No-Fault Case Law

The court considered a proceeding pursuant to CPLR article 75, seeking to permanently stay arbitration of a claim for uninsured motorist benefits. They granted a modification of the order to correct inaccuracies in the previous decisions and ordered the matter remitted to the Supreme Court, Kings County, for an evidentiary hearing on whether Allstate Insurance validly disclaimed coverage of the offending vehicle in an accident. The main issue decided was whether the petitioner was entitled to a stay of arbitration based upon the failure of the respondent to provide notice required by the automobile insurance policy, and whether Allstate Insurance disclaimed coverage of the offending vehicle. The court held that timely notice is sufficient and curbs fraud or collusion, and since the petitioner did not claim any prejudice arising from the late notice of the SUM claim, they were not entitled to a stay of arbitration. The court also held that an evidentiary hearing for Allstate Insurance to disclaim coverage of the offending vehicle was needed.

The court considered the timely submission of invoices and/or bills to the defendant, as well as the requirement for a provider to receive direct payment from the insurer under the no-fault regulations. The main issue decided was whether the denial of the claim was timely and whether the assignment of benefits was valid. The court held that the plaintiff was entitled to summary judgment as a matter of law, as the defendant's denial of claim forms was not timely and the assignment of benefits was valid. As a result, the court awarded summary judgment in favor of the plaintiff and against the defendant in the amount of $304.79, with interest, costs, and attorney's fees, and denied the defendant's cross-motion.

The court considered a case in which a medical provider sought to recover first-party no-fault benefits, with the provider's motion for summary judgment being supported by an affirmation from their counsel, an affidavit from an employee, and various documents. The defendant argued that the affidavit failed to lay a proper foundation for the documents, and thus the plaintiff did not establish a prima facie case. The main issue was whether the plaintiff made a prima facie showing of their entitlement to summary judgment, and whether the defendant was entitled to summary judgment. The holding of the court was that the plaintiff failed to make a prima facie showing of their entitlement to summary judgment, and thus their motion for summary judgment was denied. The defendant was also not entitled to summary judgment, as there was no proof that their denials were timely issued.

The main issue in this case was whether the lower court erred in granting plaintiff's motion for summary judgment and denying defendant's cross motion to dismiss the complaint for lack of subject matter jurisdiction in an action to recover assigned first-party no-fault benefits. Plaintiff had moved for summary judgment and defendant cross-moved to dismiss the complaint, arguing that the claims were separate and distinct and each was within the Civil Court's monetary jurisdictional limit of $25,000. The court found that the affidavit by plaintiff's corporate officer submitted in support of the motion failed to lay a proper foundation for the documents annexed to plaintiff's moving papers, and as a result, plaintiff failed to establish a prima facie case. Therefore, the judgment was reversed without costs, and the branch of the order entered November 18, 2005 which granted plaintiff's motion for summary judgment was vacated. The decision was to deny plaintiff's motion for summary judgment.

The relevant facts considered by the court were that Vista Surgical Supplies, Inc. was seeking to recover assigned first-party no-fault benefits from GEICO Insurance Co. The motion for summary judgment made by Vista was supported by an affirmation from their counsel, an affidavit by an officer of the company, and various documents. However, the court found that the affidavit by the company's officer was insufficient to establish personal knowledge of the company's practices and procedures, and therefore the documents could not be admitted as business records. As a result, the court denied Vista's motion for summary judgment. The main issue decided was whether Vista had made a prima facie showing of its entitlement to summary judgment, which the court found they had not. The holding was that Vista failed to make a prima facie showing of its entitlement to summary judgment, and therefore the motion was properly denied.

The court considered the facts surrounding a dispute over first-party no-fault benefits, with the plaintiff, Mega Supply & Billing, Inc., seeking summary judgment. The main issue decided was whether the defendant, AIU Insurance Company, had established a triable issue of fact concerning the denial of the claim based on the assignor's nonattendance at an examination under oath (EUO). The holding of the court was that the defendant failed to raise a triable issue of fact, as they did not establish by admissible proof that the EUO scheduling letters were mailed, therefore granting the plaintiff's motion for summary judgment and remanding the matter for the calculation of interest and attorney's fees.

The main issue in this case was whether the provider, Alfa Medical Supplies, Inc., was entitled to recover assigned first-party no-fault benefits from Liberty Mutual Ins. Co. The court considered the fact that Alfa Medical Supplies, Inc. had filed a motion for summary judgment supported by an affirmation from plaintiff's counsel, an affidavit by an employee of plaintiff, and various documents. However, the court denied the motion on the ground that the employee's affidavit failed to set forth her job duties or the basis of her personal knowledge of plaintiff's billing procedures. As a result, the court held that plaintiff failed to make a prima facie showing of its entitlement to summary judgment. Therefore, the order denying plaintiff's motion for summary judgment was affirmed.

The court considered the issue of whether the provider in a no-fault benefits case made a prima facie showing to support their motion for summary judgment. The main issue decided was whether the documents annexed to plaintiff's motion papers were admissible as business records, as the affidavit submitted by the plaintiff's employee did not establish the employee's personal knowledge of the plaintiff's practices and procedures. The holding of the case was that plaintiff's motion for summary judgment should have been denied, as they failed to make a prima facie showing of their entitlement to summary judgment. The court also stated that the defendant was not entitled to relief since there was no proof that the defendant's denials were timely issued.

The relevant facts considered by the court in the case involved an insurance company denying a claim for first-party no-fault benefits on the ground of medical necessity, and the plaintiff's contention that the denial of claim form was defective. The main issues decided by the court were whether the denial of claim form was timely and whether it was defective due to being issued by an unlicensed insurance adjuster. The holding of the case was that the court affirmed the denial of the plaintiff's motion for summary judgment, as the affidavits submitted by the defendant sufficiently established the timely mailing of the verification requests and the denial of claim form. Additionally, the court found that the plaintiff had failed to establish that the denial of claim form was defective.

The main issue in this legal case was whether a radiological medical provider, seeking to recover no-fault benefits provided to a patient based upon a referring physician's prescription, was required to produce an individual with personal knowledge of the medical necessity for the radiological scans or X-rays it performed for the patient. The court held that it was not necessary for the radiological medical provider to produce a person for its deposition with personal knowledge of the necessity of the services rendered, and that the defendant's remedy to obtain such information was to depose the patient/assignor's nonparty referring or treating physician. The court also found that the notice to take deposition issued by the defendant was too broad, as it directed the plaintiff to produce a person to contest the defense to be offered by the defendant insurer at the trial, and required the plaintiff to produce records and reports of other persons and companies. As a result, the defendant's notice to take deposition was deemed improper and was stricken.