No-Fault Case Law

The main issue at hand is whether a no-fault provider has established its prima facie entitlement to summary judgment by proof of submission to the defendant of a claim form, the fact and amount of the loss sustained, and proof that the defendant failed to pay or deny the claim within a 30-day period, or that the defendant had issued a timely denial of claim that was conclusory, vague, or unlawful. The court held that the medical license of the defendant's sole member was suspended in 2007, rendering him disqualified from practicing medicine and continuing as a member of the plaintiff company. This led to the dissolution of the company since there were no remaining members of the professional limited liability company. As a result, the branch of the defendant's motion seeking discovery related to plaintiff's current corporate status was denied. The court also denied the plaintiff's motion for summary judgment on the grounds that plaintiff had failed to establish its prima facie entitlement to summary judgment.

The main facts of the case involved an insurance dispute over first-party no-fault benefits that were assigned to Radiology Today, P.C. The issue before the court was whether New York Central Mutual Fire Insurance Company had failed to establish that Radiology Today did not comply with their requests for verification of the benefits. The court found that the insurance company had submitted evidence showing that they had timely mailed their requests for verification, and that Radiology Today had failed to provide the MRI films that had been requested. As a result, the court held that the 30-day period within which the insurance company was required to pay or deny the claims had not commenced, and therefore Radiology Today's action was premature. The court ultimately reversed the lower court's decision and granted the insurance company's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in this case were that the process server served the summons and complaint upon a clerk employed by the defendant's third-party claims administrator, rather than on an authorized individual. This led to a lack of personal jurisdiction over the defendant. The main issue decided was whether the failure to serve process in an action renders all subsequent proceedings null and void. The holding of the court was that the Civil Court never obtained jurisdiction over the defendant, and therefore, the defendant's motion to vacate the default judgment and dismiss the complaint should have been granted. The order denying the defendant's motion was reversed, and the defendant's motion to vacate the default judgment and dismiss the complaint was granted.

The relevant facts considered in this case were that the plaintiff, W.H.O. Acupuncture, P.C., sought to recover first-party no-fault benefits for services rendered by a licensed acupuncturist to the plaintiff's assignor. The defendant, GEICO General Insurance Co., argued that they had properly reimbursed the plaintiff for these services using the workers' compensation fee schedule for acupuncture services performed by chiropractors. The main issue decided by the court was whether it was proper for the defendant to use the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive for services rendered by a licensed acupuncturist. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint should have been granted, as it was proper for the defendant to use the workers' compensation fee schedule to determine the amount owed to the plaintiff for the acupuncture services. Additionally, the judgment in the case was found to have been improperly prepared and entered, and was reversed by the court.

The court considered the facts that the plaintiff, Citywide Social Work and Psychological Svcs, P.L.L.C., had commenced an action to recover assigned first-party no-fault benefits in the sum of $1,181.63 and that the defendant, Allstate Ins. Co., failed to timely appear and answer. The main issue decided was whether the Civil Court was correct in denying the plaintiff's motion for leave to enter a default judgment and dismissing the complaint pursuant to CPLR 3215 (c). The holding of the court was that when a plaintiff fails to commence proceedings for the entry of a default judgment within one year of the default, the court shall dismiss the action as abandoned unless sufficient cause is shown why the action should not be dismissed, and in this case, the plaintiff failed to demonstrate a reasonable excuse for the delay in timely moving for leave to enter a default judgment and did not proffer any reasonable excuse for its delay, so the order denying the plaintiff's motion and dismissing the complaint was affirmed.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, in an action to recover assigned first-party no-fault benefits. The main issue was whether the defendant was entitled to summary judgment dismissing the complaint. The court held that the defendant's cross motion for summary judgment dismissing the complaint should have been granted, as defendant's showing that the supplies were not medically necessary was unrebutted by the plaintiff. The court also found that defendant had timely denied plaintiff's claims, and the sole issue for trial was the medical necessity of the supplies provided to plaintiff's assignor. Therefore, the defendant's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court in the case included a dispute over whether services rendered to the plaintiff's assignor were medically necessary. The main issue decided was whether the Civil Court erred in precluding the testimony of the defendant's witness, a psychologist who had prepared a peer review report upon which the claim denial was based. The holding of the court was that it was error to exclude the testimony of the psychologist since he was prepared to testify about the factual basis and medical rationale for his opinion, and was subject to cross-examination. As a result, the judgment was reversed and the matter was remitted for a new trial.

The court considered the fact that the plaintiff had filed an answer in November 2003, and had moved for default judgment in February 2004. After a so-ordered stipulation in 2006, the defendant moved to vacate the default judgment and dismiss the complaint. The main issue decided was whether the defendant's conduct in engaging in discovery acted as a waiver of the right to dismiss the complaint pursuant to CPLR 3215 (c). The court held that the defendant's conduct in engaging in discovery was a waiver of their right to dismissal, and therefore affirmed the denial of the branch of defendant's motion seeking to dismiss the complaint.

The relevant facts the court considered in this case included that the plaintiffs had appealed a Civil Court's denial of the plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits. The court had affirmed the original decision stating that the plaintiffs had established their prima facie entitlement to summary judgment, but the defendant had demonstrated that there was a triable issue of fact. Plaintiffs then moved in the Civil Court to deem certain facts established for all purposes in the action, pursuant to CPLR 3212 (g), and the Civil Court granted this motion. The main issue decided was whether the facts necessary to demonstrate the plaintiff's prima facie case were incontrovertible and could be deemed established for all purposes in the action, which the court held was not the case. The holding of the court was that the Civil Court improperly relied upon the appellate court's prior order in limiting the issues for trial pursuant to CPLR 3212 (g), and accordingly, the branch of the motion for relief pursuant to CPLR 3212 (g) was reversed, and denied.

The court considered the fact that the plaintiff in the case, a provider seeking to recover assigned first-party no-fault benefits, had failed to comply with the defendant's discovery demands within the required time frame. The main issue decided was whether the plaintiff's failure to provide the required discovery warranted the denial of their cross motion for summary judgment and the granting of the defendant's motion to vacate the notice of trial and strike the matter from the trial calendar. The holding of the court was that because the plaintiff had not provided the demanded discovery, the denial of their cross-motion for summary judgment and the granting of the defendant's motion to vacate the notice of trial and strike the matter from the trial calendar were proper. The court also directed the plaintiff to respond to the defendant's discovery demands as required.