No-Fault Case Law

The court considered the facts of R.E.G. Flushing Medical PC providing medical services to Hector Gomez after an auto accident in Queens, New York. Plaintiff sought no-fault payments from Gomez's insurer, defendant Integon National Ins. Co. d/b/a GMAC Ins. Co, but the defendant denied the claims based on North Carolina law. The main issue decided was whether the defendant could lawfully avoid paying plaintiff's no-fault claims based on their denials. The court held that North Carolina law governed the substantive issues presented and rejected the defense set forth in the denials, granting judgment to the plaintiff, R.E.G. Flushing Medical PC.

The court considered an action to recover no-fault medical payments under an insurance contract, where Nyack Hospital was seeking judgment against Allstate Insurance Company for failing to pay or deny the claim within the requisite 30-day period. The main issue was whether Nyack Hospital, as the assignee of Rochelle Ferguson, was entitled to summary judgment on its cause of action to recover the no-fault insurance medical payments. The holding of the court was that the plaintiffs made a prima facie showing that Nyack Hospital was entitled to judgment as a matter of law, and the defendant failed to raise a triable issue of fact in opposition to the motion. Therefore, the court reversed the order denying summary judgment and granted that branch of the plaintiff's motion which was for summary judgment on the first cause of action.

The relevant facts of this legal case are that a provider, Rogy Medical, P.C., sought to recover first-party no-fault benefits from GEICO Insurance Company. Rogy Medical moved for summary judgment in the Civil Court of the City of New York, which was granted on November 19, 2009. GEICO Insurance Company opposed the motion, arguing that the services provided lacked medical necessity and that the provider billed in excess of the workers' compensation fee schedule. The main issue decided by the Appellate Term was whether there was a triable issue of fact with respect to the lack of medical necessity for the services and the amount billed in excess of the fee schedule. The holding of the case was that GEICO Insurance Company demonstrated the existence of a triable issue of fact with respect to both causes of action, and therefore the judgment in favor of Rogy Medical, P.C. was reversed, the order was vacated, and the motion for summary judgment was denied.

The court considered the appeal from an order granting the plaintiff's motion for summary judgment in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the documents annexed to the plaintiff's moving papers were admissible pursuant to CPLR 4518. The court held that the affidavit submitted by the plaintiff's billing administrator was sufficient to establish that the documents were admissible. However, the court reversed the judgment, vacated the order granting plaintiff's motion for summary judgment, and denied plaintiff's motion, based on the failure of the plaintiff's assignor to appear for an examination under oath, which was deemed the same as a previous case.

The court considered an order from the Civil Court of the City of New York, which had granted defendant's cross motion to compel the plaintiff to provide bank account information and produce copies of its corporate tax returns and its billing and management agreements. The court also provided that the complaint would be dismissed if the plaintiff failed to comply with the order. However, subsequent to this order, the Civil Court entered an order dismissing the action, rendering the appeal academic. Therefore, the main issue decided was whether the appeal was moot due to the dismissal of the action, and the holding of the court was that the appeal was dismissed as academic.

The New York University-Hospital for Joint Diseases brought a lawsuit against Esurance Insurance Company to recover no-fault medical payments for a patient who was in a car accident and was assigned to the hospital. NYU-Hospital argued that Esurance's denial of the claim was untimely, factual insufficient and of no merit as a matter of law. The court acknowledged that the hospital had proof the bill was mailed and received and that the payments were overdue, but found that Esurance raised a triable issue of fact as to whether the denial of the claim was timely and whether the patient was intoxicated at the time of the accident. Therefore, the Supreme Court affirmed the denial of the hospital's motion for summary judgment on the complaint.

The relevant facts considered in this case were that the defendant, Utica Mutual Insurance Company, had denied the plaintiff's claim for first-party no-fault benefits based on the assignor's failure to attend independent medical examinations (IMEs) scheduled by Hudson Valley Medical Consultants (HVMC). The defendant submitted affidavits from an employee of HVMC and the office manager of the psychologist who was to perform the IMEs, which established that the IME requests had been timely mailed and that the plaintiff's assignor had failed to appear for the scheduled IMEs. The main issue decided was whether the defendant had properly denied the plaintiff's claim based on the assignor's failure to satisfy a condition precedent to coverage. The court held that since the assignor's appearance at an IME is a condition precedent to the insurer's liability on the policy, the defendant was not precluded from raising the issue and properly denied the claim, affirming the Civil Court's order granting defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the defendant, Commerce Insurance Company, was entitled to summary judgment dismissing the complaint on the grounds of fraudulent procurement of the insurance policy due to the assignor misrepresenting his state of residence. The court ultimately held that the defendant was not precluded from raising its defense of fraudulent procurement of the insurance policy, as the affidavits submitted by the defendant's claims adjuster established that the assignor had indeed misrepresented his state of residence, making him ineligible to receive first-party no-fault benefits under the insurance policy in question. The court therefore reversed the judgment, vacated the order denying the defendant's motion for summary judgment, granted the defendant's motion for summary judgment dismissing the complaint, and denied the plaintiff's cross motion for summary judgment.

The court considered the facts of a case in which LDE Medical Services, P.C. sued Interboro Insurance Company to recover assigned first-party no-fault benefits. Plaintiff moved for summary judgment, and the defendant cross-moved for summary judgment dismissing the complaint. In support of its cross-motion, the defendant argued that it had timely denied the plaintiff's claims on the ground that the assignor had failed to attend independent medical examinations (IMEs) and that the plaintiff's motion for summary judgment was premature. The court found that the appearance at an IME is required whether the insurance company demands the IME before the claim form is submitted or after and that the defendant failed to establish that the assignor had failed to appear at the IMEs. The judgment was affirmed by the court because the defendant failed to show that discovery was needed to establish the existence of a triable issue of fact, and therefore, the plaintiff's motion for summary judgment was properly granted.

The main issue in this case was whether the medical services rendered by the plaintiff were medically necessary, as all other elements of the case had been established and the defendant had timely denied the claim on the grounds of lack of medical necessity. At the nonjury trial, the defendant's attorney requested an adjournment to secure the appearance of its witness, but the Civil Court denied the application and issued a decision awarding judgment in the defendant's favor. The defendant appealed from this decision, arguing that the Civil Court should have granted the adjournment. The Appellate Term, Second Department found that the Civil Court did not improvidently exercise its discretion in declining to grant the adjournment and affirmed the judgment in favor of the defendant. Therefore, the holding of the case was that the judgment in favor of the defendant was affirmed.