No-Fault Case Law

The court considered the medical records and testimony of the treating physician and the defendant's expert witness, Dr. Joseph C. Cole, to determine whether an electromyography (EMG) and nerve conduction velocity (NCV) test were medically necessary. The main issue decided was whether the EMG/NCV conducted on October 5, 2006, following an automobile accident, was necessary. The court held that the defendant failed to demonstrate the lack of medical necessity for the treatment in question. The court emphasized that the defendant's expert witness's testimony did not provide a factual basis and medical rationale for the lack of medical necessity and that the plaintiff's treating physician initially recommended conservative management and only ordered the test after the patient's condition did not improve over a span of over a month. Therefore, the court ruled in favor of the plaintiff.

The case involved a dispute between Impulse Chiropractic, P.C. and New York Central Mutual Fire Insurance Company. Plaintiff's motion for summary judgment was granted in an action to recover first-party no-fault benefits. The issue on appeal was whether there was enough evidence to raise a triable issue of fact about whether the injuries sustained by the plaintiff's assignor arose from an insured incident. Defendant submitted an accident analysis report and an affidavit of a technical consultant to demonstrate this, but the affidavit did not comply with CPLR 2309 (c) because it was not accompanied by a certificate of conformity. Therefore, defendant failed to introduce competent evidence in admissible form to establish that there was a founded belief that the injuries did not arise out of an insured incident. The court held that plaintiff's motion for summary judgment was properly granted and affirmed the judgment. The constitutional challenge to CPLR 2309 (c) was unpreserved for appellate review, and defendant failed to give the requisite statutory notice to the Attorney General.

The case involved an action by a health care provider to recover no-fault benefits from an insurance company for medical treatment provided to two individuals involved in automobile accidents. The insurance company, Progressive Casualty Insurance Company, cross-moved for summary judgment denying one of the claims and granting it for the other. The court decided to grant the cross-motion for summary judgment as to the claim for medical treatment of Gary Donecker but was denied as to the claim for treatment of Ernest Cretara. The main issues the court considered were whether the insurance company, Progressive, had received sufficient verification for both claims, whether Cretara was operating a motor vehicle while intoxicated, and whether Donecker's injuries were related to a motor vehicle accident. Progressive sent various verification request forms and letters requesting documents and information related to the accidents and injuries. However, they had not received all the necessary information to verify the claims. The holding of the court was that due to insufficient verification and the lack of available information concerning Cretara's condition and Donecker's injuries, the insurance company was not required to pay or deny the claims. The court denied the motion for summary judgment as to Cretara's claim but granted it for Donecker's claim, dismissing the no-fault claim for his treatment.

The court considered an action by two medical providers to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the insurance company proffered sufficient evidence to demonstrate that there was an issue of fact as to whether the injuries sustained by the providers' assignor arose from an insured incident. The court found that the insurance company failed to provide enough evidence to show that it possessed a "founded belief that the alleged injuries did not arise out of an insured incident". Therefore, the court granted the providers' motion for summary judgment and remanded the case for a calculation of statutory interest and an assessment of attorney's fees pursuant to Insurance Law § 5106 (a). The holding of the case was in favor of the medical providers, granting their motion for summary judgment and remanding for further proceedings.

The main issue in the case was whether the plaintiff, Colonia Medical, P.C., had made a prima facie showing of its entitlement to summary judgment in a case to recover assigned first-party no-fault benefits. The court considered the affidavit from the plaintiff's corporate officer, which stated that the documents annexed to the motion papers were plaintiff's business records. The court found that this affidavit was insufficient to establish that the officer possessed personal knowledge of the plaintiff's practices and procedures, and therefore, the plaintiff failed to make a prima facie showing of its entitlement to summary judgment. The main decision of the court was to reverse the judgment, vacate the order granting plaintiff's motion for summary judgment, deny plaintiff's motion for summary judgment, and remand the matter to the lower court for determination of the defendant's cross motion to compel depositions.

The court considered the fact that Nagle Medical Plaza, P.C. was seeking to recover first-party no-fault benefits, and that the defendant, Allstate Insurance Company, denied the claim on the grounds that the plaintiff was a fraudulently incorporated professional service corporation. The main issues decided were whether the plaintiff had established a prima facie case for summary judgment and whether the defendant's cross motion for summary judgment should be granted. The holding of the case was that the court reversed the judgment, vacated the order granting plaintiff's motion for summary judgment, denied plaintiff's motion for summary judgment, and remanded the matter to the court for further proceedings. The court found that the affidavit submitted by the plaintiff's president did not establish a proper foundation for the admission of the documents annexed to the moving papers, and that the defendant's argument regarding the plaintiff's eligibility for reimbursement of no-fault benefits was not supported by the evidence.

The relevant facts the court considered in this case involved a provider seeking to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether the affidavit submitted by the plaintiff's corporate officer laid a proper foundation for the admission of documents annexed to the plaintiff's moving papers, and whether the insurance company demonstrated that it timely mailed the denial of claim forms and that there was no medical necessity for the equipment provided by the plaintiff. The holding of the court was that the affidavit submitted by the plaintiff's corporate officer was insufficient to establish a foundation for the admission of the documents, and that the insurance company demonstrated that it timely mailed the denial of claim forms and provided prima facie evidence of no medical necessity for the equipment. As a result, the court reversed the order, denied the plaintiff's motion for summary judgment, and granted the defendant's cross-motion for summary judgment dismissing the complaint.

The court considered the case of Mary Immaculate Hospital Caritas Health Care, which provided first-party no-fault benefits to persons covered by policies of insurance issued by the defendant, Government Employees Insurance Company. The main issue decided was whether the defendant had a valid defense for not paying the claim within the required 30-day period and whether the treatment provided by the plaintiff was the result of an intentional act. The court held that the defendant failed to demonstrate the existence of triable issues of fact and had not come forward with competent evidence to support its contention, thus granting summary judgment in favor of the plaintiff for legal fees and interest on the Second Cause of Action and in favor of the plaintiff on the Third Cause of Action.

The court considered the testimony and evidence presented at trial, where the plaintiff sought recovery of first party no-fault benefits for medical services rendered in connection with injuries sustained from an automobile accident. The main issue was whether EMG and NCV studies of the upper extremities were medically necessary, as the defendant insurance carrier denied payment for these services. The court found that the burden was on the defendant to establish lack of medical necessity, and both medical experts presented by the defendant testified that the tests were not medically necessary based on the information in the patient's medical records. The court concluded that the defendant had met its burden of proof, and since the plaintiff failed to produce any witnesses at trial to rebut the defendant's evidence, the plaintiff's complaint was dismissed. Therefore, the holding of the case was that the defendant insurance carrier was not obligated to pay for the services rendered, as the plaintiff did not meet its burden to establish medical necessity.

The relevant facts of the case were that the plaintiff, a medical provider, sought reimbursement for services rendered to an assignor who was injured in an automobile accident. The defendant insurance company denied the claim, stating that the assignor was a taxicab driver who was injured while driving and therefore may be eligible for Worker's Compensation benefits. The main issue decided by the court was whether the defendant had submitted sufficient evidence to show that the assignor was employed at the time of the accident. The court held that the information contained in the NF-2 form, which stated that the assignor was employed at the time of the accident, and the police accident report stating that the vehicle involved was a taxicab, were sufficient for the defendant to meet its burden. As a result, the court granted the defendant's motion for summary judgment, dismissing the complaint without prejudice, and denied the plaintiff's cross-motion for summary judgment as moot.