No-Fault Case Law

The court considered the fact that the plaintiff, a health care provider, obtained a default judgment in the action to recover assigned first-party no-fault benefits. The defendant's motion to vacate the default judgment was denied on the grounds that their papers did not establish the existence of a meritorious defense. The main issue decided was whether the defendant established that it possessed a meritorious defense to the action. The holding of the case was that since the affidavit executed by the defendant's special investigator "suffice[d] to [demonstrate] issues as to who really operated and controlled plaintiff," the defendant established the existence of a meritorious defense to the action. Therefore, the court reversed the order and granted the defendant's motion.

The court in this case considered whether an insurance company had properly denied a medical equipment provider's claim for first-party no-fault benefits based on a peer review report which stated there was no medical necessity for the equipment. The main issue decided was whether the peer review report submitted by the insurance company was in admissible form, and if it raised a triable issue of fact. The holding of the court was that the insurance company failed to raise a triable issue of fact with respect to the claim at issue, as the peer review report submitted was not in admissible form. The judgment of the lower court was affirmed, and the decision was based on the failure of the insurance company to properly deny the claim based on a peer review report that was not in admissible form.

The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits, and defendant had denied plaintiff's claims based on lack of medical necessity. The main issues decided in the case were whether defendant had established timely mailing of denial of claim forms, and whether the supplies provided by plaintiff were medically necessary. The holding of the case was that the defendant's cross motion for summary judgment was granted to dismiss the complaint seeking the sum of $925.75, as it was established that the supplies for that amount were not medically necessary. However, the defendant was not entitled to summary judgment for the claim seeking the sum of $235.63, as it was not established that those supplies were medically unnecessary.

The main issue in this case was the medical necessity of nerve testing of the assignor's upper and lower extremities in an action by a provider to recover assigned first-party no-fault benefits. The court considered the stipulated prima facie case of the plaintiff, the timely and proper denial of the claims by the defendant, and the dispute over the claims for certain diagnostic testing. The trial court entered into evidence the claim forms, denial of claim forms, and the transcript of the deposition testimony of defendant's peer review doctor. After the trial, the court awarded the judgment in the principal sum of $33.55 to the plaintiff. The appellate court affirmed the judgment, stating that the defendant's peer review doctor established a lack of medical necessity for the medical services, and the plaintiff did not offer any rebuttal evidence to show that the services were medically necessary.

The main issue in this case was whether the plaintiff was required to provide the defendant with an authorization executed by its assignor in order to obtain discovery of the defendant's no-fault file, and whether the plaintiff was responsible for the costs of reproduction of said file. The court dismissed the appeal from the order, stating that no appeal as of right lies from an order which decides a motion that was not made on notice. The court clarified that a motion is made on notice when a notice of motion or an order to show cause is served, and since no notice of motion or order to show cause was served in this case, the appeal was dismissed. The decision was made by Rudolph, P.J., McCabe and Scheinkman, JJ., and the appeal was dismissed.

The facts of the case involved a dispute between Multiquest, P.L.L.C. and Allstate Insurance Company over the reimbursement of first-party no-fault benefits for psychological services rendered in August and September 1999. The main issue decided was whether Multiquest was eligible to receive reimbursement for these services, as Allstate alleged that Multiquest was fraudulently incorporated. The court held that an Insurance Department Regulation was inapplicable to claims for services rendered prior to April 4, 2002, and in a similar case, it was held that the Regulation should be given retroactive effect. However, Allstate established that Multiquest had performed the psychological services in violation of Limited Liability Company Law, thus making them ineligible for reimbursement of no-fault benefits. The holding of the case was that Multiquest was ineligible to obtain reimbursement of the benefits and Allstate was entitled to summary judgment dismissing the complaint.

The relevant facts considered by the court in the case of Quality Health Products, Inc. v Auto One Insurance Company were that the plaintiff sought to recover first-party no-fault benefits that had been assigned to them. The main issue that was decided was whether the defendant, Auto One Insurance Company, had timely determined the plaintiff's claim for benefits. The holding of the court was that the plaintiff had established a prima facie entitlement to summary judgment, and therefore, the motion for summary judgment was granted. The court also determined that the defendant's denial of the claim was untimely, and as a result, the defendant was precluded from raising fraudulent billing as a defense in the action. The matter was remanded to the lower court for the calculation of statutory interest and an assessment of attorney's fees.

The court considered the defendant's motion to strike the plaintiff's complaint or to compel discovery, specifically seeking the production of plaintiff's certificate of incorporation, answers to written interrogatories, and an examination before trial of plaintiff's owner, Valentina Anikeyeva. Defendant had sent a good-faith letter requesting the discovery, but plaintiff rejected the demands. The court denied defendant's motion, but modified the order to compel plaintiff to produce certain requested information and to allow an examination before trial. Defendant's entitlement to discovery was based on detailed reasons to believe that plaintiff was fraudulently incorporated and ineligible for no-fault benefits. The court held that plaintiff's failure to challenge the discovery demands within the prescribed time obligated them to produce the requested information, except for matters which were palpably improper or privileged. Defendant was entitled to production of plaintiff's certificate of incorporation and certain interrogatory answers to ascertain plaintiff's eligibility for reimbursement of no-fault benefits. The court also found special circumstances that warranted the disclosure of plaintiff's corporate income tax returns. However, the defendant's motion to compel production of Anikeyeva's personal income tax returns was denied at that time, but Justice Golia dissented in part, arguing that the unique circumstances of the case justified the need for such disclosure.

The court considered the argument of Eveready Insurance that their request was premature as it was sent before the expiration of the 30-day period for providing the requested verification, which ultimately resulted in granting Infinity Health Product's motion for summary judgment and denying Eveready's cross motion for summary judgment. The main issue decided was that Eveready failed to establish that its time to pay or deny plaintiff's claims was tolled since its follow-up verification request was sent to plaintiff prior to the expiration of the 30-day period within which the verification was to be provided. Infinity Health Products was granted summary judgment and Eveready's defensive argument of excessive fees was precluded by an untimely denial. Eveready further argued that Infinity Health Products was only entitled to recover interest that accrued since the commencement of the action, but the court found that it lacked merit. Ultimately, the court held in favor of Infinity Health Products.

The relevant facts considered by the court were that the plaintiff, Vista Surgical Supplies, Inc., sought to recover no-fault benefits from the defendant, Autoone Insurance Company, on claims for $350 and $766.57. The defendant cross-moved for summary judgment dismissing the complaint, arguing that the plaintiff failed to provide the verification requested. The court found that the letters requesting verification and scheduling independent medical examinations (IMEs) were timely sent, but the plaintiff did not provide the verification requested by the defendant for the $350 claim, so the court granted summary judgment dismissing that claim as premature. However, the court found that the defendant was not entitled to summary judgment dismissing the $766.57 claim because they failed to prove the plaintiff's assignor's failure to appear for the IMEs. The holding of the case was that the plaintiff's claim for $350 was dismissed, but their claim for $766.57 was not dismissed.