No-Fault Case Law

The court considered that plaintiff filed for leave to enter a default judgment against defendants, each of which made claims for services rendered to Naz and Tahir as a result of the alleged accident. The main issue decided was whether plaintiff had sufficient proof to enter a default judgment against all defendants. The holding was that the Supreme Court denied the motion with respect to Bushra Naz, Cliffside Park Imaging & Diagnostic Center and Kimba Medical Supply, LLC, and otherwise granted the motion. The court determined that plaintiff submitted sufficient proof of the facts constituting its claim and also submitted proof of default in the form of an affirmation from its attorney regarding the defendant's default in appearing and answering. However, the plaintiff failed to prove service of the summons properly with respect to Bushra Naz and Kimba Medical Supply, LLC.

The main issue that was decided in this legal case was whether the arbitration award of the arbitrator Thomas should be vacated, as petitioned by New Century Acupuncture, P.C. The court considered the grounds for vacating an arbitration award as set forth in CPLR § 7511 (b)(1), and the limited review grounds of CPLR §7511 that apply to a no-fault arbitration award. The main holding of the case was that the court found no basis for disturbing the award and therefore denied the petitioner's motion to vacate the award. The court confirmed the award and allowed the respondent to enter judgment pursuant to CPLR § 7514. The court rejected the petitioner's argument that the arbitrator improperly applied the "preponderance" standard of proof to the respondent's defense and affirmed the arbitrator's report in its entirety. The petitioner's motion, based on various grounds, was ultimately denied.

The main issue in this case was whether the defendant-insurer was entitled to summary judgment dismissing the first-party no-fault claims of plaintiff L.N.L. Physical Therapy Rehabilitation in the amount of $2,220. The defendant made a prima facie showing of entitlement to summary judgment by establishing that it timely denied the claims based on the independent medical examination report and follow-up report of its examining orthopedic doctor. In opposition, the plaintiff failed to raise a triable issue, as the affidavit of plaintiff's treating physical therapist failed to meaningfully address the contrary findings made by the defendant's examining doctor. The court ultimately held that the defendant's motion for summary judgment was granted and the no-fault claims of plaintiff L.N.L. Physical Therapy Rehabilitation in the amount of $2,220 were dismissed.

The case Metro Health Products, Inc. v Nationwide Ins. involved a dispute over first-party no-fault benefits for medical supplies provided to an individual injured in an automobile accident. Defendant insurer sought a declaration in Supreme Court that they were not obligated to pay any of the outstanding claims. The Supreme Court granted their motion for a default judgment due to a lack of opposition from plaintiff. However, the court determined that the order did not make a conclusive final determination and therefore had no preclusive effect on the instant no-fault action. Plaintiff had failed to demonstrate their prima facie entitlement to summary judgment as they did not establish that the claims at issue had not been timely denied. As a result, the court modified the order to provide that defendant's cross motion for summary judgment dismissing the complaint is denied.

The court considered a motion for summary judgment by the defendant-insurer to dismiss the plaintiff's no-fault claims for acupuncture treatment rendered to the plaintiff's assignor. The defendant submitted an independent medical examination (IME) report of its examining acupuncturist, which concluded that no further acupuncture treatment was medically necessary. The plaintiff's opposing submissions, consisting of an attorney's affirmation and the report of its examining doctor, did not address the medical necessity of the acupuncture services rendered. The court ruled that the defendant made a prima facie showing of entitlement to summary judgment dismissing the claims for acupuncture services. However, the court also ruled that the conflicting medical expert opinions submitted by the parties raised a triable issue as to the medical necessity of the remaining medical services underlying the plaintiff's claims. The holding of the case was that the defendant was granted partial summary judgment dismissing the portion of the claims seeking reimbursement for acupuncture services, and the matter was remanded for further proceedings to determine the amount of the claims for acupuncture services. The defendant's motion for summary judgment dismissing the remaining no-fault claims was denied, and the case was remanded for further proceedings.

The relevant facts considered in this case included a declaratory judgment action instituted by the defendant, and a Supreme Court order that granted a default judgment against the plaintiff's assignor and various medical providers. The plaintiff sought to recover for supplies provided to the assignor for injuries sustained in a motor vehicle accident, but the defendant argued that a prior Supreme Court order barred the instant action under the doctrines of res judicata and collateral estoppel. The main issue decided was whether the instant action was barred by the prior Supreme Court order. The holding of the case was that the Civil Court correctly determined that the instant action was barred under the doctrine of res judicata by virtue of the prior Supreme Court order, and therefore, 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 relevant facts of this case involved a medical provider, Viviane Etienne Medical Care, P.C., seeking no-fault insurance benefits from an insurance company, Country-Wide Insurance Company, for services provided to an individual involved in a car accident. The insurer failed to respond to most of the claims submitted and denied payment on one claim, citing lack of proper proof of loss. The medical provider moved for summary judgment, arguing that it had demonstrated that payment of benefits was overdue. The main issue decided in this case was what proof a medical provider must provide to demonstrate entitlement to summary judgment in a no-fault insurance action. The court held that a plaintiff demonstrates entitlement to summary judgment by submitting evidence that payment of no-fault benefits are overdue, and proof of its claim, using the statutory billing form, was mailed to and received by the defendant insurer. The court found that the medical provider demonstrated entitlement to summary judgment and affirmed the Appellate Division's decision.

The court considered the fact that New York Diagnostic Medical Care, P.C. was seeking to recover first-party no-fault benefits from Country-wide Insurance Company, but the action was deemed premature because the plaintiff had not provided verification as requested by the defendant. The main issue decided was whether the plaintiff adequately responded to the defendant's verification requests, and the court found that triable issues of fact existed, therefore neither party was entitled to summary judgment. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was denied, and the order was modified accordingly.

The court considered an appeal from an order of the Civil Court of the City of New York denying the plaintiff's motion for summary judgment and granting the defendant reverse summary judgment dismissing the complaint. The main issue decided was whether there was a triable issue of fact as to whether the claims at issue had been submitted to the defendant. The holding of the case was that on the record before them, the court found that there was a triable issue of fact as to whether the claims had been submitted to the defendant, and therefore, neither party was entitled to summary judgment. The court modified the order by striking the provision which granted the defendant reverse summary judgment dismissing the complaint.

The court considered whether the defendant had timely and properly denied first-party no-fault benefits claims based on the plaintiff's assignor's failure to appear for examinations under oath (EUOs). The main issue was whether the defendant had demonstrated that the EUO scheduling letters had been timely mailed and that the assignor had failed to appear for the scheduled EUOs. The court held that the defendant had established that the scheduling letters had been timely mailed and that the assignor had failed to appear for the scheduled EUOs, which was a condition precedent to coverage. Therefore, the defendant was entitled to summary judgment dismissing the complaint. The court affirmed the denial of the plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment dismissing the complaint.