No-Fault Case Law

The case involves a dispute over first-party no-fault benefits in the amount of $25,000, with an insurance company seeking summary judgment to dismiss the complaint on the grounds that the injuries of the plaintiff's assignor were preexisting and unrelated to the subject accident. The plaintiff, an orthopedic surgeon, performed medical procedures on the assignor and submitted a claim for reimbursement, which was denied based on an independent peer review indicating that the injuries were unrelated to the accident. The defendant submitted medical evidence to support their motion for summary judgment, but the court found that the plaintiff's opposition, including an affidavit from the surgeon who performed the procedure, raised a genuine issue of fact that needed to be resolved at trial. Therefore, the court affirmed the order denying the defendant's motion for summary judgment.

The main issue decided in this case was whether the plaintiff's motion to vacate a prior order which had granted on default the defendant's motion to dismiss the complaint for failure to prosecute should be denied. The court considered the fact that the plaintiff had commenced the action in July 2002 to recover assigned first-party no-fault benefits, and issue was joined in September 2002. However, there was no further activity in relation to the litigation until March 2007, when the defendant served a 90-day demand pursuant to CPLR 3216 (b) and the plaintiff did not respond. The court held that the order denying the plaintiff's motion to vacate the order dismissing the complaint should be affirmed, as there was no proof that a notice of change of attorney form was executed in 2003 and filed with the Civil Court at any time prior to the defendant's service of the 90-day demand in March 2007. Therefore, proper service of the demand and of the subsequent motion to dismiss on the plaintiff's former counsel was upheld.

The court considered the plaintiff's motion for summary judgment and the defendant's cross motion to compel the plaintiff to provide discovery and produce its owner for an examination before trial. The main issues decided were whether the plaintiff was obligated to produce certain information in response to the defendant's supplemental demand for discovery and inspection and whether the plaintiff's motion for summary judgment was premature pending the completion of discovery. The holding of the court was that the defendant's cross motion to compel the plaintiff to respond to outstanding discovery demands was granted to the extent of compelling the plaintiff to provide the information sought in certain items of the defendant's supplemental demand for discovery and inspection within 60 days. Additionally, the court found that the plaintiff's motion for summary judgment was premature pending the completion of discovery.

The court found in favor of the plaintiff, Giugliano, DC, P.C. in this matter wherein plaintiff was seeking to recover first party no-fault benefits from defendant, Merchants Mutual Ins. Co. Plaintiff submitted bills for medical procedures pursuant to the New York Workers' Compensation Medical Fee Schedule, however, defendant disputed the billing practices used by the plaintiff. The main issue decided by the court was whether the plaintiff was entitled to recover for the claims submitted based on the fee schedule. The court found that plaintiff proved its prima facie case and the procedures were properly billed pursuant to the fee schedule, which is why it granted judgment in favor of the plaintiff in the amount of $2,980.58 plus costs, disbursements, statutory interest, and statutory attorney's fees.

The court considered a motion for summary judgment in a case brought by Axis Chiropractic, PLLC as assignee of Ricargo Herrera against GEICO General Insurance Company to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had made a prima facie showing of entitlement to summary judgment, with the court ultimately holding that the plaintiff failed to do so. The court found that the affidavit submitted in support of the motion for summary judgment did not demonstrate personal knowledge of the plaintiff's business practices and procedures, therefore rendering it legally insufficient. As a result, the court affirmed the denial of the plaintiff's motion for summary judgment. No other issues were considered by the court in this case.

The main issue in the case of Points of Health Acupuncture, P.C. v Lancer Insurance Company was whether the defendant had established the timely mailing of denial of claim forms and examination under oath (EUO) scheduling letters, as well as the plaintiff's failure to appear for scheduled EUOs. The court considered that the defendant had established the timely mailing of the EUO scheduling letters with respect to certain claims, and thus was entitled to partial summary judgment dismissing these claims. However, the court found that the defendant had failed to establish the timely mailing of verification requests with respect to other claims, thus precluding the defendant from raising most defenses for these claims. The court also found that plaintiff's cross motion for summary judgment was premature, and that the defendant was entitled to compel the plaintiff to respond to discovery requests. Therefore, the court reversed the order, granted partial summary judgment to the defendant, denied the plaintiff's cross motion for summary judgment, and remitted the matter to the Civil Court for further proceedings on the remaining claims.

The relevant facts of the case were that Yklik, Inc. was seeking to recover assigned first-party no-fault benefits from GEICO Ins. Co. The main issue decided was whether GEICO had timely denied the claims at issue on the ground of lack of medical necessity. The holding of the court was that defendant established that it had timely denied the claims at issue on the ground of lack of medical necessity, and the peer review reports submitted in support of defendant's cross motion for summary judgment set forth a factual basis and medical rationale for the determinations that there was a lack of medical necessity for the supplies furnished. Plaintiff failed to raise a triable issue of fact, and the court reversed the order, denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint.

The court considered whether the insurance company, the defendant, had timely denied the provider's claims based on the failure of the provider's assignor to appear for an examination under oath (EUO). The main issue was whether the defendant had demonstrated that its initial and follow-up requests for verification were timely and whether the assignor had failed to appear for the EUOs. The holding of the court was that the defendant failed to establish that the EUO scheduling letters were timely mailed, and therefore, failed to demonstrate that the 30-day claim determination period was tolled. As a result, the defendant failed to establish that its denial of claim forms were timely, and thus, was not precluded from raising as a defense the failure of plaintiff's assignor to appear for an EUO. Therefore, the judgment in favor of the plaintiff was affirmed.

The relevant facts considered by the court were that Astoria Wellness Medical, P.C. was seeking to recover assigned first-party no-fault benefits, but the defendant argued that the acupuncture services were rendered by a professional service corporation owned by a doctor who was not licensed to perform acupuncture. The main issue decided in this case was whether the plaintiff was eligible for reimbursement of the no-fault benefits because the acupuncture services were allegedly rendered by a licensed acupuncturist employed by the plaintiff. The court ultimately affirmed the lower court's decision to grant the defendant's motion for summary judgment and deny the plaintiff's cross motion as moot, based on a similar case with similar facts. Therefore, the holding of the case was that the defendant's motion for summary judgment dismissing the complaint was affirmed.

The court considered the fact that Alfa Medical Supplies, Inc. was seeking to recover first-party no-fault benefits as the assignee of two individuals, Zoila Correa and Miriam Soto. GEICO General Insurance Company denied the claims on the grounds of lack of medical necessity. The main issue decided was whether Alfa Medical Supplies, Inc. provided sufficient evidence to establish its entitlement to summary judgment. The holding of the case was that Alfa Medical Supplies, Inc. failed to provide sufficient evidence to establish its entitlement to summary judgment for its claims as the assignee of Zoila Correa and Miriam Soto. Therefore, the motion for summary judgment was denied, and the judgment in favor of Alfa Medical Supplies, Inc. was reversed.