No-Fault Case Law

The court considered the facts that AVA Acupuncture, P.C. was seeking to recover first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The issue was whether AVA Acupuncture, P.C. had established its prima facie entitlement to summary judgment, and whether New York Central Mutual Fire Insurance Company had demonstrated the existence of a triable issue of fact. The court held that AVA Acupuncture, P.C. had established its entitlement to summary judgment based on the submission of statutory claim forms and that New York Central Mutual Fire Insurance Company had failed to establish that it timely denied the claims, and thus was precluded from asserting its defenses. Therefore, the judgment awarding AVA Acupuncture, P.C. the sum of $2,580.09 was affirmed.

The relevant facts considered by the court were that the master arbitrator had upheld the arbitrator's award, which had denied the petitioner's claims for no-fault benefits. The main issue decided by the court was whether there was a rational basis for the determination of the master arbitrator in upholding the arbitrator's award. The court's holding was that there was a rational basis for the master arbitrator's determination, and, therefore, the court properly denied the petition to vacate the master arbitrator's award. The court also noted that, pursuant to CPLR 7511(e), upon denying the petition, the court was required to confirm the award. The decision was rendered on November 15, 2006.

The relevant facts the court considered were a dispute over the payment of no-fault benefits for medical services provided to an assignor by Andrew Carothers M.D., P.C. The main issue decided by the court was whether the Plaintiff had standing to bring the action and whether they established a prima facie entitlement to the no-fault benefits. The court held that the Plaintiff did have standing based on the assignment provided for services rendered to their assignor and that they established a prima facie case by submitting proof that the claim was timely sent, received by the defendant, and not paid or denied within thirty days. The court also held that the Defendant failed to substantiate their basis for denying the claim on the grounds of lack of medical necessity, and as a result, judgment was entered for the Plaintiff in the amount of $2670.39.

The court considered an action to recover no-fault medical payments in a case where the plaintiff sought summary judgment on a cause of action to recover unpaid medical treatment. The plaintiff submitted a hospital bill with a signed certified mail return receipt and the affidavit of its third-party biller, which showed that the defendants failed to pay the claim or issue a denial of claim form. The defendants were unable to raise a triable issue of fact in opposition to the motion for summary judgment and failed to demonstrate their entitlement to judgment as a matter of law in their cross motion. The Supreme Court found that the defendants' failure to timely object to the adequacy of the claim forms or seek verification of the assignment constituted a waiver of any defenses based thereon. Therefore, the court affirmed the order granting the plaintiff's motion and denying the defendants' cross motion.

The relevant facts considered by the court were in relation to a denied claim for first-party no-fault benefits for medical supplies. The main issue decided was whether the insurer had provided a sufficient basis and medical rationale for its denial of the claim. The decision of the court was that the insurer failed to establish its prima facie entitlement to summary judgment because the denial form was factually insufficient, and the peer review report was not attached or supplied to the claimant within 30 days of receipt. As a result, the insurer was precluded from asserting the defense of lack of medical necessity, and the denial of the claim was affirmed without costs.

The court considered that plaintiff established a prima facie entitlement to summary judgment by proof that it submitted claims and that payment of no-fault benefits was overdue. The defendant's acknowledgment of receipt on its denial form cured any deficiencies in the plaintiff's proof of mailing. However, the court ruled that the defendant's denial was untimely, precluding most defenses. The untimely denial did not preclude the defendant from interposing the defense that the injuries were not causally related to the accident, but the defendant's accident analysis report was not in admissible form. The court affirmed the order without costs. Therefore, the main issues decided included the timeliness of the denial, whether the injuries were caused by the accident, and the admissibility of the defendant's accident analysis report. The holding of the case was that the plaintiff was entitled to summary judgment and the defendant's denial was untimely.

The main issues in this case were whether the defendant was entitled to discovery pertaining to its defenses of lack of medical necessity and fraudulent billing, including the deposition of Dr. Arkady Levitan. The court considered the fact that the defendant timely denied the plaintiff's claims and that the plaintiff's assignor appeared for an independent medical examination (IME) performed by the defendant within the required 30 days. The court held that the defendant was entitled to discovery and granted the defendant's motion for discovery. Therefore, the order of the Civil Court, Bronx County, which denied the defendant's motion to compel discovery, was reversed, and the defendant's motion for discovery was granted.

The main issue in this case was whether the denial of claim forms for first-party no-fault benefits by the insurance company were defective. The court considered whether the denial forms were sufficient, as they stated that the claims were denied based on a peer review report provided to the plaintiff. The holding of the appellate court was that where the insurer provides a factually sufficient peer review report to the plaintiff within the 30-day claim determination period, an NF-10 that states the claim was denied based on the peer review report provided to the plaintiff is sufficient to preserve a defense of lack of medical necessity. The court affirmed the denial of the branches of the plaintiff's motion which sought summary judgment upon the claims in question because the insurer's opposition to the motion included an affidavit from the peer reviewer which incorporated the unsworn peer review report, and therefore the plaintiff was not entitled to summary judgment.

The case involves Fernando Castillo-Gomez appealing an order that denied his motion to dismiss a proceeding as untimely and granted a petition by the Government Employees Insurance Company. The respondent had been in an accident caused by an uninsured vehicle and had sent a letter to his insurer claiming no-fault insurance benefits, uninsured motorist benefits, and supplemental uninsured motorist benefits. The insurer responded by commencing a proceeding to stay arbitration on the grounds that the offending vehicle was insured on the date of the accident, and the respondent moved to dismiss the proceeding as untimely. The Supreme Court stayed arbitration, finding the proceeding to be timely. However, the Appellate Division reversed the order, stating that the proceeding to stay arbitration was time-barred based on the compliance requirements of CPLR 7503 (c), meaning that since the respondent's April 9, 2003 notice of intention to arbitrate complied with all of the statutory requirements, it was sufficient to commence the 20-day period of limitations.

The relevant facts the court considered in this case were that plaintiff AB Medical Services, PLLC, sought to recover first-party no-fault benefits for medical services rendered to its assignor. Plaintiff moved for partial summary judgment, while defendant cross-moved for summary judgment dismissing the complaint. The main issue decided by the court was whether plaintiff had established its prima facie entitlement to summary judgment by annexing the claim forms being sued upon to its motion papers. The court found that plaintiff did not annex any exhibits to its moving papers, and the document entitled "EXHIBITS SERVED WITH THE PLAINTIFF'S SUMMARY JUDGMENT MOTION" was rejected by the court below and not considered in reaching its determination. Therefore, the court affirmed the order denying plaintiff's motion for partial summary judgment without costs and without prejudice to renewal upon proper papers.