No-Fault Case Law

The relevant facts the court considered were that Align for Health Chiropractic filed suit to recover first-party no-fault benefits, based on their affidavit and documents they claimed as business records. The main issue was whether the affidavit and documents presented by Align for Health Chiropractic were sufficient to establish their right to summary judgment. The court found that the affidavit and documents were not sufficient to establish their right to summary judgment. The holding of the court was that the denial of Align for Health Chiropractic's motion for summary judgment was proper, but that the defendant failed to demonstrate that they timely mailed the verification and follow-up verification requests, and therefore, their cross motion for summary judgment should have been denied.

The main issues considered in this case were whether the insurance company, Allstate, had a valid defense of lack of medical necessity for four claims submitted by Midisland Medical, PLLC. The court found that Allstate had validly denied two of the claims based on lack of medical necessity, but had not addressed the mailing of the denials for the other two claims, therefore precluding the defense. As a result, the court granted summary judgment to Midisland Medical for the two claims that were not properly addressed by Allstate, and remanded the case for further proceedings on the remaining claim. The holding of the court was that Midisland Medical was entitled to summary judgment on two of the four claims and the case was remanded for further proceedings.

The relevant facts the court considered in this case included an action by medical service providers to recover assigned first-party no-fault benefits, and the denial of the plaintiffs' motion for summary judgment by the court below. The main issue decided was whether the affidavit executed by plaintiffs' medical billing manager was sufficient to lay a foundation for the admission, as business records, of the documents annexed to plaintiffs' moving papers. The holding of the case was that the affidavits submitted by defendant's investigators were sufficient to demonstrate that defendant possessed a "founded belief that the alleged injuries do not arise out of an insured incident," therefore demonstrating the existence of a triable issue of fact as to whether there was a lack of coverage. Consequently, the order denying plaintiffs' motion for summary judgment was affirmed.

The main issue in this case was whether a medical equipment provider could recover assigned first-party no-fault benefits from an insurance company. The court considered the evidence presented by both parties, including a peer review report that determined the medical supplies were not medically necessary, and an affidavit from the chiropractor who conducted the peer review. The court ultimately held that the denial of the claim form was sufficient to avoid preclusion of the defense of lack of medical necessity, and that the evidence presented by the defendant demonstrated the existence of a triable issue of fact as to medical necessity. As a result, the court reversed the judgment, vacated the order granting the plaintiff's motion for summary judgment, and denied the motion for summary judgment.

The court considered a case in which Supple Mind Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from State Farm Insurance Company. The parties stipulated that Supple Mind Acupuncture proved its prima facie case, but the sole issue at trial was whether the injuries sustained by the plaintiff's assignor were caused by the accident. State Farm's expert testified that the force of the impact was minimal and the injuries could not have been caused by the accident. However, the expert's testimony and report relied almost exclusively on hearsay evidence, and State Farm did not present any testimony to show that the material relied upon by the expert was accepted in the profession as reliable. As a result, the court held that the expert's testimony and report were inadmissible, and the judgment in favor of Supple Mind Acupuncture was affirmed.

The court considered the plaintiff's action to recover no-fault benefits as assignee of three individuals and the defendant's motion to sever the causes of action into separate actions due to three separate and distinct claims involving different questions of fact and law. The main issue was whether the claims, arising out of three separate motor vehicle accidents and three insurance policies, should be severed into separate actions. The court held that the decision to grant severance was an exercise of judicial discretion and that, in the absence of a party's showing of prejudice to a substantial right, should not be disturbed on appeal. The court further held that the particular facts relating to each claim at issue were likely to raise few, if any, common issues of law or fact, and that a single trial involving different sets of facts regarding three underlying accidents and injuries would pose the danger of being unwieldy and confusing. Therefore, the court affirmed the order granting defendant's motion to sever the causes of action.

The relevant facts considered by the court were that Delta Diagnostic Radiology, P.C. was seeking to recover first-party no-fault benefits from Unitrin Advantage Insurance Company, and the court granted Delta Diagnostic Radiology's motion for summary judgment. However, Unitrin Advantage Insurance Company appealed the decision, arguing that the affidavit submitted by Delta Diagnostic Radiology's officer did not lay a proper foundation for the admission of the documents annexed to the moving papers, and therefore Delta Diagnostic Radiology failed to establish a prima facie case. The main issue decided by the court was whether Delta Diagnostic Radiology had provided sufficient evidence to demonstrate its entitlement to summary judgment. The court held that the affidavit submitted by Delta Diagnostic Radiology's officer was insufficient to demonstrate personal knowledge of the company's practices and procedures, and thus failed to lay a proper foundation for the admission of the documents annexed to the moving papers. As a result, the court reversed the judgment, vacated the order granting Delta Diagnostic Radiology's motion for summary judgment, and denied Delta Diagnostic Radiology's motion for summary judgment, without costs.

The court considered whether the plaintiff, A.T. Medical, P.C., was entitled to summary judgment to recover assigned first-party no-fault benefits from American Transit Insurance Company. The main issue decided was whether the plaintiff made a prima facie showing that the claims were submitted to the defendant, as required by Insurance Law § 5106(a). The court held that the plaintiff failed to establish that the claims were mailed to the defendant, as the affidavit and post office ledger provided were insufficient to prove mailing, and the plaintiff's attorney's affirmation was unsubstantiated hearsay. Additionally, the affidavit by the plaintiff's corporate officer failed to lay a proper foundation for the admission of the documents annexed to the moving papers. Therefore, the plaintiff's motion for summary judgment was denied, and the judgment awarding the plaintiff the principal sum of $7,791.06 was reversed.

The court considered the denial of first-party no-fault benefits by the insurance company based on peer review reports that found a lack of medical necessity for the services provided by the plaintiff. The main issue was whether the denial of the claims was valid and whether the insurer sufficiently informed the plaintiff of the reasons for the denial. The court held that the denial of the claims was not vague or misleading, as the insurer's NF-10 denial of claim forms clearly stated the basis for the denial and the accompanying explanation of benefits forms provided further explanation. The court also held that it was improper for the court to grant summary judgment to the defendant based on the issue of medical necessity since this was not the subject of the plaintiff's motion for summary judgment. Therefore, the judgment denying the plaintiff's motion for summary judgment and granting summary judgment to the defendant was reversed.

The court was asked to determine the medical necessity of electromyogram testing and nerve conduction velocity testing performed on the plaintiff's assignor, Vanessa Garcia, for injuries sustained in a motor vehicle accident. The main issue in the case was whether the testing was done in a manner that rendered the results medically unnecessary, despite the fact that the tests were prescribed correctly. The court relied on previous decisions in similar cases to define what constitutes "medical necessity" and ultimately held that even if the tests were not conducted properly, reimbursement is warranted as long as they were medically necessary. The court found in favor of the plaintiff, as the defendant did not meet the burden of demonstrating a lack of medical necessity for the services rendered. Therefore, the plaintiff was awarded $2,832.14, plus statutory interest, attorney fees, and costs and disbursements.