No-Fault Case Law
JJ & R Chiropractic, PC v Integon Natl. Ins. Co. (2021 NY Slip Op 51149(U))
December 6, 2021
The relevant facts considered by the court in this case were that the plaintiff sued the defendant insurance company to recover unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor, Desocorro. The defendant moved for summary judgment dismissing the plaintiff's complaint on the ground that the medical services provided were not medically necessary and that the amount billed had exceeded the applicable Workers Compensation fee schedules. The main issue decided by the court was whether the defendant's motion for summary judgment was timely, as the notice of trial was filed on August 5, 2020, and the deadline for moving for summary judgment was December 3, 2020. The holding of the court was that the defendant's motion was untimely, as it was served on January 21, 2021, and the defendant failed to establish good cause for the delay in filing the motion, resulting in the denial of the motion for summary judgment.
RX for You v Nationwide Ins. Co. of Am. (2021 NY Slip Op 51171(U))
December 3, 2021
The relevant facts of the case involved a provider seeking to recover assigned first-party no-fault benefits, with the defendant arguing that the plaintiff's assignor had failed to appear at scheduled examinations under oath (EUOs). The main issue decided was whether there was a genuine issue of fact as to whether the EUOs were scheduled at a place reasonably convenient to the plaintiff, and whether there was a mutual agreement to reschedule the EUO. The holding of the case was that the court found a triable issue of fact regarding the convenience of the scheduled EUOs and the rescheduling agreement, and therefore, the defendant's motion for summary judgment to dismiss the complaint was denied. The court also found that the plaintiff's request for a finding that the prima facie case had been established and an order sanctioning the defendant lacked merit.
Forest Hills Healthcare Physician, P.C. v Lancer Ins. Co. (2021 NY Slip Op 51170(U))
December 3, 2021
The relevant facts of the case included a provider seeking to recover assigned first-party no-fault benefits, and the defendant moving for summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor was not a passenger in the defendant's insured's car when the accident occurred. The main issue decided was whether the defendant's moving papers established, prima facie, that the plaintiff's assignor was not a passenger in the defendant's insured's vehicle when the accident occurred. The holding of the case was that the defendant's moving papers did not establish, prima facie, that the plaintiff's assignor was not a passenger in the defendant's insured's vehicle, and therefore the denial of the defendant's motion for summary judgment to dismiss the complaint was required. As a result, the order denying the defendant's motion was affirmed.
New York Med. & Diagnostic Ctr. v GEICO Ins. Co. (2021 NY Slip Op 51138(U))
December 2, 2021
The court considered the fact that the plaintiff sued the defendant insurance company to recover unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor, Browne. The defendant moved to dismiss the complaint on the grounds that the plaintiff submitted some claims untimely and other claims exceeded the fee amount prescribed by applicable fee schedules. The main issue decided was whether the plaintiff's untimely submission of claims and failure to comply with fee schedules excused the defendant from liability for the payment of the claims. The holding of the case was that the defendant's motion for summary judgment was granted as to the early July 2019 bills, but denied for the late July 2019 bill. The plaintiff's cross-motion for summary judgment in its claims was ultimately denied.
Veraso Med. Supply Corp. v Nationwide Ins. (2021 NY Slip Op 51167(U))
November 26, 2021
The main issue in this case was whether Veraso Medical Supply Corp. was eligible to recover first-party no-fault benefits. The court considered whether the company had complied with the applicable New York State or local licensing requirements necessary to perform such services in New York. The court found that Veraso Medical Supply Corp. had failed to comply with the local licensing requirements and therefore was not eligible for reimbursement under 11 NYCRR 65-3.16 (a) (12). As a result, the judgment of the Civil Court dismissing the complaint was affirmed. The holding of the court was that Veraso Medical Supply Corp. was not eligible to recover the sought-after first-party no-fault benefits due to their failure to meet licensing requirements.
Rite Aid Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2021 NY Slip Op 51161(U))
November 19, 2021
In the case of Rite Aid Medical Supply Corp. v New York Central Mutual Fire Insurance Company, the main issue was whether the defendant's motion to sever the claim of each assignor into separate actions should be granted. The relevant facts considered by the court included the claims arising from two different accidents on different dates, as well as the denial of one claim on the ground of lack of medical necessity and the denial of the other claim due to a failure to cooperate with the defendant's attempt to investigate the alleged accident. The court ultimately held that the defendant's motion to sever the claim of each assignor into separate actions should have been granted due to the different questions of fact and law involved. The order denying the defendant's motion was reversed, and the defendant's motion to sever the claim of each assignor into separate actions was granted.
Sabodash v Hereford Ins. Co. (2021 NY Slip Op 51099(U))
November 19, 2021
The court considered the fact that the plaintiff, Valeriy Sabodash, MD, sought payment of no-fault benefits for medical treatment for an individual who was involved in a motor vehicle accident and sought medical treatment from the plaintiff for injuries sustained. The treatment provided totaled $1,789.19 and was covered by the defendant's policy but was not paid. The main issue was whether the defendant's denial of the claims for medical services under the no-fault portion of its policy, on grounds that it did not insure any of the vehicles involved in the assignor's accident, was valid, and if the plaintiff could not establish the defendant's lack of coverage. The holding of the court was that the defendant's motion was denied, and the plaintiff's cross-motion was granted, as the defendant failed to establish prima facie entitlement to summary judgment and there was an issue of fact regarding the denial of the claim and payment of benefits for medical treatment.
Psychology After Acc., P.C. v New York Cent. Mut. Fire Ins. Co. (2021 NY Slip Op 51072(U))
November 12, 2021
The relevant facts considered by the court were that the defendant in the case had moved for summary judgment dismissing the complaint on the ground that the plaintiff's assignors had failed to appear for duly scheduled independent medical examinations (IMEs). The main issue decided was whether the plaintiff's assignors had failed to appear for the IMEs, and if so, whether the defendant was entitled to summary judgment dismissing the complaint. The holding of the case was that the proof submitted by the defendant was sufficient to demonstrate that the plaintiff's assignors had failed to appear for the IMEs, and as the plaintiff had not rebutted this showing, the defendant's motion for summary judgment dismissing the complaint was granted.
Country-Wide Ins. Co. v Yao Jian Ping (2021 NY Slip Op 50997(U))
October 26, 2021
The court considered whether to strike the complaint or preclude the plaintiff from offering evidence at trial for failure to comply with discovery orders, as well as whether to allow the defendant to amend his answer to include a counterclaim for $24,938.59 in no-fault benefits. The main issues decided were whether the plaintiff's responses to discovery were sufficient, and if the defendant had a reasonable excuse for his delay in seeking leave to amend his answer. The holding of the case was that the court affirmed the denial of the defendant's motions, as the court found that the plaintiff's responses to discovery were sufficient, and the defendant did not have a reasonable excuse for the delay in seeking leave to amend his answer. The court also found that the proposed amendment would prejudice the plaintiff at that stage of the proceedings.
American Tr. Ins. Co. v Smiley (2021 NY Slip Op 05807)
October 26, 2021
The relevant facts the court considered include that notice was served on defendants' insurer about payments of personal injury protection benefits for medical bills covering the nonparty injured person and that a general release was executed by the injured party after the payment demand was sent. The main issues decided were whether the insurer's right to subrogation accrued before the release was signed and whether the notice was required to be sent directly to the defendants. The holding of the case was that the rights were accrued before the release was signed, as the insurer had imputed knowledge of the right to subrogation and that the notices were properly sent to the defendants' insurer and did not require direct service to the defendants, which establishes the plaintiff insurer's right to subrogation. As such, the defendants' motion to dismiss the action was denied.