No-Fault Case Law

The main issue in this case was whether the defendant, a Massachusetts-based insurance company, was obligated to pay first-party no-fault benefits to a medical provider for services provided to a patient injured in a motor vehicle accident in New York. The court considered the conflicting interests in tort cases with multi-state contacts and ultimately decided to apply Massachusetts law as dispositive factors weighed in favor of applying Massachusetts law. The court held that the defendant did not sufficiently prove that the insured breached the duty to cooperate or that the insurer suffered actual prejudice due to lack of cooperation. Additionally, the court found that the insurer's reservation of rights letter was vague and ambiguous and that there was no evidence of the insurer's diligence and good faith in obtaining the insured's cooperation. Therefore, the plaintiff's motion and the defendant's cross motion were both denied.

The relevant facts of this case included a medical provider seeking to recover first-party no-fault benefits and the insurance company denying the claims due to the assignor's failure to attend scheduled independent medical examinations and provide requested documentary verification. The main issue decided in this case was whether the insurance company was entitled to summary judgment dismissing the claims. The holding of the case was that the insurance company failed to establish that the assignor had not appeared for scheduled IMEs, and also failed to establish that the claims for services provided by the assignor were premature. The court determined that the insurance company did not meet its burden of proof and held that the medical provider did not establish its prima facie case, therefore modifying the lower court's decision to strike the provision implicitly finding that the medical provider had established its case.

The main issue in Eagle Surgical Supply, Inc. v GEICO Gen. Ins. Co. was whether the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs). The appellate court found that the defendant failed to meet its burden at trial, as it did not submit evidence from a person with personal knowledge of the alleged nonappearances. Consequently, the judgment dismissing the complaint was reversed, and the matter was remitted to the Civil Court for the entry of a judgment in favor of the plaintiff in the principal sum of $918.75, plus statutory interest and attorney's fees. The appellate court found in favor of the plaintiff, stating that the defendant did not establish that the assignor had failed to appear for the scheduled IMEs.

This legal case involves a dispute between All Borough Group Medical Supply, Inc., the assignee of Joyce Glover, and GEICO Insurance Company. The case involves a nonjury trial where the Civil Court denied plaintiff's motions to admit into evidence some of plaintiff's documents, and ultimately, found in favor of the defendant. After presenting the relevant facts, the court held that the plaintiff had properly laid a foundation for the admissibility of its assignment of benefits form. The court also found that the plaintiff's delivery receipt and claim form should have been admitted into evidence because it was plaintiff's regular business practice to make such records. As a result, the judgment was reversed, the complaint was reinstated, and the matter was remitted to the Civil Court for a new trial.

The relevant facts considered by the court were that the plaintiff, Calvin Alford, was a pedestrian struck by a vehicle insured by Fiduciary Insurance Company of America (Fiduciary Ins.) in February 2009. Plaintiff attempted to obtain the identity of the vehicle that struck him but was unable to do so until June 1, 2009. Plaintiff filed a timely application for benefits with the Motor Vehicle Accident Indemnification Corporation (MVAIC) in April 2009 and continued his efforts to discover the identity of the vehicle. Fiduciary Ins. denied plaintiff's claim due to late notice and failure to provide written proof of the claim. Plaintiff filed a motion for summary judgment against Fiduciary Ins. declaring that they must provide no-fault benefits to him, while Fiduciary Ins. cross-moved for summary judgment dismissing the summons and complaint. The main issue decided by the court was whether Fiduciary Ins. was obligated to provide no-fault benefits to the plaintiff despite the late notice and failure to provide written proof of the claim. The court held that plaintiff was entitled to summary judgment as a matter of law. Plaintiff's notice of claim was technically late, but the court found that he was entitled to consideration due to the difficulty in ascertaining the identity of the vehicle that struck him as a pedestrian. The court also found that plaintiff had provided written notice, as requested by Fiduciary Ins., and that Fiduciary Ins.'s denial of the claim was unpersuasive. The court granted plaintiff's motion for summary judgment against Fiduciary Ins. and declared that Fiduciary Ins. must provide no-fault benefits to plaintiff with regards to the February 2009 automobile accident. The court also denied Fiduciary Ins.'s cross-motion for summary judgment.

The main issues in this case involved the denial of first-party no-fault benefits by the defendant and the plaintiff's appeal to compel the defendant to produce its Special Investigation Unit (SIU) file. The court held that the defendant failed to demonstrate that it had decided to deny the plaintiff's claims prior to commencing its investigation, making the contents of the defendant's SIU file discoverable. Additionally, the court ruled that the defendant was not entitled to any discovery regarding whether the plaintiff was in compliance with applicable state or local licensing laws, as this issue was previously resolved in a stipulation and not actually litigated. However, the court also determined that the plaintiff was obligated to produce the requested information and that the defendant was entitled to depose specific individuals. Therefore, the order was modified to grant the branch of the plaintiff's motion seeking to compel the defendant to produce its SIU file.

The relevant facts the court considered in the case were that Bright Medical Supply Co. was seeking to recover first-party no-fault benefits, but the defendant had denied the claims based on the plaintiff's failure to appear for scheduled examinations under oath. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the case was that the defendant's motion was properly denied because they failed to submit proof from someone with personal knowledge of the plaintiff's nonappearance for the examinations under oath. Therefore, the order denying the defendant's motion was affirmed.

The court considered the fact that the defendant, Tri State Consumer Ins. Co., had moved for summary judgment dismissing the complaint brought by Bright Medical Supply Co. as the assignee of Roshel Pakanayev, alleging that it had never received the claim at issue. The main issue decided was whether the plaintiff's opposition to the motion was sufficient to demonstrate proof of proper mailing of the claim form, which would give rise to a presumption of receipt. The court held that the affidavit of defendant's claims representative established that the defendant had never received the claim in question from the plaintiff, and that not only was the plaintiff's opposition to the defendant's motion insufficient to demonstrate proof of proper mailing of the claim form, but the defendant also demonstrated that the address to which the plaintiff had allegedly mailed the claim, a post office box in Philadelphia, was not the defendant's address. Therefore, the court reversed the previous order and granted the defendant's motion for summary judgment dismissing the complaint.

The court considered the denial of a claim for assigned first-party no-fault benefits by Quality Health Products for their assignors Lony Beatris, Francois Stevenson, and Milord Guerson. Defendant GEICO General Insurance Company established the mailing of the denials and the lack of medical necessity for the supplies provided to the assignors. Quality Health Products did not submit any medical evidence to rebut GEICO's prima facie showing of a lack of medical necessity. The court affirmed the judgment which granted the branches of defendant's cross motion seeking summary judgment dismissing the portion of the complaint that sought to recover upon claims for the assignors based on a lack of medical necessity.

According to the fact pattern of the case, a professional corporation provided MRI services for patients injured in car accidents. The corporation then submitted the assigned claims for reimbursement to the responsible insurers and self-insurers, including the defendant, Progressive Insurance Company (Progressive), which after failing to pay the claims, led to the commencement of a lawsuit. The total amount sought for the claims in all of these actions was approximately $18 million. The defense asserted was that the professional corporation was ineligible to recover no-fault benefits due to its failure to comply with licensing requirements. After a joint trial, a jury returned a verdict in favor of all defendants, and the Civil Court denied the plaintiff's motion to set aside the verdict. The Holding was that the court affirmed the judgment of the Civil Court without costs, in favor of the defendant, Progressive.