No-Fault Case Law

The case involved an action to recover first-party no-fault benefits under an insurance contract. The plaintiff, Vista Surgical Supplies, Inc., sought summary judgment on the complaint, which the defendant, Travelers Insurance Company, opposed with peer review reports. The court held that the peer review reports were inadmissible because they contained computerized, affixed, or stamped facsimiles of the physician's signature, which failed to comply with CPLR 2106. As a result, the reports did not constitute competent evidence sufficient to defeat the plaintiff's motion for summary judgment. Therefore, the Appellate Term affirmed the plaintiff's motion for summary judgment on the complaint, as the defendant failed to raise a triable issue of fact in opposition to the plaintiff's showing.

The court considered that the provider had previously commenced an identical action, which was dismissed for failure to comply with a so-ordered discovery stipulation. Defendant argued that this dismissal should be with prejudice, and the court sided with the defendant, agreeing that the dismissal was with prejudice and that the plaintiff was therefore barred from commencing a second action. The main issue decided was whether the dismissal of the prior action was with prejudice, and the holding of the court was that it was, and therefore the defendant's motion for summary judgment dismissing the complaint based on the doctrine of res judicata was affirmed.

The Court heard a case involving a medical provider seeking to recover first-party no-fault benefits totaling $5,855.82 from an insurance company. The provider was initially awarded the full amount but the insurance company sought to amend the judgment to limit the attorney's fees awarded. The insurance company claimed that attorney's fees could only amount to 20% of the total first-party benefits, with a statutory maximum of $850 for the entire action. The Court ultimately ruled in favor of the medical provider, stating that attorney's fees were to be calculated on a "per claim" basis, with each claim eligible for the full statutory maximum of $850 in attorney's fees. The ruling was based on Insurance Law § 5106 (a) and LMK Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co. (46 AD3d 1290 [2007]), and effectively overturned the previous decision of the court below to revise the amount of attorney's fees on the judgment.

The relevant facts the court considered included a judgment entered in New York County awarding the defendant medical provider the sum of $12,638.96. This brought up for review an order granting the defendant's motion for summary judgment on its claim for first-party no-fault insurance benefits. The main issue decided was whether the defendant was entitled to judgment as a matter of law, as they established that necessary billing documents were mailed to and received by the plaintiff insurer and that payment of the no-fault benefits was overdue. The court held that the defendant did establish prima facie its entitlement to judgment, but the plaintiff raised a triable issue of fact whether the claimed benefits were properly denied for lack of medical justification. The decision was reversed on the law, with defendant's motion for summary judgment denied and the judgment vacated.

The main issues for consideration in this case were whether the injuries sustained by the plaintiff's assignor were causally related to a motor vehicle accident, and whether the defendant had met their burden of proving that the injuries were not causally related to the accident. The court considered the testimony of the assignor and the defendant's expert, as well as conflicting inferences drawn from the evidence. The court found that the defendant failed to meet their burden of proving that the injuries were not causally related to the accident, and therefore affirmed the judgment in favor of the plaintiff, awarding them the principal sum of $5,250.45. The court's holding was that the defendant's contentions were either unpreserved for appellate review or without merit, and therefore the judgment in favor of the plaintiff was affirmed.

The relevant facts considered by the court in this case were that the plaintiff, Eastern Medical, P.C., moved to reargue and renew the prior order of the court, which granted the defendant, Allstate Insurance Company, the relief requested. The main issues decided were whether the defendant's motion to strike the notice of trial was supported by the requisite affidavit detailing the need for additional discovery, and whether the consolidation of all pending no-fault cases involving the same parties was proper. The court held that the defendant's motion was justified due to outstanding demands for documents, and that the consolidation of the pending cases was proper for the purpose of entertaining the Mallela defense, which served judicial economy and efficiency. Additionally, the court held that the Appellate Division's recent decision in Fair Price Med. Supply Corp. v Travelers Indem. Co. did not change the prior determination, as a Mallela defense is not waived by the failure to assert it in a denial of claim form, nor is it precluded as a result of an untimely denial. Therefore, upon review, the court adhered to its original determination.

The main issue in this case was whether the defendant, Liberty Mutual Insurance Company, was entitled to summary judgment dismissing the action for no-fault first party benefits on the ground that the medical services were performed by an independent contractor. The court considered the fact that the plaintiff provider submitted the treating physician's affidavit stating that he is the plaintiff's president and sole shareholder, not an independent contractor, and that the box for "Independent Contractor" on the NF-3 claim form had been marked erroneously. The court held that in these circumstances, the record presented issues of fact as to whether the services were performed by the plaintiff through its officer rather than an independent contractor. Therefore, the court affirmed the order of the Civil Court denying the defendant's motion for summary judgment.

The relevant facts considered by the court include the defendant's motion to dismiss the plaintiff's complaint for failure to comply with discovery requests, specifically the demand for a verified bill of particulars and combined demand request. The defendant alleged that the plaintiff's failure to respond to the requests would prejudice them at trial. The main issues decided were whether the plaintiff's response to discovery was proper, whether the defendant was entitled to further discovery, and whether the defendant's request for Mallela type documents was justified. The holding of the court was that the defendant's motion to dismiss and for summary judgment was denied, and the court issued a protective order limiting discovery to specific items. The court also found that the plaintiff did not need to further respond to the verification requests.

The court considered the plaintiff’s claim to recover no-fault benefits for medical services rendered to the insured, Jose Rodriguez, after a motor vehicle accident, which the defendant insurance company denied coverage for, alleging it was a staged, intentional collision. The main issue was whether the accident was a covered event under no-fault insurance, and the holding was that the defendant failed to meet its burden of proof in rebutting the plaintiff’s prima facie case of providing medical services. The court also emphasized that under the Fair Price decision, the extent to which the medical services billed for were actually rendered was not the ultimate issue for the court to decide, and regretfully awarded judgment to the plaintiff based on the lack of coverage defense raised by the defendant. The court expressed regret in having to make an award in the event there was provider fraud, but was constrained by higher authority.

The relevant facts of the case involved a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company moved to dismiss the complaint based on the pendency of a prior action in Queens County Civil Court for the same cause of action. The court granted the insurance company's motion only to the extent of deeming the prior action in Queens County Civil Court discontinued, and denied the motion seeking the imposition of costs pursuant to part 130 of the Rules of the Chief Administrator. The main issue decided by the court was whether the instant complaint should be dismissed based on the pendency of a prior action for the same cause of action. The court held that both lawsuits were predicated on the same cause of action, and that the prior action had proceeded to discovery, so the court should properly have dismissed the instant complaint. The court also ruled that the branch of the insurance company's motion seeking costs pursuant to a specific rule was properly denied. The holding of the case was that the order was modified to provide for the dismissal of the instant complaint and affirmed without costs.