with a condition precedent to coverage. The court reversed the previous order and denied the defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that the plaintiff in this case, a medical provider, was seeking to recover first-party no-fault benefits from the defendant insurance company. The main issue in the case was whether the defendant had properly established that the scheduling letters for an independent medical examination and examination under oath had been timely mailed, and whether the plaintiff's assignor had failed to comply with these requirements. The court held that the scheduling letters were not mere delay letters, that the plaintiff's assignor had failed to appear for the scheduled examinations, and that the defendant had timely denied the claims at issue. As a result, the court affirmed the order granting the defendant's motion for summary judgment and dismissing the complaint.