No-Fault Case Law

The court considered an appeal from an order of the Civil Court that denied the plaintiff's motion for partial summary judgment in an action to recover first-party no-fault benefits for medical services rendered to its assignor. The main issue decided was whether a billing provider seeking to recover no-fault benefits for services rendered by treating health care providers who are independent contractors is considered a "provider" of the health care services within the meaning of the law. The court held that where a billing provider seeks to recover no-fault benefits for services rendered by independent contractors, it is not considered a "provider" of the health care services within the meaning of the law and is therefore not entitled to recover direct payment of assigned no-fault benefits from the insurer. The court also held that lack of specificity in the business relationship of the treating provider does not establish plaintiff's prima facie entitlement to summary judgment as a matter of law.

The relevant facts the court considered were that Avenue N Medical, P.C. initiated a compulsory arbitration proceeding against New York Central Mutual Fire Insurance Company to recover first-party no-fault benefits for medical services rendered to its assignor following an automobile accident. The arbitrator and master arbitrator both denied Avenue's claim for benefits. Avenue then sought to vacate the master arbitrator's award, but the court below denied the petition, finding a rational basis for the master arbitrator's determination. The main issue decided by the court was whether there was a rational basis for the master arbitrator's decision to deny Avenue's claim for benefits. The court held that there was a rational basis for the master arbitrator's determination, and, pursuant to CPLR 7511 (e), the court was required to confirm the award. Therefore, the holding of this legal case was that the court affirmed the denial of the petition to vacate the master arbitrator's award and added a provision confirming the award. The case concluded that a special proceeding should terminate in a judgment, not an order.

The court considered the fact that the plaintiff established its entitlement to summary judgment by showing that it submitted claims and that payment of no-fault benefits was overdue. The court also considered the defendant's verification requests for independent medical examinations (IMEs) and the plaintiff's assignor's failure to attend these IMEs. The main issues decided were that the plaintiff was awarded partial summary judgment in the principal sum of $357.94, and the matter was remanded for the calculation of statutory interest and an assessment of attorney's fees. The holding was that the defendant failed to show a triable issue of fact as to the medical necessity of the services rendered, and that the plaintiff is entitled to partial summary judgment in the principal sum of $357.94.

The relevant facts considered by the court in this case included an appeal from an order of the Civil Court of the City of New York, Kings County, denying the plaintiff's motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff had established a prima facie case by presenting proof that it submitted statutory claim forms and that payment of no-fault benefits was overdue. The court held that the affidavit executed by the plaintiff's corporate officer failed to establish submission of the claim form, and that the plaintiff did not adequately establish that it submitted the claim form to the defendant. Therefore, the order was affirmed without costs. In summary, the court considered the lack of evidence to support the submission of the statutory claim forms by the plaintiff, and ultimately held that the burden never shifted to the defendant, resulting in the denial of the plaintiff's motion for summary judgment.

The relevant facts considered by the court were that Delta Diagnostic Radiology, P.C. sought to recover first-party no-fault benefits for medical services rendered to its assignor. The plaintiff submitted a statutory claim form and claimed that payment of no-fault benefits was overdue. The main issue was whether the defendant's denial of the claim was sufficient, as the plaintiff argued that the denial did not explicitly set forth the reason for the denial. The court decided that the defendant "fully and explicitly" set forth the reasons for the denial in its peer review report, raising a triable issue of fact. The holding of the case was that the court affirmed the denial of the plaintiff's cross motion for summary judgment, finding that the defendant's denial was sufficient.

The court considered the requirements for a prima facie showing of entitlement to summary judgment in a first-party no-fault benefits case. The main issues decided were whether the plaintiff had submitted a claim and whether the defendant's denial was untimely. The holding of the case was that the plaintiff had failed to establish a prima facie entitlement to summary judgment, as it did not provide sufficient proof that it submitted the claim to the defendant. The court also found that the defendant's denial was untimely and that the defendant had failed to establish a triable issue of material fact as to fraud. The dissenting opinion argued that the majority's decision expanded the requirements for a prima facie case and allowed for a relaxed standard in no-fault matters.

Facts: This case involves an action for first-party benefits brought pursuant to the No-Fault Insurance Law by a health services provider who rendered medical services to a patient in exchange for the patient's rights to collect no-fault benefits. The plaintiff's claim for medical services was received by the defendant insurer on August 11, 2005, and the defendant made an initial verification request that was mailed on August 22, 2005. The plaintiff, however, did not respond to these verification demands. Issues: The main issue in this case is whether the production of an electronic signature assignment of benefits and NF-3 claim form in response to an insurer's verification demand recommences the running of a tolled 30-day no-fault insurance claim denial period. Decision: The court held that the insurer was not obligated to accept electronic records or signatures and may require that such records and signatures are submitted in hard copy form. Thus, the defendant's verification request was proper, and the plaintiff's claim was determined to be premature. As a consequence, the defendant's motion to dismiss the plaintiff's complaint was granted, and the plaintiff's cross motion for summary judgment was denied as moot.

The relevant facts considered by the court were that Capri Medical, P.C. sought to recover first-party No-Fault benefits for medical services provided to Nail Abusov. The plaintiff submitted proof of submitted statutory claim forms and alleged that the defendant issued untimely denials in response. The main issue decided by the court was whether the plaintiff was entitled to summary judgment as a matter of law. The holding of the case was that the plaintiff's motion for summary judgment was granted, and the plaintiff was awarded judgment in the amount of $4,204.33 plus statutory interest, costs, and attorneys' fees. The court found that the defendant failed to raise a triable issue of fact and that the plaintiff established a prima facie entitlement to summary judgment.

The main issue before the court was whether the plaintiff's assignor, Jonathan Laul, qualified for MVAIC no-fault benefits. The defendant argued that there was no coverage with MVAIC due to Laul's failure to qualify for these benefits and because the statute of limitations had expired. The plaintiff claimed that it had rendered services to Laul and submitted bills and claims to the defendant in accordance with no-fault regulations. The court considered the evidence submitted by both parties and ultimately held that the defendant failed to meet its burden of proof for summary judgment. Therefore, the motion for summary judgment by the defendant was denied.

The court considered the facts of a motor vehicle accident on January 27, 2003, and subsequent acupuncture treatments received by the injured party, along with the requirement to provide timely notice of claim to the defendant, Motor Vehicle Accident Indemnification Corporation (MVAIC). The main issue decided was whether the plaintiff fulfilled the reporting requirements of Insurance Law Article 52, specifically the requirement to provide a police report and notarized household affidavit to MVAIC to qualify for benefits. The holding of the court was that the plaintiff failed to establish that the claimant was a "covered person" entitled to MVAIC benefits by not timely filing a proper notice of claim, and therefore, the defendant's motion for summary judgment was granted, resulting in the dismissal of the plaintiff's cause of action for unpaid medical bills in the amount of $1,080.00.