No-Fault Case Law

The court in this case considered an appeal from an order of the Civil Court of the City of New York that denied the defendant's cross motion for summary judgment dismissing the complaint and found that the plaintiff had established its prima facie case. The main issues before the court were whether the plaintiff had indeed established its prima facie case, and whether the defendant had provided enough evidence to support the dismissal of certain claims. The court held that the plaintiff had not established its prima facie entitlement to summary judgment, as the affidavit submitted was insufficient to prove the admissibility of the documents provided. The court also held that the defendant did not provide sufficient evidence to warrant the dismissal of certain claims, but did provide enough evidence to support the dismissal of the plaintiff's claims for certain dates of service. Therefore, the court modified the order to reflect these holdings.

The court considered a motion by the defendant to amend its answer to include affirmative defenses asserting the existence of a personal injury deductible in the insurance contract and denying that the plaintiff's assignor was an eligible injured person. The delay in filing the motion to amend was lengthy but plaintiff did not deny that discovery and trial postponements intervened to delay the action and for reasons unrelated to the motion's merits. The relevant fact was based on the claim of prejudice or surprise, and the main issue was whether the delay in filing the motion to amend was ground for denial. The holding of the case was that the delay in filing the motion to amend was not a barrier to amendment absent a showing of "significant" prejudice to the opposing party, and the court affirmed the order without costs.

The appellate court considered a case where Ava Acupuncture, P.C. was seeking to recover no-fault benefits for medical services provided to its assignors. The defendant, NY Central Mutual Fire Ins. Co., had previously obtained a declaratory judgment from the Supreme Court, stating that they had no obligation to furnish benefits to the parties involved. Ava Acupuncture, P.C. then filed a motion to compel discovery and the defendant cross-moved for summary judgment to dismiss the complaint, citing the previous declaratory judgment. The main issue decided was whether the previous order of the Supreme Court, which declared that the defendant had no present or future obligation to furnish benefits, would bar the instant action. The court held that the instant action was barred under the doctrine of res judicata, as to hold otherwise could result in a judgment that would impair rights established by the order rendered by the Supreme Court. The court further emphasized that the Supreme Court's order constituted a conclusive final determination, and therefore, the plaintiff's motion to compel discovery or strike defendant's answer was rendered moot and properly denied. The order of the Civil Court was affirmed.

The court considered a case in which Ave T MPC Corp., as assignee, sought to recover assigned first-party no-fault benefits from Travelers Property Casualty Ins. Co. The main issues decided were whether the plaintiff's action should be struck from the trial calendar and whether the plaintiff's owner should be compelled to undergo an examination before trial. The court held that because the notice of trial and certificate of readiness filed by the plaintiff contained the erroneous statement that discovery had been completed, the Civil Court properly granted the branch of defendant's motion seeking to strike the matter from the trial calendar. The court also found no basis to disturb the Civil Court's order compelling the plaintiff's owner to undergo an examination before trial, and therefore denied the plaintiff's cross motions seeking costs and sanctions.

The relevant facts considered by the court were that the Civil Court granted the plaintiffs' motion to restore the action to the trial calendar pursuant to Uniform Rules for New York City Civil Court. The owner of plaintiff Exact Medical Services, P.C. had passed away and an administrator had been appointed to preserve the estate's value. The main issue decided was whether the action should be restored to the trial calendar, and the holding was that the order granting the restoration was affirmed by the court. The decision was made based on similar reasons as another case, and the judges Weston, Pesce, and Rios all concurred with the decision.

The relevant facts the court considered were that the plaintiff, Upper E. Side Surgical, PLLC, sought reimbursement for medical services provided to an insured individual from the defendant, State Farm Insurance Company. The plaintiff claimed the defendant timely denied their claim and cited that the fees claimed were not in compliance with the New York Workers' Compensation Board Schedule of Medical Fees. The main issue was whether the plaintiff was entitled to reimbursement under the no-fault insurance law and what rate of reimbursement they were entitled to. The court held that while the plaintiff was entitled to reimbursement for the medical services provided, the facility fees set forth by the NY State Workers' Compensation Board were not applicable to the plaintiff as they were not listed as a Public Health Law Article 28 facility. The court also held that a trial of the issue was necessary to determine the amount of the charge for services. As a result, the defendant's motion for summary judgment was denied on the fee schedule issue and granted on the issue of timely denial of claim.

The defendant insurance company had refused to pay first-party no-fault benefits to the plaintiffs, which were providers in this case. Their claims had been marked off the trial calendar but were later moved to restore the action to trial. However, the defendant argued that prosecution of the claims of the plaintiff Painless Medical, P.C. could not be pursued due to the death of the sole shareholder, officer, and director of the company. The defense claimed that the appointed administrator, Anna Val, did not have the authority to pursue pending litigation or collect settlements and judgments involving this provider. The court ruled that Ms. Val had the authority and power to recover property belonging to the estate, prosecute an action to recover assets belonging to the estate, and settle claims for money owed to the estate, and she did not have to be a member of the profession in which the professional corporation was authorized to practice. The main issue decided was whether Anna Val had the authority to pursue pending litigation or collect settlements and judgments involving the provider after being appointed as administrator of the estate, and the court ruled that she did have the authority. The holding of the court was that the motion to restore the action was made within a year after it had been marked off the trial calendar, and counsel's affirmation satisfactory justified the reason, showing a readiness to proceed to trial, and the order was affirmed.

The relevant facts the court considered for this case involved a dispute over first-party no-fault benefits for psychological services provided to an individual involved in a motor vehicle accident. The plaintiff sought reimbursement for several psychological services, but the defendant denied them as medically unnecessary. The main issue decided in the case was whether the defendant had proven the lack of medical necessity for the services for which reimbursement was sought. The court held that the defendant met its burden of proof in establishing the lack of medical necessity through a peer review report and medical records, and the plaintiff failed to rebut the evidence with its own. As a result, the court denied the plaintiff's motion for a directed verdict and granted judgment to the defendant, dismissing the complaint with prejudice.

The relevant facts the court considered were that the plaintiff sought to recover first-party no-fault benefits for psychological services provided to the subject assignor. The plaintiff was paid for the initial interview, but the rest of the services were denied by the defendant as medically unnecessary and for fees not in accordance with fee schedules. The main issues decided were lack of medical necessity and fees not in accordance with fee schedules. The holding of the court was that the defendant successfully proved lack of medical necessity for four of the six psychological services allegedly provided, as well as the review of records, and the explanation and interpretation of results. The court granted a partial judgment to the plaintiff in the amount of $266.61, plus interest, costs, and attorney's fees, and dismissed the balance of the claim with prejudice.

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint in an action to recover first-party no-fault benefits. The court considered the evidence provided by the defendant, including the timely mailing of denial of claim forms and competent medical evidence that the diagnostic testing giving rise to the plaintiff's claims lacked medical necessity. The main holding of the case was that the defendant was entitled to summary judgment, as they had made a prima facie showing of entitlement by establishing the proper and timely mailing of denial of claim forms and submitting competent medical evidence. The court found that the plaintiff's opposition, consisting of an attorney's affirmation unaccompanied by any medical evidence, was insufficient to raise a triable issue. Therefore, the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment, dismissing the complaint.