No-Fault Case Law

In this case, the plaintiffs, a group of insurance companies, sought a preliminary injunction to prohibit several medical treatment facilities and individuals from prosecuting lawsuits and arbitration proceedings against them to recover No Fault first-party medical benefits. The plaintiffs alleged that these facilities and individuals had defrauded them by submitting bills for medical services rendered by corporations not truly owned by holders of medical licenses. The plaintiffs demonstrated a likelihood of ultimate success on the merits based on fraudulent incorporation, as well as irreparable injury if provisional relief was withheld. The court granted the preliminary injunction, finding that equitable relief was necessary to prevent repetitive litigation and arbitration of numerous No Fault claims for reimbursement by medical providers with the same defense of fraudulent incorporation. The plaintiffs' motion for a preliminary injunction was granted, and the parties were instructed to submit affidavits concerning the proper amount of the undertaking at the time of the settlement of the order.

The court considered the complaint filed by certain insurance companies, claiming that they were defrauded by several medical providers and their affiliated management companies, who submitted bills for services under the Comprehensive Automobile Insurance Reparations Act, resulting in payments made by the insurers. The insurers alleged common law fraud, unjust enrichment, illegal fee-splitting, and violations of New York State laws. The main issue was whether the complaint adequately alleged fraud, unjust enrichment, and other causes of action. The holding of the court was that the complaint adequately alleged fraud, unjust enrichment, and other causes of action, denying the defendants' motions to dismiss most of the causes of action while granting dismissal for some damages before April 4, 2002. Additionally, the court ordered the severance of the causes of action against each group of defendants, requiring separate actions to be maintained against each group.

The relevant facts considered by the court in this case were that the plaintiff, a medical provider, was seeking to recover assigned first-party no-fault benefits from the defendant insurance company. The defendant sought to disqualify Gary Tsirelman, Esq., and Gary Tsirelman, P.C. from representing the plaintiff in the case, as Tsirelman was both counsel to and sole owner of the plaintiff medical provider. The main issue decided by the court was whether Tsirelman should be allowed to act as both attorney and witness in the case, and the court held that in a disqualification situation, any doubt should be resolved in favor of disqualification. The court affirmed the order without costs, concluding that the defendant had raised an issue of fact as to whether the plaintiff was eligible to receive reimbursement of first-party no-fault benefits, and that Tsirelman would likely be called as a witness, potentially impacting the credibility of the case. Therefore, the court held that Tsirelman and his law firm were disqualified from representing the plaintiff in the action.

The court considered the issue of whether a medical provider was entitled to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance policy was obtained fraudulently as a result of identity theft, and whether the medical provider's assignor was aware or involved in the fraudulent scheme. The court held that there was no evidence that the assignor participated in or was aware of the fraudulent scheme, and since the insurance company did not cancel the policy prior to the accident, they failed to demonstrate the existence of an issue of fact to defeat the medical provider's motion for summary judgment. The holding of the case was that the lower court's denial of the provider's motion for summary judgment was reversed, and the matter was remitted for the calculation of interest and assessment of attorney's fees.

The plaintiffs in this case, who are assignees of no-fault benefits, brought an action to recover for health services rendered to the beneficiaries of the defendant's no-fault insurance contracts. Each assignor received medical treatment from the plaintiffs after separate automobile accidents. The complaint contained 17 causes of action, but the Supreme Court denied the plaintiffs' motion for summary judgment and granted those branches of the defendant's cross-motion which were to dismiss several of these causes of action. The court concluded that the plaintiffs were barred from recovery due to Workers' Compensation Law § 11, as the assignors were injured during the course of their employment. Upon reargument, the court adhered to its original determination, but the Appellate Division modified the order upon reargument, vacating the original determination and remanding the matter to the Workers' Compensation Board for a new determination. The Supreme Court properly denied the plaintiffs' motion for summary judgment on the complaint, as their entitlement to judgment as a matter of law was not demonstrated.

The relevant facts of the case involved two separate instances where the defendant, Government Employees Insurance Company, requested verification of claims submitted by the plaintiff, Custom Orthotics, Ltd. The plaintiff's attorney responded to the verification requests with identical "compliance letters" in each case. The main issues decided by the court were whether the defendant's verification requests were proper, if the plaintiff's responses to the defendant's verification requests were sufficient, and whether the defendant was obligated to respond further to the plaintiff in some form to communicate its position that the response was insufficient. The court found that the verification requests were proper and reasonable, and in the Graulan matter, the plaintiff's response was found to be sufficient. However, in the Iori matter, the plaintiff's response was found to be insufficient, and the defendant was not obligated to respond further. Therefore, the court dismissed the complaint in the Iori matter as premature.

The relevant facts were that a provider brought an action to recover assigned first-party no-fault benefits, and the defendant appealed from an order granting plaintiff's motion for summary judgment. The main issue decided was whether the plaintiff made a prima facie showing of its entitlement to summary judgment, as the motion was supported by an affidavit of an employee of a third-party billing company that failed to comply with CPLR 4518. The holding of the court was that the judgment was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion for summary judgment was denied, as they failed to make a prima facie showing of entitlement to summary judgment.

The relevant facts considered by the court were that Andromeda Medical Care, P.C. was seeking to recover assigned first-party no-fault benefits from Utica Mutual Insurance Company. The main issue decided was whether the defendant's motion for summary judgment should be granted or denied, and whether the plaintiff's cross motion for summary judgment was proper. The holding of the case was that the defendant's motion for summary judgment was denied, as the affidavits in support of the motion did not comply with CPLR 2309 (c) and thus failed to introduce competent evidence in admissible form. The court also ruled that the plaintiff's cross motion for summary judgment was properly denied, as the billing records did not constitute evidence in admissible form.

The court considered the fact that plaintiff J & S Medical Supplies, Inc. brought an action against defendant Republic Western Insurance Co. for first party no-fault benefits. The main issue in the case was whether the action was time-barred. The court held that assuming the defendant qualified as a self-insurer, the plaintiff's action for first party no-fault benefits was governed by a six-year statute of limitations, and was therefore timely commenced. The court affirmed the order of the Civil Court of the City of New York, Bronx County, which denied the defendant's motion to dismiss the action as time-barred.

The court considered a case in which the plaintiff alleged that the defendants had committed slander per se by reporting to the police that the plaintiff had filed a fraudulent claim for no-fault medical benefits for his son. The plaintiff's complaint failed to comply with CPLR 3016(a), which required that a complaint sounding in defamation set forth the particular words complained of. The defendants' motion to dismiss the complaint for failure to state a cause of action was denied by the Supreme Court. However, the Appellate Division reversed that decision, holding that the plaintiff's complaint did not meet the requirements set forth in CPLR 3016(a) and that the motion to dismiss the complaint should have been granted. Therefore, the Appellate Division ruled in favor of the defendants and ordered the dismissal of the complaint.