No-Fault Case Law

The relevant facts of the case were that D & R Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits and appealed from an order that denied its motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided in this case was whether the provider was entitled to recover assigned first-party no-fault benefits. The holding of the court was that the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment was affirmed, with $25 costs. This decision was based on the reasons stated in a previous case, D & R Med. Supply v American Tr. Ins. Co., where similar issues were decided.

The court considered the untimely request for additional verification from the defendant, in the form of an examination under oath (EUO) of the plaintiff medical provider. The main issue decided was whether the defendant's request for additional verification was untimely and did not serve to toll the defendant's time to pay or deny the claim. The holding of the case was that the denial of the defendant's motion for summary judgment dismissing the first-party no-fault action was sustained because the request for additional verification was made well beyond the requisite 15-day time period following the assignor's EUO, as per 11 NYCRR 65-3.5[b] and 65—3.8[a][1]. Therefore, the denial of the defendant's motion was affirmed, and the decision and order of the court constituted the final ruling.

The relevant facts considered by the court in this case involved a dispute between Sutter Medical Care P.C. and Progressive Casualty Ins. Co. regarding the provider's entitlement to no-fault benefits under New York law. Progressive had commenced a declaratory judgment action against Sutter Med in the Supreme Court, Nassau County, alleging that Sutter Med had failed to satisfy conditions precedent to Progressive's obligation to cover a series of no-fault claims. Sutter Med failed to answer the declaratory judgment complaint, and a default judgment was entered in favor of Progressive. Sutter Med then commenced a series of no-fault lawsuits against Progressive in the District Court, Nassau County, seeking payment of no-fault benefits. Progressive moved for summary judgment dismissing each of those cases on the ground that each lawsuit was barred by the default judgment rendered in the declaratory judgment action. The main issue decided was whether the lawsuits were barred by the default judgment, and the holding of the court was that defendant's motion was granted, and the complaint was dismissed. In summary, the court considered the default judgment entered in the declaratory judgment action, the failure of Sutter Med to contest the allegations made by Progressive, and the claims for medical services rendered to Atisha Grant under a specific claim number. The main issue decided was whether the default judgment precluded Sutter Med from pursuing its claims for no-fault benefits in the subsequent lawsuits, and the holding was that defendant's motion for summary judgment was granted, and the complaint was dismissed.

The main issue decided in this case was whether the defendant was entitled to summary judgment based on the plaintiff's failure to submit to two properly scheduled Examinations Under Oath (EUO), which is a condition precedent to insurance coverage. The court held that the defendant properly sought the EUO of the treating physician and that the notices and denials were timely received by the plaintiff. The court also found that the lack of certified mail receipts was insignificant, and that the certificates of conformity were admissible despite lacking the words "under penalty of perjury". The court ultimately granted the defendant's motion for summary judgment and dismissed the complaint with prejudice.

The relevant facts considered by the court in this case were that Flatlands Medical, P.C. was seeking to recover assigned first-party no-fault benefits, but the defendant, State Farm Mutual Automobile Ins. Co., moved to dismiss the complaint based on the plaintiff's failure to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the plaintiff had failed to satisfy a condition precedent to coverage by not appearing for the scheduled EUOs. The court ultimately held that the defendant had established that the EUO scheduling letters had been timely mailed and that the plaintiff had failed to appear at the scheduled EUOs, thus failing to satisfy a condition precedent to the defendant insurer's liability on the subject policy. As a result, the court affirmed the order, dismissing the complaint.

The court was considering an appeal from an order granting a motion to dismiss the complaint of a provider seeking to recover assigned first-party no-fault benefits. The order compelled the plaintiff to respond to the defendant's discovery demands. Subsequent to this order, the Civil Court entered another order dismissing the complaint, which made the appeal academic. The main issue of the case was whether the dismissal of the complaint made the appeal moot. The holding of the court was that the dismissal of the complaint rendered the appeal academic, and therefore, the appeal was dismissed.

The relevant fact considered by the court was that a no-fault provider was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the provider demonstrated its prima facie entitlement to summary judgment by proving the submission of a claim form, proof of the amount and fact of the loss sustained, and the failure of the defendant to pay or deny the claim within the requisite 30-day period. The holding of the case was that the provider failed to demonstrate that the defendant had failed to deny the claim or that the denial of the claim was legally insufficient, thus granting summary judgment to the defendant and dismissing the complaint.

The case involved a chiropractic office, Axis Chiropractic, attempting to recover assigned first-party no-fault benefits from Geico General Insurance Company. Axis Chiropractic appealed an order from the Civil Court which denied their motion for summary judgment and granted Geico’s cross motion for summary judgment. Geico had submitted an affidavit and independent medical examination (IME) reports that supported their denial of the claim based on lack of medical necessity. Axis Chiropractic failed to submit an affirmation or affidavit from a medical professional to rebut the IME reports, and therefore did not raise a triable issue of fact. As a result, the judgment to dismiss the complaint was affirmed by the court.

The relevant facts considered by the court were that plaintiff, as an assignee of an individual, was seeking to recover first-party no-fault benefits from defendant. Plaintiff's motion for summary judgment was denied and defendant's cross motion for summary judgment was granted, resulting in the dismissal of the complaint. The main issue decided by the court was whether defendant timely mailed denial of claim forms and whether there was a lack of medical necessity for the services rendered. The holding of the court was that defendant had timely mailed the denial of claim forms and had provided an affirmed independent medical examination report setting forth a basis and medical rationale for the determination of lack of medical necessity. In addition, the court held that plaintiff failed to raise a triable issue of fact by not submitting evidence rebutting the conclusions set forth in the independent medical examination report, and therefore the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment was proper.

The relevant facts considered by the court were that defendant had timely mailed denial of claim forms which denied the claims on the ground of lack of medical necessity, and had submitted an independent medical examination (IME) report which provided a factual basis and medical rationale for the determination by defendant's chiropractor that there was a lack of medical necessity for the services rendered. The main issue decided by the court was whether plaintiff raised a triable issue of fact in opposition to defendant's cross motion for summary judgment dismissing the complaint. The holding of the court was that in opposition to defendant's motion, plaintiff failed to raise a triable issue of fact, as it did not submit an affirmation or an affidavit from a medical professional rebutting the conclusions set forth in the IME report, so the Civil Court's grant of defendant's cross motion for summary judgment dismissing the complaint was proper.