No-Fault Case Law

The court considered the fact that Post Traumatic Medical Care, P.C. was seeking to recover no-fault benefits from The Travelers Home and Marine Insurance Company. The main issue decided was whether plaintiff's affidavit was sufficient to establish personal knowledge and lay a foundation for the admission of documents as business records. The holding of the case was that the affidavit submitted by plaintiff's medical billing manager was insufficient to establish personal knowledge of plaintiff's practices and procedures, therefore failing to make a prima facie showing of entitlement to summary judgment. As a result, the Civil Court's decision to deny plaintiff's motion for summary judgment was affirmed.

The court considered the fact that the plaintiff, a medical services provider, sought to recover no-fault benefits for services rendered by independent contractors. The main issue decided was whether the plaintiff was entitled to recover these benefits as a provider under Insurance Department Regulations. The court held that where a billing provider seeks to recover no-fault benefits for services not rendered by it or its employees, but rather by independent contractors, it is not considered a "provider" of the medical services within the meaning of the regulations. The judgment granting the defendant's motion for summary judgment dismissing the complaint was affirmed.

The relevant facts in this case included a dispute over whether the defendant had properly denied the claim on the grounds that the supplies provided were not medically necessary, and the verification requests that had been sent. The main issue was whether the defendant had tolled the prescribed 30-day period for determining the claim, and whether the denial of the claim was properly issued. The holding of the court was that the judgment in favor of the plaintiff was reversed without costs, the order granting the plaintiff's motion for summary judgment was vacated, and the plaintiff's motion was denied. The court found that the defendant had properly tolled the claim determination period, and the motion for summary judgment was denied based on the existence of an issue of fact as to the medical necessity of the supplies provided.

The relevant facts considered in this case were that the plaintiff sought to recover first-party no-fault benefits from the defendant for medical services provided to an assignor who was involved in an automobile accident. The defendant argued that the underlying insurance policy was retroactively cancelled and deemed void ab initio due to misrepresentations made by the insured. The main issue decided was whether the retroactive cancellation of the insurance policy was valid, and the holding of the case was that under New Jersey law, no-fault benefits are unavailable when sought as part of an insured's first-party claim for benefits under their own policy of insurance declared void because of material misrepresentations made to the insurer. The court found that the misrepresentations made by the insured were material and warranted the retroactive cancellation of the insurance policy, and as a result, the plaintiff, standing in the shoes of its assignor, could not recover first-party no-fault benefits from the defendant. Therefore, the defendant's motion for summary judgment was granted and the action was dismissed.

The main issue in this case was whether plaintiff, Careplus Medical Supply, Inc., was entitled to summary judgment in their action to recover first-party no-fault benefits. The court considered the affidavit submitted by plaintiff's president and medical biller, which failed to establish that the documents annexed to plaintiff's moving papers were admissible pursuant to CPLR 4518. As a result, the court held that plaintiff failed to make a prima facie showing of its entitlement to summary judgment and therefore denied plaintiff's motion. Therefore, the holding of the case was that plaintiff's motion for summary judgment was properly denied.

The court considered the plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The defendant had served the plaintiff with various discovery demands and argued that the plaintiff did not make a prima facie showing of entitlement to judgment. The defendant also claimed that the plaintiff's motion should be denied because the plaintiff's owner failed to appear for examinations under oath and failed to respond to discovery demands seeking information about the plaintiff's eligibility for reimbursement of benefits. The main issue decided was whether the plaintiff made a prima facie showing of entitlement to summary judgment, and the court held that the plaintiff failed to do so because the affidavit submitted by the plaintiff's billing manager did not establish that the documents annexed to the plaintiff's motion were admissible. Therefore, the court affirmed the order denying the plaintiff's motion for summary judgment.

The relevant facts in this case were that three medical service providers were seeking to recover first-party no-fault benefits from an insurance company. The providers moved for summary judgment, and the insurance company cross-moved for summary judgment to dismiss the complaint. The main issue decided by the court was whether the providers had made a prima facie showing of their entitlement to judgment as a matter of law, and whether the insurance company had submitted sufficient proof to support its defense that the providers were fraudulently incorporated. The holding of the court was that the providers failed to make a prima facie showing of their entitlement to summary judgment, as the affidavit submitted by their medical biller did not establish that the documents annexed to their moving papers were admissible. Therefore, the court affirmed the order denying the providers' motion for summary judgment.

The court considered a motion for summary judgment in an action by medical providers to recover assigned first-party no-fault benefits. The main issue decided was whether the affidavit submitted by the plaintiffs' medical biller was legally sufficient. The court denied the plaintiffs' motion for summary judgment on the grounds that the affidavit failed to establish that the documents annexed to the moving papers were admissible pursuant to CPLR 4518. As a result, the plaintiffs failed to make a prima facie showing of their entitlement to summary judgment, and their motion was properly denied. Therefore, the holding of the case was that the plaintiffs' motion for summary judgment was denied.

The case involved an appeal from an order denying a motion by defendant to compel plaintiff to accept its late answer or extend its time to serve the answer in a first-party no-fault benefits action. The court considered whether defendant had demonstrated a reasonable excuse for the default and a meritorious defense. The court held that defendant's contention that plaintiff should be compelled to accept its answer was without merit, and defendant failed to establish a reasonable excuse for the default. Therefore, the order denying defendant's motion was affirmed.

The relevant facts considered by the court were that the plaintiff, Ranbow Supply of NY, Inc., sought to recover assigned first-party no-fault benefits from the defendant, NY Central Mutual Fire Ins. Co. Defendant moved for summary judgment dismissing the complaint, which was granted by the Civil Court. However, the affidavit of the defendant's claims representative failed to establish the defendant's entitlement to summary judgment due to a lack of medical necessity. The affidavit was inconsistent, stating that the defendant did not receive the claims at issue prior to the commencement of the action while also stating that it received the claims on specified dates prior to the commencement of the action and timely denied them. The main issue decided was whether the defendant was entitled to summary judgment, and the holding of the court was that the order granting defendant's motion for summary judgment was reversed and defendant's motion for summary judgment was denied.