No-Fault Case Law

The main issue in this case was whether the insurer, GEICO General Ins. Co., was entitled to summary judgment dismissing the complaint brought by Chi P&L Acupuncture, P.C. as the assignee of several individuals, on the ground that the plaintiff failed to appear for duly scheduled examinations under oath. The relevant facts considered by the court were that the plaintiff was seeking to recover assigned first-party no-fault benefits, and the defendant sought to dismiss the complaint based on the plaintiff's failure to appear for examinations under oath. The court ultimately held that, for the reasons stated in a related case, the order denying the defendant's motion for summary judgment was affirmed. Therefore, the defendant's motion for summary judgment dismissing the complaint was denied, and the order, insofar as appealed from, was affirmed.

The court considered an appeal from an order of the Civil Court denying the defendant's motion for summary judgment to dismiss the complaint by a provider seeking first-party no-fault benefits. The issue was whether the defendant's motion had established that the plaintiff had failed to appear for scheduled examinations under oath (EUOs) and whether the defendant had timely denied the plaintiff's claims after the plaintiff's failure to appear for the EUOs. The holding was that the defendant's motion failed to demonstrate that it was not precluded from raising its defense, and thus the motion for summary judgment dismissing the complaint was properly denied. The order was affirmed, and the decision was made on July 15, 2022.

The court considered the fact that the defendant, GEICO General Insurance Company, had sought to dismiss the complaint on the grounds that the plaintiff, Chi P&L Acupuncture, P.C., had failed to appear for scheduled examinations under oath. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the order denying the defendant's motion for summary judgment was affirmed, with the court stating that for the reasons stated in a similar case, the order was affirmed.

The court considered whether the plaintiff was entitled to recover assigned first-party no-fault benefits for claims of medical services rendered. The main issues decided were whether the amounts sought for recovery exceeded the workers' compensation fee schedule and whether the defendant had paid the claims in full. The holding of the case was that the defendant was entitled to summary judgment dismissing claims for services billed under certain codes and for claims where the defendant had not received the claim forms. However, the court granted the plaintiff summary judgement for a claim for services rendered on a specific date and billed under a specific code in the principal sum of $97.14.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, granting the defendant's cross motion for summary judgment dismissing the complaint and denying, as academic, the plaintiff's motion to compel discovery and dismiss the defendant's affirmative defenses in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had provided the requested verification or had set forth a reasonable justification for the failure to comply with the defendant's verification requests. The holding of the case was that the plaintiff failed to demonstrate that it had provided the requested verification or had set forth a reasonable justification for the failure to comply with the defendant's verification requests, and thus the court found no basis to disturb the order granting the defendant's cross motion for summary judgment and denying the plaintiff's motion. Therefore, the order was affirmed.

The court considered whether a medical provider, Jules Francois Parisien, M.D., as assignee of Nicanor Gonzales, was entitled to recover first-party no-fault benefits from Travelers Insurance Company. The main issue was whether the medical provider failed to appear at duly scheduled examinations under oath (EUOs), and whether the letters sent by the provider demanding an up-front fee and seeking to reschedule the EUOs demonstrated the existence of an issue of fact as to whether the EUOs were scheduled at reasonably convenient times. The court held that the provider's letters demanding a flat up-front fee and seeking to repeatedly reschedule the EUOs to unspecified dates two months later were insufficient to demonstrate the existence of an issue of fact as to whether the EUOs were scheduled at reasonably convenient times, and therefore affirmed the order granting the defendant's motion for summary judgment dismissing the complaint, and denying the plaintiff's cross motion for summary judgment.

The court considered the motion by the defendant to amend the caption and for summary judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for duly scheduled examinations under oath (EUOs). The main issue decided was whether the defendant had twice duly demanded an EUO, that the assignor twice failed to appear, and that defendant issued a timely denial as to each claim after the second failure to appear. The holding of the case was that the order, insofar as appealed from, is affirmed, with $25 costs, as defendant failed to demonstrate that fact as a matter of law concerning the rescheduling of the EUO. As the denials were not timely, an issue of fact remained as to whether defendant's denials were timely and, thus, whether defendant is precluded from interposing its defense that the plaintiff's assignor failed to appear for duly scheduled EUOs.

In this case, Columbus Imaging Center, LLC brought an action to recover first-party no-fault benefits from Nationwide Ins. The main issue in the case was whether or not defendant was entitled to summary judgment dismissing the complaint on the ground that plaintiff's assignor had failed to appear for independent medical examinations (IMEs). Defendant argued that IME scheduling letters had been timely and properly mailed, but the doctors scheduled to perform the IMEs did not establish personal knowledge of the assignor's nonappearance. The court ultimately held that defendant failed to establish its entitlement to judgment since the affidavits from the IME doctors did not support their contention. However, the court also held that plaintiff's cross motion for summary judgment should have been denied as the proof submitted in support of its cross motion failed to establish that the claims had not been timely denied or that defendant had issued timely denial of claim forms. Therefore, the court modified the order by denying plaintiff's cross motion for summary judgment.

The court considered the facts that an insurance company had denied a chiropractic clinic's claim for first-party no-fault benefits on the grounds that the clinic's assignor had failed to appear for scheduled independent medical examinations (IMEs). The main issue decided was whether the insurance company was entitled to partial summary judgment dismissing the second and third causes of action based on the assignor's failure to attend the IMEs. The holding of the case was that the insurance company was entitled to partial summary judgment dismissing the second and third causes of action, as the assignor had failed to comply with a condition precedent to coverage and the insurance company had timely denied the claims on that ground. The court also held that the assignor's denial of receipt of the IME scheduling letters was insufficient to rebut the presumption that the letters were received. Therefore, the insurance company's motion was granted and the order was reversed.

The relevant facts of the case revolve around a motor vehicle accident in 2008, where the plaintiff's car was struck from behind by a sanitation truck. As a result, the plaintiff underwent surgery to remove his L5-S1 disc and replace it with an artificial lumbar disc. The defendant, the plaintiff's insurance company, denied the claim for first-party no-fault benefits on the grounds that the surgery was not medically necessary. The main issue before the court was whether the plaintiff was entitled to recover the first-party no-fault benefits under his insurance policy to cover the cost of his surgery. The court held that the plaintiff made a prima facie showing of entitlement to judgment as a matter of law by submitting evidence that the statutory billing forms were mailed and received, and that the payment of no-fault benefits was overdue. The court also found that the plaintiff had standing to pursue his claims for no-fault benefits and affirmed the judgment in favor of the plaintiff in the principal sum of $44,573.86.