No-Fault Case Law

The court considered the fact that the defendant had timely mailed its initial and follow-up requests for verification to the plaintiff, in accordance with insurance department regulations. The plaintiff's office manager denied receiving the verification requests, but this did not overcome the presumption that the proper mailing had occurred. Since the plaintiff did not serve responses to the verification requests prior to the commencement of the action, the defendant's motion for summary judgment dismissing the complaint should have been granted. The main issue decided was whether the defendant had followed proper procedures in mailing the verification requests and whether the plaintiff's denial of receipt was enough to overcome the presumption of proper mailing. The holding of the court was that the order denying the defendant's motion for summary judgment was reversed, and the defendant's motion for summary judgment dismissing the complaint was granted.

The court considered the denial of claim forms by the defendant and whether they were sufficient to preserve the defendant's fee schedule defense. The main issue was whether the defendant had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. The court held that while the denial of claim forms were sufficient to preserve the defendant's fee schedule defense, there were triable issues of fact as to whether the defendant had fully paid the plaintiff for the services in accordance with the fee schedule. Therefore, the court denied the defendant's motion for summary judgment and modified the order accordingly.

The court considered an appeal and cross-appeal from an order of the Civil Court of the City of New York related to an action by a provider to recover assigned first-party no-fault benefits. The court denied the plaintiff's motion for summary judgment and also denied the defendant's cross motion for summary judgment on various causes of action. The main issues decided were whether the denial of certain claims based on the plaintiff's assignor's failure to appear for scheduled examinations under oath was untimely and whether the defendant's denial of receipt of certain claims was sufficient to rebut the presumption of receipt established by the plaintiff's proof of mailing. The holding was that the plaintiff's motion for summary judgment was granted, and the matter was remitted to the Civil Court for a calculation of statutory interest and an assessment of attorney's fees.

The main issues considered in this case were whether an insurance company was justified in denying first-party no-fault benefits due to the failure of the provider to appear for scheduled examinations under oath (EUOs). The court ultimately decided that the insurance company was justified in denying the benefits, as it had demonstrated that the provider had failed to comply with a condition precedent to coverage. The court reversed the judgment, vacated part of the order, and granted the insurance company's motion to dismiss the portion of the complaint seeking to recover $501.50, as the provider had failed to comply with the scheduled EUOs and there was no need for the insurance company to issue new scheduling letters for this particular bill.

The court considered the appeal of a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the services rendered by the provider were medically necessary. The court held that the provider did not raise a triable issue of fact as to the medical necessity of the psychological testing at issue. The provider's submission of a letter of medical necessity and prior trial testimony of a doctor did not meaningfully refer to, let alone rebut, the conclusions of the insurance company's psychologist. As a result, the judgment granting the insurance company's motion for summary judgment and dismissing the complaint was affirmed.

The main issue in Compas Med., P.C. v Praetorian Ins. Co. was the awarding of first-party no-fault benefits to the provider, Compas Medical, P.C. as Assignee of Michael Odus. The Court considered the motion for summary judgment by the plaintiff and cross motion for summary judgment dismissing the complaint by the defendant. The Court found that the defendant had timely requested verification from the plaintiff for certain claims, which had not been provided, making those causes of action premature. Additionally, the Court found that the plaintiff's assignor had failed to appear for duly scheduled IMEs, and the denial of claim forms had been timely mailed by the defendant. As a result, the judgment was reversed and the plaintiff's motion for summary judgment was denied, while the defendant's cross motion for summary judgment was granted.

The relevant facts considered by the court in this case were that Quality Psychological Services, P.C., as an assignee of Tanisha Mighten, was seeking to recover assigned first-party no-fault benefits from Metropolitan Casualty Insurance Company. The main issue decided by the court was whether defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the court was that defendant's motion for summary judgment was denied, as they failed to establish that the scheduled examinations under oath (EUOs) had been properly scheduled and mailed prior to the dates of the scheduled EUOs. Therefore, the court affirmed the order denying defendant's motion for summary judgment.

The court considered the evidence presented by both the plaintiff and defendant in a case where Compas Medical, P.C. was suing Praetorian Ins. Co. to recover assigned first-party no-fault benefits. The main issues decided were whether the defendant had timely scheduled independent medical examinations and whether the plaintiff had provided the requested verification for certain claims. The holding of the case was that the judgment was reversed, and the branches of defendant's cross motion seeking summary judgment dismissing plaintiff's first, third, fourth, fifth, sixth, seventh and ninth causes of action were vacated. Plaintiff's motion was denied, and those branches of defendant's cross motion were granted. The court found that the defendant had provided sufficient evidence to support its position that IME scheduling letters had been timely mailed and that the plaintiff had failed to provide requested verification for certain claims. However, the defendant failed to address certain causes of action, so summary judgment was not granted in those instances.

The case involves an appeal from a provider seeking to recover assigned first-party no-fault benefits. The court considered whether the services rendered were medically necessary and if the provider had established its prima facie case. The court found that the provider had raised a triable issue of fact as to the medical necessity of the services through the submission of an affirmation by a medical doctor. However, the court also found that the provider's cross motion failed to establish its prima facie case as the affidavit submitted did not prove that the claims had not been timely denied or that the denials were conclusory, vague, or without merit. As a result, the court modified the order by denying the defendant's motion for summary judgment to dismiss the complaint. The holding of the court was that the defendant's motion for summary judgment was denied.

The main issue in this case was whether the defendant insurer had timely denied the plaintiff's claims on the grounds of lack of medical necessity, and whether the defendant had provided sufficient proof to establish this defense. The appellant, Jamaica Medical Supply, Inc., argued that the defendant failed to provide proof in admissible form to establish its defense of lack of medical necessity due to the use of electronic stamped facsimiles of the peer reviewers' signatures on affirmations executed by the peer review physicians. However, the court held that the affidavit submitted by the defendant established the timely mailing of the denial of claim forms, and that the defendant had submitted peer review reports as well as affirmations executed by the physicians who had performed the peer reviews, which set forth a factual basis and medical rationale for the conclusion that there was no medical necessity for the medical supplies at issue. Therefore, the judgment of the Civil Court, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment, was affirmed.