No-Fault Case Law

The court considered a motion for summary judgment made by the defendant, an insurance company, to dismiss a complaint brought by the plaintiff, an acupuncture clinic, for first-party no-fault benefits. The insurance company established that it had timely and properly mailed notices for independent medical examinations (IMEs) to the plaintiff's assignor, and that the assignor failed to appear for the examinations. The plaintiff did not specifically deny the assignor's nonappearance or raise a triable issue with respect to the mailing or reasonableness of the notices. Therefore, the court held that the insurance company had the right to deny all claims retroactively to the date of loss, regardless of whether the denials were timely issued, and affirmed the lower court's decision to grant the insurance company's motion for summary judgment.

The Court considered the appeal from an order and subsequent judgment of the Civil Court which granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was that the branches of plaintiff's motion seeking summary judgment on the first through thirteenth causes of action should have been denied, and the branches of defendant's cross motion for summary judgment seeking to dismiss those causes of action should have been granted. However, the Court did not disturb the branches of the order that granted the branch of plaintiff's motion seeking summary judgment on the 14th cause of action and denied the branch of defendant's cross-motion seeking summary judgment dismissing that cause of action. The holding of the case was that the judgment was reversed and the matter was remitted to the Civil Court for the entry of judgment in favor of the defendant dismissing the first through thirteenth causes of action and in favor of the plaintiff on the fourteenth cause of action following a calculation of statutory interest and an assessment of attorney's fees.

The court considered the appeal from an order of the Civil Court of the City of New York, Kings County. The order denied the defendant's cross motion for summary judgment dismissing the complaint brought by Clinton Place Medical, P.C. as the assignee of Jorge Done, seeking to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The main issue was whether the denial of claim forms had been timely mailed in accordance with defendant's standard mailing practices and procedures, as the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The court held that the denial of claim forms had been timely mailed in accordance with the defendant's mailing practices, and as the plaintiff had not challenged the finding that the defendant was otherwise entitled to judgment, the order was reversed and the defendant's cross motion for summary judgment dismissing the complaint was granted.

The court considered a dispute over a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issue to be decided was whether the insurance company timely denied the plaintiff's claims, after the plaintiff's assignor failed to appear for scheduled medical exams. The court held that there was a question of fact as to whether the insurance company timely denied the claims, and that such a defense is subject to preclusion if the denials were untimely. The court affirmed the lower court's order, which denied the insurance company's cross motion for summary judgment dismissing the complaint.

The main issue in this case is whether the defendant, GEICO General Insurance Company, properly denied a claim for first-party no-fault benefits based on a lack of medical necessity. The court considered the evidence presented by both parties and found that there is a triable issue of fact regarding the medical necessity of the services at issue. Therefore, the court reversed the order granting the defendant's cross motion for summary judgment and denied the motion to dismiss the complaint. The holding of the case is that there is a triable issue of fact regarding the medical necessity of the services, and as a result, the defendant's cross motion for summary judgment dismissing the complaint was denied.

The court considered the motion for summary judgment by the defendant to dismiss the complaint brought by a provider seeking first-party no-fault benefits. The defendant argued that the claims at issue were properly denied based on the plaintiff's failure to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the defendant's motion for summary judgment should be granted. The court held that the defendant's motion was properly denied because they failed to submit proof by someone with personal knowledge of the plaintiff's nonappearance for the EUOs in question. Therefore, the order denying defendant's motion was affirmed.

The court considered an appeal from an order of the Civil Court which granted the defendant's motion for summary judgment dismissing the complaint in an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the denial of claim form had been timely mailed, and the plaintiff contended that the affidavits and documents submitted by the defendant were not sufficient to establish this. However, the court held that the affidavits and documents submitted by the defendant were indeed sufficient to establish that the denial of claim form had been timely mailed. The judgment was affirmed.

The case involved the New York University Hospital-Tisch Institute filing a lawsuit to recover no-fault benefits from the Government Employees Insurance Company under two insurance contracts. The Supreme Court initially denied the plaintiffs' motion for summary judgment on the first cause of action. Upon reargument, the court vacated its determination and granted summary judgment for the plaintiffs. The main issue to be decided was whether the defendant raised a triable issue of fact in opposition to the plaintiffs' motion for summary judgment. The court held that the defendant did raise a triable issue of fact, as the evidence submitted demonstrated that it received the responses to its requests for additional verification within the requisite time period and subsequently denied the claim within the 30-day period after issuing the last verification request. Therefore, the Supreme Court's initial denial of that branch of the plaintiffs' prior motion for summary judgment on the first cause of action was adhered to.

The relevant facts considered by the court were that the plaintiff, New Way Medical Supply Corp., was seeking to recover first-party no-fault benefits from defendant GEICO Insurance Co. The plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment dismissing the complaint, based on a lack of medical necessity. The main issue decided by the court was whether there was a lack of medical necessity for the supplies at issue. The holding of the court was that the defendant's cross-motion for summary judgment dismissing the complaint was granted, as the plaintiff did not rebut the defendant's showing of lack of medical necessity, and did not submit any medical evidence in support of its motion for summary judgment. Therefore, the CPLR 3212 (g) findings in favor of the plaintiff were vacated and the defendant's cross-motion was granted.

The court considered an action by a provider to recover assigned first party-no-fault benefits. Defendant appealed from an order of the Civil Court that denied defendant's cross motion for summary judgment dismissing the complaint. The court decided that the branches of defendant's cross motion seeking summary judgment dismissing claims based on the workers' compensation fee schedule should have been granted as defendant timely denied the claims at issue and demonstrated that its denial was based on the fee schedule. Additionally, the court found that defendant had properly denied plaintiff's claim in accordance with the workers' compensation fee schedule because the claim was contrary to Physical Medicine Ground Rule 11. However, the court also held that plaintiff had raised a triable issue of fact as to the medical necessity of the remaining claims, thus modifying the order to provide that the branches of defendant's cross motion seeking summary judgment dismissing the unpaid portion of plaintiff's $1,291.96 claim should also be granted.