No-Fault Case Law

The relevant facts considered by the court were that the plaintiff was seeking to recover assigned first-party no-fault benefits for medical supplies provided to an individual who had been injured in a motor vehicle accident. The defendant had previously obtained a declaratory judgment in a separate action, determining that the medical providers, including the plaintiff, and the injured individual were not entitled to recover benefits related to the accident. The main issue decided by the court was whether the current action was barred by the previous declaratory judgment under the doctrine of res judicata. The holding of the court was that the instant action was indeed barred by the previous declaratory judgment, and therefore the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment was affirmed.

The court considered the appeal of a case involving Excel Imaging, P.C. as an assignee of Kenneth Owens against Allstate Insurance Company. Allstate Insurance Company denied the claim due to the assignor's alleged failure to appear at examinations under oath (EUOs). Defendant moved for summary judgment dismissing the complaint, arguing that the assignor had failed to comply with a condition precedent to coverage. However, the court found that there was an issue of fact as to whether the assignor failed to comply with the condition precedent. The court stated that there were details missing from the record, preventing them from determining the reasonableness and timeliness of each party's conduct. Ultimately, the court affirmed the order, ruling in favor of Excel Imaging, P.C. as the plaintiff.

The court considered the fact that the defendant-insurer timely and properly denied the plaintiff's no-fault claims on the ground that the fees charged for the acupuncture services exceeded the amount permitted by the applicable worker's compensation fee schedule. The main issue decided was whether the defendant was entitled to summary judgment dismissing the claims, and the court held that the defendant made a prima facie showing of entitlement to judgment as a matter of law. The court also held that the plaintiff failed to raise a triable issue in opposition, and that the defendant established its entitlement to summary judgment dismissing the claims.

The court considered the evidence submitted by the defendant that established that it timely denied the plaintiff's no-fault claims for services rendered on certain dates, on the ground that the amounts charged were in excess of the fees set forth in the applicable worker's compensation fee schedule. The main issue decided was whether the defendant properly denied the plaintiff's claim for $61.43, billed under a specific CPT code, thus precluding summary judgment dismissing this claim. The holding of the court was that the order of the Civil Court, which granted the defendant partial summary judgment dismissing plaintiff's no-fault claims, was modified to reinstate plaintiff's claim for first-party no-fault benefits billed under the specific CPT code, and as modified, the order was affirmed. The court found triable issues as to whether defendant properly denied the specific claim, and therefore, summary judgment dismissing this claim was precluded.

The court considered the issue of whether the defendant-insurer was entitled to summary judgment dismissing the plaintiff-provider's claim for first-party no-fault benefits. The defendant made a prima facie showing of entitlement to summary judgment by establishing that they properly mailed notices for independent medical examinations to the plaintiff's assignor and her attorney, and that the assignor failed to appear. The plaintiff failed to raise a triable issue with respect to the assignor's nonappearance or the mailing and reasonableness of the notices. Therefore, the court held that the defendant-insurer was entitled to deny all claims retroactively to the date of loss, regardless of whether the denials were timely issued. The court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The relevant facts the court considered included a medical provider’s action against an insurance company to recover first-party no-fault benefits. The insurance company had raised a defense of lack of medical necessity. The main issues decided in the case were whether the insurance company was entitled to conduct a deposition of the plaintiff on the issue of medical necessity, and whether the service of a notice of deposition together with other discovery demands rendered the notice procedurally premature. The holding of the case was that the order striking the notice of deposition and denying the motion to compel the plaintiff to appear for a deposition was reversed. The notice of deposition was reinstated and the motion seeking to compel the plaintiff to appear for a deposition was granted, as the insurance company had preserved its defense of lack of medical necessity and the notice of deposition did not constitute an unreasonable annoyance, cause unnecessary expense, or otherwise prejudice the plaintiff.

The main issue in this case was whether a declaratory judgment action brought by the defendant in the Supreme Court, Nassau County had preclusive effect in the instant no-fault action. The defendant sought summary judgment dismissing the complaint in the case at bar on the ground that the action was barred by the doctrines of res judicata and collateral estoppel by virtue of the March 2010 Supreme Court order in the declaratory judgment action. However, the appellate court held that the March 2010 Supreme Court order in the declaratory judgment action cannot be considered a conclusive final determination and, thus, can have no preclusive effect in the instant no-fault action. The order, insofar as appealed from, was affirmed.

The court considered the facts surrounding a motor vehicle accident in which the plaintiff's assignor was injured while riding in a vehicle insured by a New Jersey automobile insurance policy issued by the defendant. Plaintiff filed a lawsuit to recover first-party no-fault benefits for services rendered to its assignor, alleging that its claims were unpaid. The main issues decided were whether New Jersey law and the insurance policy in question required arbitration, and whether the court had jurisdiction over the case. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied, as the court found that the case was properly before the court and that arbitration was not required under New Jersey law.

The court considered the case of Natural Therapy Acupuncture, P.C. v Geico Ins. Co., where plaintiff's assignor was injured in a motor vehicle accident while riding in a vehicle insured by a New Jersey automobile insurance policy issued by the defendant. Plaintiff sought to recover first-party no-fault benefits for the services it had rendered to its assignor, alleging that its claims were unpaid. Defendant argued that New Jersey law and the insurance policy required arbitration and that the case was not properly before the court as it had no jurisdiction. The main issue decided was whether the matter should be submitted to arbitration under New Jersey law and the insurance policy, and whether the court had jurisdiction. The holding was that the defendant's cross motion for summary judgment dismissing the complaint was denied, and the court affirmed the order with modifications.

The court considered an appeal from an order in a case where Prepetit Medical, P.C. sought to recover assigned first-party no-fault benefits from Allstate Insurance Company. The main issue was whether the lower court properly granted the branch of defendant's motion seeking to compel the plaintiff to appear for a deposition. The court's holding was that the order, insofar as appealed from, is affirmed, with $25 costs. This decision was based on the reasoning and decision in a previous case involving similar circumstances, Farshad D. Hannanian, M.D., P.C. v Allstate Ins. Co., and was supported by the concurring judges.