No-Fault Case Law

The relevant facts considered by the court were the defendant's motion to dismiss the case based on the alleged failure of Dr. Noel Howell, the president of the plaintiff medical provider, to appear for scheduled examinations under oath (EUOs). The main issue decided by the court was whether the defendant had submitted competent proof in admissible form to establish the dates of receipt of the claims and whether its EUO requests were made in compliance with the time limits set forth in the verification procedures. The holding of the court was that the defendant failed to provide sufficient evidence to establish that its EUO requests were made in compliance with the time limits, and therefore, there was no basis for the Civil Court to direct a deposition of Dr. Howell. As a result, the court modified the order to vacate the portion directing the deposition of Dr. Howell and affirmed the order as modified.

The court considered the fact that St. Paul Travelers Insurance Company (Travelers) issued automobile insurance policies and compensated or refused to compensate certain professional corporations for acupuncture services rendered to its policyholders under the state's No-Fault Insurance laws and regulations. Travelers alleged that the medical professional corporations were not entitled to payment because they were fraudulently incorporated, were not licensed to provide acupuncture services, and all or some of the services billed to Travelers were performed by independent contractors. The main issues decided were whether the professional corporations were entitled to collect No-Fault benefits for unpaid charges for acupuncture services and whether Travelers' claims for fraud and unjust enrichment due to the alleged fraudulent incorporation and licensing could be limited to payments made on or after April 4, 2002. The holding of the case was that the causes of action for fraud and unjust enrichment by Travelers were limited to payments made to the defendants on or after April 4, 2002, and that a preliminary injunction enjoining the No-Fault collection actions for acupuncture services pending the determination of the action was granted.

The main issue in this case was whether IVB Medical Supply, Inc. was entitled to summary judgment in a case to recover assigned first-party no-fault benefits. The court considered the affidavit submitted by the plaintiff's corporate officer in support of the motion, which failed to lay a proper foundation for the documents annexed to plaintiff's moving papers. The court held that the affidavit was insufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures so as to lay a foundation for the admission, as business records, of the documents annexed to plaintiff's moving papers. As a result, plaintiff failed to make a prima facie showing of its entitlement to summary judgment and the motion for summary judgment was properly denied. Therefore, the order denying plaintiff's motion for summary judgment was affirmed.

The court considered the fact that V.S. Medical Services, P.C. was seeking to recover assigned first-party no-fault benefits from New York Central Mutual Insurance, but their motion for summary judgment was denied by the Civil Court of New York. The main issue decided was whether there was an issue of fact as to whether V.S. Medical Services used an improper code in their billing. The holding of the court was that the affidavit submitted by V.S. Medical Services' corporate officer was insufficient to establish personal knowledge of the company's practices and procedures, and therefore failed to make a prima facie showing of entitlement to summary judgment. As a result, the lower court's denial of their motion for summary judgment was affirmed.

The court considered a case in which Richmond Radiology, P.C. was seeking to recover first-party no-fault benefits from State Farm Insurance Company. The main issue decided was that the order granting defendant's motion for severance was entered on default, as the plaintiff failed to submit opposition to the motion. As a result, the court dismissed the appeal, as no appeal lies from a default order by the defaulting party. The holding of the case was that the appeal from the order granting defendant's motion for severance was dismissed, as the plaintiff failed to oppose the motion, and the order was entered on default.

The relevant facts considered by the court were that the plaintiff, LMS Medical Care, P.C., sought to recover assigned first-party no-fault benefits, and their motion for summary judgment was granted. The main issue decided by the court was whether the defendant, State Farm Mutual Auto. Ins. Co., provided sufficient evidence to demonstrate a triable issue of fact regarding the belief that the alleged injuries did not arise from a covered incident. The holding of the court was that the defendant failed to establish a founded belief, as the accident reports and other documents offered by the defendant did not constitute evidentiary proof in admissible form and were without probative value. The court affirmed the order granting plaintiff's motion for summary judgment, with one justice dissenting.

The court considered the submission of a Notice to Admit as the sole evidence to establish a prima facie case to recover no-fault first party benefits for unpaid medical services. The main issue was whether the submission of a Notice to Admit is sufficient to establish a prima facie case, and whether the failure to respond to a Notice to Admit should be deemed as an admission to material facts. The holding of the case was that Notice to Admit could not be used as the sole evidence to establish a prima facie case, and the failure to respond to the Notice to Admit cannot be deemed as an admission to material facts. The plaintiff failed to provide any additional evidence at trial, and thus was unable to prove through admissible evidence that payment was not made on a timely submitted claim, resulting in the dismissal of the plaintiff's action.

The main issue in this case was whether the defendant, GEICO General Insurance Co., was entitled to summary judgment in the principal sum of $6,139.59 against A.I.D. Medical Supplies. The court considered the fact that the defendant had timely denied the plaintiff's no-fault claim on the grounds of lack of medical necessity, supported by a peer review report. The court determined that the defendant had raised a triable issue of fact and was entitled to deny the claim, as the regulations provide that if a claim is denied based on a medical examination or peer review report, the insurer must release a copy of the report to the applicant or its attorney. The court held that the denial of claim form did not require the carrier to set forth a medical rationale, reversing the order of the Civil Court and remanding the matter for further proceedings.

The main issue in this case was the interpretation of 11 NYCRR 65-4.6 (e), which pertained to attorney's fees in a case with multiple claims in the same action. The defendant and plaintiff disagreed on the interpretation of the statute. The defendant argued that the $850 limitation applied to the action as a whole, whereas the plaintiff argued that it applied to each individual cause of action. The court held that the limitation of $850 for attorney's fees applied to each cause of action, supporting the plaintiff's position in its interpretation of the statute. The court concluded that the plaintiff should be able to enter judgment for any amounts that remained unpaid per cause of action and denied the defendant's motion to the contrary.

The court considered an action to recover no-fault insurance benefits under certain contracts of insurance. The plaintiff, Westchester Medical Center, as assignee of Demetrio Recinos (hereinafter WMC), sought recovery from the defendant, Safeco Insurance Company of America, for its failure to pay or deny the claim within the requisite 30-day period. WMC demonstrated its prima facie entitlement to judgment as a matter of law by submitting the necessary billing forms, certified mail receipt, signed return receipt card referencing Recinos and the forms, and an affidavit of its biller. The defendant failed to raise a triable issue of fact in opposition. The Supreme Court correctly granted WMC's cross motion for summary judgment on the first cause of action. The main issue decided was whether WMC was entitled to recover no-fault insurance benefits from Safeco Insurance Company of America, and the court held that WMC was entitled to judgment as a matter of law due to Safeco's failure to pay or deny the claim within the requisite 30-day period.