No-Fault Case Law

The court considered the facts surrounding a claim for assigned first-party no-fault benefits filed by MSB Physical Therapy against Nationwide Insurance. The main issues centered on whether the plaintiff had failed to comply with the required examinations under oath, which was claimed by the defendant as a basis for dismissing the action. The Civil Court initially denied the defendant's motion for summary judgment and granted the plaintiff's cross-motion for summary judgment. However, upon appeal, the court reversed the Civil Court's order, granting the defendant's motion and denying the plaintiff's cross-motion, thus siding with the defendant's argument regarding the plaintiff's non-compliance with the examination requirements.

In this case, the court considered that the plaintiff, a physical therapy provider, failed to appear for scheduled examinations under oath (EUOs) related to their claims for no-fault insurance benefits. The defendant, Nationwide Insurance, demonstrated that it had sent timely notices for the EUOs before and after the claims were submitted and provided evidence of the plaintiff's repeated failures to attend these examinations. The main issues decided included whether the defendant's motions for summary judgment should be granted based on the plaintiff's non-compliance with the EUO requirements and whether the plaintiff could raise any triable issues of fact. The court ultimately reversed the prior order, granting the defendant's motion for summary judgment and denying the plaintiff's cross-motion, establishing that the plaintiff's failure to comply with the EUO process precluded recovery of the asserted benefits.

The court considered the fact that MSB Physical Therapy, P.C., as the assignee of a patient, failed to attend scheduled examinations under oath (EUOs) required for the processing of no-fault insurance claims. The defendant, Nationwide Insurance, established that it had properly mailed the scheduling letters for the EUOs and demonstrated that plaintiff's non-appearance justified the denial of claims. The main issues decided included whether the plaintiff's non-compliance with the EUO requirements warranted the dismissal of the complaint and the denial of plaintiff's cross-motion for summary judgment. The court held that since the plaintiff did not raise a triable issue of fact against the defendant’s prima facie showing, the motion for summary judgment by Nationwide Insurance was rightly granted, and the plaintiff's cross-motion was denied.

The court considered relevant facts surrounding a default judgment entered in favor of the plaintiff, GC Chiropractic, for no-fault benefits, totaling $3,623.62, and the subsequent appeal by the defendant, Allstate Insurance Company. Allstate deposited the amount with the New York City Department of Finance while appealing the order that denied its motion to vacate the judgment. The main issues addressed included whether the deposit tolled the accrual of interest and whether the plaintiff was obliged to recover the deposited undertaking. The court held that the deposit did not toll interest accrual and that the amount of the deposit alone was insufficient to satisfy the entire judgment. Consequently, the court reversed the lower court's order directing the plaintiff to recover from the Department of Finance and vacated the direction to provide a satisfaction of judgment upon full payment.

The court considered several relevant facts, particularly focused on the plaintiff's failure to provide requested verification of documents necessary to substantiate their claim for no-fault benefits. The main issues involved whether the defendant was entitled to summary judgment based on the plaintiff's noncompliance with verification requests and whether collateral estoppel applied from a previous Supreme Court ruling that denied the defendant's summary judgment in a separate declaratory judgment action. The court held that the defendant's request for additional information during the verification process was proper and that the denial of the previous summary judgment motion did not have preclusive effect on the current case, as it was not a final determination on the merits. Consequently, the Civil Court's decision to dismiss the complaint was affirmed, with the appeal rejected.

The court considered the relevant facts surrounding a provider's attempt to recover assigned first-party no-fault benefits from an automobile insurance company. The primary issue was whether the plaintiff had met the necessary verification requirements as demanded by the defendant for the claim to proceed. The Civil Court had granted the defendant's cross-motion for summary judgment, dismissing the complaint on the grounds that the plaintiff failed to provide the requested verification. The Appellate Term upheld this decision, affirming the dismissal of the complaint and ruling that the plaintiff had not fulfilled the verification obligations necessary for recovery of benefits.

The court considered the facts surrounding a no-fault insurance claim filed by Burke Physical Therapy, P.C. as an assignee of Felix Guzman. The main issue was whether the plaintiff provided the necessary verification requested by State Farm, which led to the dismissal of the complaint. The Civil Court had granted State Farm's cross-motion for summary judgment based on the plaintiff's failure to comply with verification requests. Ultimately, the appellate court affirmed this decision, concluding that the lower court's ruling was justified in light of the lack of required documentation from the plaintiff. The affirmation included a directive to pay $25 in costs to the defendant.

In this case, the court addressed a claim by a physical therapy provider seeking to recover assigned no-fault benefits from an insurance company. The central issue was whether the provider had adequately provided the necessary verification requested by the insurer. The court found that the failure to supply this verification justified the dismissal of the complaint. Consequently, the Appellate Term affirmed the lower court's decision to grant the insurance company's cross-motion for summary judgment. The ruling underscored the importance of compliance with verification requests in no-fault benefit claims. The court also noted a parallel case with similar reasoning, reinforcing the decision made.

The court considered several relevant facts, including the initial action brought by Horizon P.T. Care against Kemper Insurance Company to recover no-fault benefits for services provided to Anthony Ghee, who was involved in a motor vehicle accident. The defendant, Kemper Insurance, argued that the case was barred by res judicata due to a prior declaratory judgment action in which Unitrin Auto & Home Insurance Company claimed that Horizon had breached policy terms by not appearing for scheduled examinations under oath. The main issues decided included whether the declaratory judgment barred Horizon's claims and the adequacy of the evidence presented by Kemper to support its assertion as the proper insurer. The holding of the court was that Kemper's cross-motion for summary judgment was properly denied since it did not provide sufficient evidence to demonstrate that the declaratory judgment constituted a final adjudication of the present claims, but the court modified the order regarding the prima facie case finding, emphasizing that it could not be conclusively established at this point.

The court considered that the plaintiff, Ahmed Medical Care, P.C., filed an action to recover no-fault benefits for services provided to Wesley Isaacs, stemming from a motor vehicle accident. The Civil Court dismissed the complaint based on the doctrine of res judicata, referencing a prior judicial determination that the plaintiff was not entitled to payment for several bills that included seven of the eight claims in the current action. The main issues decided included whether the prior judgment barred the current claims and whether the eighth and ninth causes of action were also affected. The court held that the first through seventh causes of action were properly dismissed as they were indeed barred by res judicata, while the eighth cause of action, which was not part of the earlier judgment, and the ninth cause concerning interest and attorney's fees, were improperly dismissed. The order was modified to allow these two causes of action to proceed and remitted the case to the Civil Court for a merits determination on the discovery motion.