No-Fault Case Law

The main issues in this case involved an action by a provider to recover assigned first-party no-fault benefits. The plaintiff moved for summary judgment, but the defendant opposed on the basis that it timely denied the claims due to the assignor's failure to appear for scheduled independent medical examinations. The defendant cross-moved to dismiss the complaint for the plaintiff's failure to appear at an examination before trial. The court below denied the plaintiff's motion for summary judgment and granted the defendant's cross-motion to the extent of compelling the plaintiff to appear for an examination before trial. The Appellate Term determined that the defendant failed to establish the existence of a triable issue of fact and reversed the order. The holding of the case was that the plaintiff's motion for summary judgment was granted, and the matter was remanded to the court below for the calculation of statutory interest and an assessment of attorney's fees.

The relevant facts the court considered in this case were that the plaintiffs were seeking to recover first-party no-fault benefits, but their motion for summary judgment was denied by the lower court due to issues regarding compliance with independent medical examination (IME) requests. The main issue decided was whether the defendant's submission of an affidavit from an employee was sufficient to establish that the IME notices were mailed. The holding of the case was that the affidavit submitted by the defendant was indeed sufficient to establish that the IME notices were mailed, and therefore the order denying the plaintiffs' motion for summary judgment was affirmed.

The relevant facts in this case involved an action by a provider to recover assigned first-party no-fault benefits. The plaintiff's motion for summary judgment was supported by an affirmation from plaintiff's counsel, an affidavit from plaintiff’s president, and various documents annexed thereto. The defendant argued that the affidavit by plaintiff's president failed to set forth facts sufficient to demonstrate personal knowledge of the facts, and as a result, plaintiff failed to establish a prima facie case. The court denied the motion on the ground that defendant raised an issue of fact as to whether the injuries arose from a covered incident. The main issue decided was whether the affidavit submitted by plaintiff's president was sufficient to establish personal knowledge and lay a foundation for the admission of the documents as business records. The holding was that the plaintiff failed to make a prima facie showing of its entitlement to summary judgment, and therefore the motion for summary judgment was properly denied.

The relevant facts in the case were that the plaintiff, Crossbay Acupuncture, P.C., as Assignee of Juan Sanchez, sought to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Company. The main issue decided by the court was on the effect of Lien Law § 169-b on services provided by the petitioner. The court held that the matter should be remitted and that Special Term should consider whether the effect of Lien Law § 169-b on the services provided by the petitioner. The decision of the court was that the lower court erred in determining the issues of the cause of action to be tried. Specifically, the Medical Society never disclaimed any express or implied warranty that the Blood Plasma was fit for its intended purpose. Therefore, there was no error in the instruction of the trial court.

The court heard a case in which Webster Diagnostic Medicine, P.C. was seeking to recover first-party no-fault benefits from State Farm Insurance Company. State Farm Insurance Company moved for summary judgment stating that the injuries under consideration did not arise from the traffic incident and, if they did, the incident was staged to defraud the insurance company. Webster Diagnostic Medicine, P.C. then filed a motion for summary judgment, which State Farm Insurance Company opposed. The main issue decided in this case was whether a defense of staged-accident fraud raised by the insurance company was sufficient to establish a triable issue of fact and whether this warranted a summary judgment. The Court held that the quantum of proof needed to obtain summary judgment is higher than that necessary to establish a triable issue of material fact in opposition to such a motion. Therefore, contrary to the determination of the court below, the prior order which denied defendant's motion for summary judgment did not bar reconsideration of defendant's proof of fraud in opposition to plaintiff's motion. The court found that the offered proof of fraud by the insurance company was not sufficient to raise a triable issue of fact.

The relevant facts in this case involved Primary Psychiatric Health, P.C. seeking to recover first-party no-fault benefits from State Farm Mutual Auto Insurance for psychological services provided to multiple assignors. The only open claims were for psychological services provided to assignors Everald Poole and Terry Johnson. State Farm's sole defense to the claims was that there was "no coverage at all" under its policy because neither of the assignors suffered a psychological injury as a result of the underlying motor-vehicle accident. The court considered the testimony of two expert witnesses, Dr. Rosenfeld and Dr. Rock, who both testified that the assignors did not sustain a psychological injury as a result of the accident. The court held that, based on the evidence presented, there was no coverage for the claims, and entered judgment in favor of the defendant, dismissing the claims.

The court considered the terms of the insurance policy which required the insured to notify the insurance company as soon as reasonably possible of any accident or loss, including the names and addresses of injured persons and witnesses. The main issue decided was whether the insured's failure to comply with these notification duties prejudiced the insurance company, and thus relieved them of the duty to provide coverage under the policy. The court held that the duties under the insurance policy had to be strictly complied with in order for the insured to be entitled to coverage, and that the failure to notify the insurance company as required prejudiced them, thus relieving them of the duty to provide coverage. Therefore, the petition to stay arbitration was denied and the proceeding was dismissed.

The relevant facts that the court considered in "Montefiore Med. Ctr. v Nationwide Mut. Ins. Co." are that Montefiore Medical Center, as assignee of Sherice Haye, was seeking to recover no-fault medical payments under contracts of insurance. Montefiore appealed the denial of their motion for summary judgment on the first cause of action. The primary issue was whether there was a triable issue of fact as to whether the patient’s treatment was unrelated to her motor vehicle accident, as raised by the hospital records and other material submitted by the defendant. The court held that a triable issue of fact existed regarding whether the defendant's denial of no-fault benefits in this case was proper, and therefore they affirmed the lower court’s order.

The relevant facts considered by the court in this case were that the plaintiff, a medical supply company, had failed to comply with a court-ordered examination before trial in a lawsuit seeking no-fault benefits from the defendant insurance company. The main issue decided was whether the plaintiff's failure to comply with the court-ordered examination before trial warranted dismissal of the plaintiff's action. The holding of the court was that the plaintiff's failure to comply with the court-ordered examination before trial resulted in a waste of judicial resources and could not be tolerated, leading to the dismissal of the complaint. The court also affirmed the denial of the plaintiff's motion for reargument and renewal, as there was no reasonable justification for the failure to present new facts that would change the prior determination.

The relevant facts considered by the court in this case include the denial of the plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The plaintiff's motion was supported by an affirmation from their counsel, an affidavit by an officer of the plaintiff, and various documents annexed to the motion papers. However, the court found that the affidavit executed by the plaintiff's officer was insufficient to establish personal knowledge of the plaintiff's practices and procedures, and therefore failed to make a prima facie showing of entitlement to summary judgment. The main issue decided was whether the plaintiff had made a sufficient showing of entitlement to summary judgment, and the court held that they had not. The appeal from the order denying the plaintiff's motion for summary judgment was dismissed, and the order was affirmed without costs. The court also dismissed the appeal from the order entered February 22, 2006, as the plaintiff had raised no issue with respect to that order.