No-Fault Case Law

The court considered the facts of the case, which involved an action to recover assigned first-party no-fault benefits. The main issue decided was whether the alleged injury arose out of an insured incident. The court held that defendant's submissions in opposition to plaintiff's motion for summary judgment raised triable issues of fact as to whether the injury did not arise out of an insured incident, and thus, plaintiff's motion for summary judgment should have been denied. Therefore, the court reversed the order granting plaintiff's motion for summary judgment and remanded the matter for further proceedings.

The main issue in the case was the entitlement of the plaintiff to the summary judgment. The facts reveled that the affidavit submitted by the plaintiff's owner failed to lay a proper foundation for the documents annexed to the moving papers and it was insufficient to establish personal knowledge needed to lay a foundation for the admission of business records as documents. Hence, plaintiff failed to make a prima facie showing of entitlement to summary judgment. Defendant did not cross-appeal from so much of the order as denied its cross motion for summary judgment dismissing the action. However, the Court granted summary judgment to the non-appealing party. Defendant's peer review report established prima facie that there was no medical necessity for the MRIs performed by plaintiff, therefore defendant was entitled to the relief.

The court considered that the defendant did not deny the subject claims within the 30-day timeframe required by law. As a result, the defendant was precluded from asserting any statutory defenses, defenses predicated upon breach of conditions precedent or policy exclusion, or a defense of provider fraud based on fraudulent billing practices. The main issue decided was whether the defendant's untimely denial of the claims precluded them from asserting any statutory defenses or policy exclusions. The holding of the court was that the defendant's untimely denial did preclude them from asserting these defenses, and as a result, the plaintiffs' motion for summary judgment was granted in the principal amount of $21,913.39.

The main facts considered by the court were that the plaintiff's motion for summary judgment was denied due to the insufficiency of certain documents and the lack of justification for not presenting new facts. The main issue was whether the plaintiff had a reasonable justification for failing to present the new facts and whether there had been a change in the law that would warrant a renewed motion for summary judgment. The court held that the plaintiff failed to provide a reasonable justification for not presenting the new facts on the original motion and that the cases cited by the plaintiff did not represent changes in the decisional law. Therefore, the denial of the motion for summary judgment was affirmed, and it was determined that a motion should have been made to reargue if the plaintiff felt that the motion court had overlooked or misapprehended existing law.

The main issue in this case was whether the plaintiff, Psychological Practice, P.C., was entitled to summary judgment in a lawsuit to recover assigned first-party no-fault benefits from NY Central Mutual Fire Ins. Co. The court considered the sufficiency of the affidavit submitted by the plaintiff's owner, which stated conclusorily that the documents attached to the motion papers were plaintiff's business records. The court found that the affidavit was insufficient to establish the owner's personal knowledge of the plaintiff's practices and procedures, and therefore failed to lay a foundation for the admission of the documents as business records. As a result, the plaintiff failed to make a prima facie showing of its entitlement to summary judgment, and the denial of the motion for summary judgment was affirmed. Therefore, the holding of the case was that the plaintiff's motion for summary judgment was properly denied.

The relevant facts considered by the court were that Diamond Chiropractic, P.C. appealed a judgment from the Civil Court of the City of New York, which denied their petition to vacate the master arbitrator's award and dismissed the proceeding. The main issue decided was whether there was a rational basis for the determination of the master arbitrator upholding the arbitrator's award which denied petitioner's claims for first-party no-fault benefits. The holding of the court was that there was indeed a rational basis for the determination of the master arbitrator, and therefore the judgment was modified to confirm the master arbitrator's award. The court also noted that the petition was timely filed.

Facts: The plaintiff, East Acupuncture, P.C., brought a lawsuit against Electric Insurance Co. to recover assigned first-party no-fault benefits. The plaintiff filed two separate motions for summary judgment to recover treatment costs for different individuals. Defendant then cross-moved for summary judgment. Plaintiff’s proof of mailing of the claim forms was insufficient for one of the claims. Issues: The main issues in this case were whether the plaintiff’s motions for summary judgment should be granted and whether the defendant’s denials were untimely, and if the plaintiffs were defrauding the defendant. Holding: The court modified the order by denying plaintiff’s motions for summary judgment and affirmed without costs. The court ruled that the plaintiff’s motion for summary judgment should have been denied in one of the claims due to insufficient proof of mailing. In addition, the defendant’s denials were found to be untimely, and there was not enough proof that the plaintiffs were defrauding the defendant, so the defendant was not precluded from asserting a defense.

The relevant facts considered by the court were that the Plaintiff was seeking to recover no-fault first party benefits for medical services provided following a motor vehicle accident. The Plaintiff argued that the Defendant failed to pay or issue a valid denial within thirty days of receipt of the claim. The Defendant argued that it had issued a denial based on the untimeliness of the Plaintiff's claim. The main issue decided by the court was whether the Defendant's proof of mailing of its denial was sufficient to defeat the Plaintiff's motion for summary judgment. The holding of the court was that the Plaintiff's motion for summary judgment was granted, and the Defendant's cross-motion for summary judgment was denied. The Plaintiff was entitled to a judgment in the amount of $12,734.17, plus interest, statutory attorneys' fees, costs, and disbursements of the action.

The relevant facts of the case are that the plaintiff, VA Acutherapy Acupuncture, P.C., sought to recover assigned first-party no-fault benefits, providing evidence of the submission of a statutory claim form and overdue payment. The main issue was whether the defendant, State Farm Ins. Co., was justified in denying the plaintiff's claims due to suspicions of insurance fraud and a belief that the plaintiff was fraudulently incorporated. The holding of the case was that the denial of the plaintiff's claims by the defendant was justified based on a founded belief that the alleged injuries did not arise from an insured incident. The court also found that the defendant's opposition papers raised a genuine issue of fact as to whether the plaintiff was fraudulently incorporated and therefore ineligible for reimbursement of no-fault benefits. As a result, the plaintiff's motion for summary judgment was denied.

The court considered the fact that Respondent, Response Equipment, Inc., was seeking to recover assigned first-party no-fault benefits on claims submitted for Hypolite Francis. The main issue decided was whether Francis was acting as an employee at the time of the accident, as this would require the plaintiff to pursue a compensation claim before the Workers' Compensation Board. The court held that the defendant's proof, including the police accident report, raised a question of fact as to whether Francis was acting as an employee, and this issue must be resolved by the Workers' Compensation Board. Therefore, the order was reversed, and the matter was remanded to the court below with the direction to hold the matter in abeyance pending a prompt application to the Workers' Compensation Board for a determination of the parties' rights under the Workers' Compensation Law.