No-Fault Case Law

The main issues in the case involved a provider seeking to recover assigned first-party no-fault benefits. The defendant insurance company had moved for summary judgment dismissing the complaint or, alternatively, for a finding that certain correspondence was timely and valid. They also sought an order compelling the plaintiff to appear for an examination before trial. The Civil Court granted both motions to the extent that the only remaining issues for trial were related to the medical necessity of the services provided and whether the billing was in accordance with the New York State Workers' Compensation Fee Schedule. The court found that the plaintiff had established its prima facie case, and the defendant's motion for summary judgment was properly denied. However, the defendant's motion for an order compelling the plaintiff to appear for an examination before trial was granted, with the examination to be held within 60 days. The Appellate Court affirmed this decision.

The relevant facts that the court considered were that the plaintiff, City Dental Services, P.C., sought to recover first-party no-fault benefits that were assigned to them. The defendant, Country Wide Insurance Company, attempted to file opposing papers almost two months after the stipulated due date, and the court rejected them, granting the plaintiff's motion on default. The main issue decided by the court was whether the defendant should be allowed to "renew and reargue" its opposition to the plaintiff's motion for summary judgment, and whether the previous default order should be vacated. The holding of the court was that the branch of the defendant's motion seeking leave to "renew" its opposition to plaintiff's motion for summary judgment was proper, as the defendant had defaulted in opposing the motion, and their remedy was to seek to vacate the default order. The court also noted that the branch of the plaintiff's motion seeking to vacate the previous order remained pending and undecided.

The court considered the issue of a provider's right to recover assigned first-party no-fault benefits in this case. The main issues decided were whether the denial of claim forms and verification requests had been timely mailed by the defendant, and whether the plaintiff had failed to respond to defendant's verification requests. The court held that the denial of claim forms and verification requests had been timely mailed and that the plaintiff had failed to respond to defendant's requests, entitling the defendant to summary judgment dismissing the complaint. Additionally, the court found that the plaintiff's treating doctor had failed to rebut the conclusions set forth in the peer review reports submitted by the defendant, leading to the granting of summary judgment dismissing plaintiff's first, second and fourth causes of action.

This case involves a motion for summary judgment by Lancer Insurance Company against the insured participants for a motor vehicle accident that the company claims was staged. Lancer sought a default judgment against defendants Torres and Duran, as well as the dismissal of Utopia Equipment's counterclaims for no-fault benefits and attorneys' fees. The court denied Lancer's motion for a default judgment against Torres and Duran because the publication order for serving them did not comply with the requirements of the law. The court also denied Lancer's motion for a declaratory judgment that the accident was staged, stating that the circumstantial evidence presented was not sufficient to meet the burden for summary judgment. Additionally, the court ruled that Utopia had the right to recover attorneys' fees in defending against Lancer's declaratory judgment action, as it had been assigned the right to payment from Torres and Duran prior to the initiation of the action. Therefore, Lancer's motion was denied in its entirety.

The case involved an insurance dispute between Lotus Acupuncture, P.C. and State Farm Mutual Automobile Insurance Company over an examination under oath (EUO). State Farm sent an initial and follow-up EUO request that Lotus failed to comply with. The issue before the court was whether the follow-up request by State Farm was timely. The court interpreted two state regulations, 11 NYCRR 65-3.6 and 65-3.8, which govern the timing of verification requests. While State Farm submitted that other judges had decided the issue contrary to the original determination by the court, the court disregarded these determinations. The court also considered an opinion by the New York State Department of Financial Services, which supported the original conclusion of the court that a follow-up EUO notice must be sent within 10 calendar days of the missed EUO. Therefore, the court adhered to its original determination granting Lotus summary judgment.

The court considered whether the defendant's motion in limine should be granted and if the plaintiff met its prima facie case of entitlement to no-fault benefits at trial. The main issue decided was whether AR Medical Rehabilitation could pursue no fault benefits in a civil action, based on the defendant's contention that the company was a Mallela corporation and its true owners were unauthorized to collect no fault benefits under New York law. The court held that the defendant's motion in limine was denied and that the plaintiff's evidence was insufficient to establish its prima facie case, ultimately awarding a verdict in favor of the defendant. The court found that the defendant failed to demonstrate that AR Medical Rehabilitation was a fruit of a fraudulent scheme and that the plaintiff's witness's testimony was inconsistent and insufficient to lay the foundation necessary to establish the plaintiff's billing documents as business records.

The court considered the defendant-insurer's motion for summary judgment to dismiss a complaint regarding no-fault claims. The main issue decided was whether the insurer made a prima facie showing of entitlement to summary judgment by establishing that it timely and properly mailed notices for independent medical examinations (IMEs) to the plaintiff's assignor, and that the assignor failed to appear. The court held that the defendant-insurer did make a prima facie showing of entitlement to summary judgment by establishing that it timely and properly mailed the IME notices to the plaintiff's assignor, and that the assignor failed to appear. As a result, the court reversed the previous order, granted the motion in its entirety, and dismissed the complaint.

The court considered a provider’s attempt to recover no-fault benefits, with the defendant appealing from an order denying its motion to dismiss the complaint on the grounds that it failed to establish the transactions giving rise to the cause of action. The main issue decided was whether the complaint gave sufficient notice of the transactions intended to be proved, and whether the requisite elements of any cause of action could be discerned from its averments. The holding of the court was that the complaint did state a cognizable cause of action and was sufficient to give the defendant notice of the transactions intended to be proved, and thus the order denying the motion to dismiss was affirmed.

The court considered the case of Alrof, Inc. v Safeco Natl. Ins. Co., in which the plaintiff, Alrof, Inc., sought to recover first-party no-fault benefits from the defendant, Safeco National Insurance Company. The main issue before the court was whether the defendant's argument that the plaintiff failed to appear at a properly noticed examination under oath (EUO) was supported by admissible evidence. The court held that a conclusory statement from an attorney lacking personal knowledge was insufficient to support the defendant's cross motion for summary judgment. Additionally, the court found that an alleged noncompliance with an EUO must be established by admissible evidence. Ultimately, the court affirmed the order granting the plaintiff's motion for summary judgment and denying the defendant's cross motion.

The court considered an action by a provider to recover assigned first-party no-fault benefits. Plaintiff appealed from an order of the Civil Court which denied its motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant's denial of the claim was conclusory, vague, or without merit as a matter of law, and whether the denial was supported by a factual basis and medical rationale for the lack of medical necessity for the services rendered to the three assignors. The holding of the court was that the defendant was not entitled to summary judgment dismissing the claim for services rendered to Jeannette Lugaro, but that the branches of defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claims of the other three assignors were properly granted.