No-Fault Case Law

The court considered the fact that the plaintiffs were appealing from an order of the Civil Court which denied their motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the affidavit in support of the plaintiffs' motion had established that the bills at issue had not been timely denied or that the defendant had issued timely denials of claim that were conclusory, vague, or without merit as a matter of law. The decision was that the affidavit in support of the plaintiffs' motion had failed to establish their prima facie entitlement to summary judgment, and therefore, the order denying their motion for summary judgment was affirmed.

The relevant facts considered in this case were that defendant, GEICO Ins. Co., denied the plaintiff's claims for no-fault benefits on the grounds that the claims exceeded the amount permitted by the workers' compensation fee schedule. The main issue decided in this case was whether or not the denial of the claims by the defendant was proper. The Court held that the denial of the claims by the defendant was proper, as they had sufficiently established the timely mailing of the denial of claim forms and had used the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive. Therefore, the Court reversed the order granting the plaintiff's motion for summary judgment and denied the motion.

The court considered the fact that the defendant insurer timely and properly mailed its initial and follow-up verification demands to the plaintiff medical provider at the listed street address. The plaintiff's third-party biller, Spendan Service Corp., claimed that it did not receive the verification demands, but did not meaningfully challenge the procedures followed by the defendant in mailing the demands or deny its receipt of the demands. The main issues decided were whether the plaintiff's claim for assigned first-party no-fault benefits should be dismissed, and whether the verification demands were effectively mailed to the plaintiff's authorized representative. The holding was that summary judgment dismissal of the plaintiff's claim for assigned first-party no-fault benefits was warranted, as the plaintiff failed to make any showing that the verification demands were not received by the billing entity due to the absence of its suite number or otherwise. The court reversed the order, granted the defendant's motion for summary judgment, and dismissed the complaint.

The court considered the fact that the plaintiff's third-party biller acknowledged receipt of the defendant's follow-up verification demand, but failed to explain why it took no responsive action. In addition, the plaintiff neither claimed nor showed that it responded in any way to the defendant's properly issued verification demands. The main issue decided was whether the defendant-insurer's motion for summary judgment dismissing the first-party no-fault action should be granted. The holding was that the defendant's motion for summary judgment dismissing the complaint was granted, and the complaint was dismissed.

The court considered the residence of the insured and his family as the relevant facts in this case. The main issue decided was whether the insured fraudulently procured insurance coverage by falsely listing a different residence on the insurance application. The court held that the standard for determining residency for insurance coverage requires some degree of permanence and intention to remain, and that the insured's mere intention to reside at a certain premises was not sufficient. The court found that the insured fraudulently listed a different residence on the insurance application, and that the plaintiff, as the assignee standing in the shoes of the insured, failed to raise a triable issue of fact. Therefore, the court reversed the lower court's order denying the defendant's motion for summary judgment and granted the motion, dismissing the complaint.

The court considered an appeal from an order of the Civil Court of the City of New York denying the plaintiff's motion for summary judgment and granting the defendant's cross motion to compel discovery pursuant to CPLR 3124. The main issue decided in this case was whether the defendant properly substantiated its allegations of fraudulent incorporation in order to warrant disclosure. The holding of the court was that the defendant did properly substantiate its allegations, and therefore, the Civil Court did not improvidently exercise its discretion in denying the plaintiff's motion for summary judgment and granting the defendant's cross motion to compel disclosure. The order was affirmed by the court, and the plaintiff's remaining contentions on appeal were found to lack merit.

The court considered the fact that the defendant had timely mailed requests and follow-up requests for verification for the first-party no-fault benefits. The main issue decided was whether the defendant had received the requested verification, and if the 30-day period within which the defendant was required to pay or deny the claims had begun to run. The holding of the case was that the defendant demonstrated it had not received the requested verification, and the plaintiff did not show that such verification had been provided to the defendant prior to the commencement of the action. Consequently, the court held that the plaintiff's action was premature, and the defendant's motion for summary judgment dismissing the complaint was granted.

The court considered the denial of first-party no-fault benefits by GEICO Insurance to Flushing Traditional Acupuncture. The main issue in the case was whether GEICO had timely mailed denial of claim forms and whether they had fully paid for the services in accordance with the workers' compensation fee schedule. The holding of the court was that the denial of the claims for services rendered from March 31, 2009 to September 24, 2009 was valid and that GEICO had fully paid plaintiff for those services in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. Additionally, the court held that the claims for services rendered on September 25, 2009 were also validly denied based on an independent medical examination, and that GEICO's cross motion for summary judgment was granted, reversing the judgment in favor of Flushing Traditional Acupuncture.

The court considered the fact that in an action by a provider to recover assigned first-party no-fault benefits, the defendant moved for summary judgment dismissing the complaint and the plaintiff cross-moved for summary judgment. The main issue decided was whether the defendant's denial of claim form had been timely mailed, and if so, whether the plaintiff was otherwise entitled to judgment. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was granted, as the affidavit executed by the defendant's litigation examiner demonstrated that the denial of claim form had indeed been timely mailed, and the plaintiff did not challenge the finding that the defendant was otherwise entitled to judgment. Therefore, the defendant's motion was granted and the plaintiff's complaint was dismissed.

The relevant facts considered by the court in Hollis Med. Servs., P.C. v GEICO Ins. Co. included an action by a medical services provider to recover assigned first-party no-fault benefits. The main issue decided was whether the affidavit by defendant's employee was sufficient to establish that the denial of claim forms had been timely mailed. The holding of the case was that the affidavit by the defendant's employee was indeed sufficient to establish that the denial of claim forms had been timely mailed, and that the defendant had submitted enough evidence to support their position. As a result, the court granted the defendant's cross motion for summary judgment and dismissed the complaint, reversing the judgment and vacating the previous order.