No-Fault Case Law

The main issues in the case involved a no-fault provider's entitlement to recover assigned first-party benefits, and whether the defendant had timely denied the claims based on a lack of medical necessity. The court considered whether the plaintiff had submitted proof of the submission to the defendant of a claim form, proof of the fact and the amount of the loss sustained, and proof that the defendant had failed to pay or deny the claim within the requisite 30-day period. The court also addressed whether the defendant had timely denied the plaintiff's claim for a specific amount, and if the plaintiff had established its prima facie entitlement to summary judgment. The holding was that the order denying the branch of plaintiff's motion seeking summary judgment on the complaint insofar as it sought to recover upon plaintiff's claim for $879.73 was reversed, and plaintiff was granted summary judgment on that claim. The matter was remitted to the Civil Court for a calculation of statutory interest and an assessment of attorney's fees as to that claim.

The main issue in this case was an appeal from an order of the Civil Court that denied the plaintiff's motion for summary judgment and granted the defendant's cross motion to compel the plaintiff to provide responses to its discovery demands and to produce an individual for an examination before trial. The court found that subsequent to the entry of the order, the Civil Court dismissed the complaint, rendering the appeal academic. As a result, the appeal was dismissed. The relevant facts considered by the court were the actions of the lower court and the subsequent dismissal of the complaint, which led to the decision to dismiss the appeal as academic.

The case involved an action by a provider to recover assigned first-party no-fault benefits. Plaintiff had appealed an order of the Civil Court which denied plaintiff's motion for summary judgment and granted defendant's cross motion to compel plaintiff to provide full and complete responses to defendant's discovery demands and to produce Vladimir Grinberg for an examination before trial (EBT). Plaintiff had failed to challenge the propriety of defendant's discovery demands in a timely manner. Defendant had set forth detailed reasons for believing that plaintiff was ineligible to recover no-fault benefits and sought discovery of certain documents as well as an EBT of Vladimir Grinberg. As a result, the court affirmed the order, finding that the defendant's discovery demands were not palpably improper, and defendant was entitled to the information and EBT they were seeking.

The relevant facts of the case involved a New York corporation, Advanced Medical Diagnostics of Queens, P.C., which provided medical services to its assignor in New York after she was injured in a motor vehicle accident. The vehicle was owned by a New Jersey resident and was insured by a New Jersey automobile insurance policy. The main issue in the case was whether New York or New Jersey law should control the payment of no-fault benefits and the jurisdiction of the Civil Court. The holding of the case was that under a "center of gravity" or "grouping of contacts" analysis, the dispositive factors weighed in favor of New Jersey and its law should control. Therefore, the provider's motion for summary judgment was denied, as under New Jersey law, the provider had to establish the medical necessity of the services provided, and failed to do so. Additionally, the Civil Court did not lack jurisdiction as disputed resolution was not mandatory under the New Jersey insurance policy, and therefore the defendant's cross motion for summary judgment dismissing the complaint was also denied.

The main issues decided in this case were whether the Civil Court properly granted the defendant's motion to stay the action pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law, and whether the subsequent dismissal of the complaint rendered the appeal academic. The court considered the fact that the Civil Court had granted the defendant's motion to stay the action, and that the complaint had been dismissed subsequent to that order. The court held that the dismissal of the complaint rendered the appeal academic, and therefore dismissed the appeal.

The main issue in this case was whether a provider was entitled to recover assigned first-party no-fault benefits for claims of service on certain dates. The relevant facts the court considered included a timely denial by the insurance company on the ground of lack of medical necessity, as well as the submission of an affirmed peer review report and an affirmed independent medical examination (IME) report providing a factual basis and medical rationale for the determination of lack of medical necessity. The court held that the provider's motion for summary judgment should have been denied and the insurance company's cross-motion for summary judgment should have been granted. Therefore, the judgment was reversed, and the branch of the provider's motion seeking summary judgment was vacated, while the branch of the insurance company's cross-motion seeking summary judgment was granted.

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.