No-Fault Case Law

The court considered the defendant's concession of receiving the claim forms and the lack of authentication of the assignor's signature as not constituting a defect in the absence of any statutory or regulatory requirement for the same. The main issue decided was whether the plaintiff established a prima facie case and if the burden shifted to the defendant to demonstrate the existence of a triable issue of fact. The holding was that the defendant's opposition papers established that the plaintiff's assignor failed to appear for pre-claim independent medical examinations, rebutting the presumption that the services rendered were medically necessary, and therefore raised a triable issue of fact. As a result, the plaintiff's motion for summary judgment was properly denied.

The court considered the fact that the defendant had received the claim forms in question in an action to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff had established a prima facie case, and if the defendant had demonstrated the existence of a triable issue of fact. The holding of the case was that the lack of authentication of the assignor's signature did not constitute a defect, as there was no statutory or regulatory requirement for the same. Additionally, the defendant's opposition papers established that the plaintiff's assignor had been sent a request to appear for pre-claim independent medical examinations and had failed to appear, leading to the conclusion that the services rendered by the plaintiff were not medically necessary. As a result, the defendant's opposition papers raised a triable issue of fact, leading to the denial of the plaintiff's motion for summary judgment.

The relevant facts in this case included a dispute over whether a provider established prima facie entitlement to summary judgment in an action to recover assigned first-party no-fault benefits. The main issue decided in this case was whether the plaintiff had sufficiently established the mailing of the claim forms to the defendant, and whether the defendant had demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage. The holding of the case was that the plaintiff's moving papers were insufficient to establish the mailing of the claim forms, but the deficiency was cured by the denial of claim form relating to all of the claims which adequately established that plaintiff sent, and that defendant received, the claim forms. Additionally, the defendant's assertion of a defense that the collision was in furtherance of an insurance fraud scheme was found to be based upon a "founded belief that the alleged injuries do not arise out of an insured incident," and therefore, the lower court properly denied plaintiff's motion for summary judgment.

The court considered the case of Andrew Carothers, M.D., P.C. v. Travelers Insurance Company, where the plaintiff sought first-party benefits, attorney's fees, and statutory interest against the defendant, pursuant to the New York Insurance Law and the No-Fault regulations. The defendant moved to preclude the admission of plaintiff's bills into evidence, arguing that the bills were defective since the relationship between the provider and treating physician was not noted. The main issue decided by the court was whether the plaintiff was entitled to direct payment of no-fault benefits if the alleged medical treatments were provided by an independent contractor. The court held that the defendant failed to demonstrate that the services were rendered by an independent contractor and that the plaintiff's prima facie entitlement to no-fault benefits was established, granting judgment in favor of the plaintiff in specific amounts for each assignor, as well as statutory interest and attorney's fees.

The court considered whether Allstate Insurance Company had a reasonable excuse for the default in the case regarding first-party no-fault benefits. They were required to establish both a reasonable excuse for the default and a meritorious defense. The court held that Allstate Insurance Company failed to establish a meritorious defense, as they had failed to proffer a meritorious defense. Despite their claims, the court held that they were not entitled to delay payment of benefits and that their defense had no merit as a matter of law. Therefore, the court reversed the order that had granted Allstate's motion to vacate the default judgment and found that the motion should have been denied.

In the case of Post Traumatic Med. Care P.C. v Travelers Home & Mar. Ins. Co., the court considered an action to recover assigned first-party no-fault benefits, in which the plaintiff sought summary judgment and was required to respond to defendant's discovery demands. The main legal issue decided was whether the plaintiff was entitled to judgment as a matter of law, by showing that the prescribed statutory billing forms were mailed and received, and that payment of no-fault benefits was overdue. The court held that the plaintiff's submissions were insufficient to establish that payment was overdue, and defendant's papers did not cure such deficiency, thus the plaintiff's cross motion was properly denied. The Appellate Term affirmed the order without costs, and the decision date was October 27, 2006.

The relevant facts considered by the court included an action to recover assigned first-party no-fault benefits by Bell Air Medical Supply LLC. The appellant sought summary judgment for claim forms totaling $738 and $861.50 sent to the defendant, State Farm Ins. Claim Office, after the defendant failed to pay the claim within the prescribed 30-day period. The main issues decided were whether the plaintiff sufficiently established prima facie entitlement to summary judgment and whether the defendant demonstrated the existence of a triable issue of fact as to lack of coverage. The holding of the case was that the plaintiff established its prima facie entitlement to summary judgment as to the $738 claim but not the $861.50 claim, and the burden then shifted to the defendant to demonstrate the existence of a triable issue of fact. The defendant was precluded from raising most defenses due to the untimely denial of the claim but could assert its defense that the collision was in furtherance of an insurance fraud scheme. The lower court's denial of plaintiff's motion for summary judgment was affirmed.

The relevant facts of this case were that a health care provider was seeking first-party no-fault benefits for services rendered to its assignors. The main issue the court decided was whether the insurance policy at issue was properly canceled, and if so, whether the cancellation was retroactive. The court held that the insurance policy was properly canceled retroactively under Virginia law, and therefore, plaintiff's motion for summary judgment was denied, and defendant's cross-motion for an order dismissing the complaint was granted. The court found that the application of Virginia law was proper based on the significant contacts with the contract and legitimate governmental interest.

The court considered the fact that the plaintiff settled his personal injury case and subsequently sued his own insurer, State Farm Mutual Automobile Insurance Company, to recover damages under the supplementary underinsured motorist endorsement of his policy. State Farm raised the affirmative defense that the plaintiff did not sustain a serious injury within the meaning of Insurance Law section 5102 (d), arguing that its policy contained an exclusion requiring the policy holder to sustain a serious injury to recover SUM benefits. The court decided that the insurer cannot raise the defense of lack of serious injury as the plaintiff was not required to demonstrate a serious injury for his breach of contract action against his insurer to recover benefits under the optional, underinsurance endorsement of his insurance policy. The court held that the serious injury threshold was not mandated by law and therefore less favorable to the insured than section 3420 (f) (2) and should not be given effect. Therefore, State Farm's defense was stricken, and the order of the Supreme Court was affirmed.

The court considered that the plaintiff, a health care provider, had submitted evidence that the prescribed statutory billing forms had been mailed and received and that payment of no-fault benefits was overdue. The main issue decided was whether the plaintiff had established a prima facie entitlement to summary judgment, and the court held that they had, as they had shown proof that the billing forms had been properly addressed and mailed and that payment was overdue. The court also considered the defendant's failure to raise any triable issues of fact in opposition to the plaintiff's motion for summary judgment. In the end, the court affirmed the order granting plaintiff's motion for summary judgment and held defendant responsible for $10 in costs.