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 to recover $6,544.71 in first-party no-fault benefits for medical services rendered. The main issue decided was whether the health care providers had established a prima facie entitlement to partial summary judgment by proving the submission of claims, the amounts of losses sustained, and that payment of no-fault benefits was overdue. The court held that the affidavit provided by the medical billing manager of the plaintiff provider companies was insufficient to establish the plaintiff's prima facie entitlement to partial summary judgment. Therefore, the order of the court below was affirmed without costs.

The relevant facts considered by the court in this case involved an action to recover no-fault insurance benefits on behalf of Mount Sinai Hospital, as the assignee of Lily Sagiv. The main issue that was decided was whether the defendant, Allstate Insurance Company, was entitled to summary judgment dismissing the first cause of action on the ground that the policy limits had been exhausted. In its holding, the court reversed the lower court's decision, granting summary judgment to the plaintiffs, and instead granted the defendant's cross motion for summary judgment dismissing the first cause of action, as the defendant had established its entitlement to judgment as a matter of law based on the exhaustion of policy limits. The court found that the plaintiffs had failed to raise a triable issue of fact, and therefore dismissed the first cause of action.

The court considered two consolidated cases involving a health services provider's claim for compensation for an electrical diagnostic test known as current perception threshold testing (CPT) and sensory nerve conduction threshold testing (sNCT). The defendant argued that the medical tests are not compensable under Medicare and that the tests constituted "provider fraud." The court took judicial notice of statements issued by the federal Centers for Medicare and Medicaid Services, which classified CPT and sNCT as procedures not compensable under Medicare. The court found that the available scientific evidence did not demonstrate the accuracy of sNCT as compared to nerve conduction studies and concluded that the scientific and medical literature did not demonstrate the tests' necessity for diagnosing sensory neuropathies in Medicare beneficiaries. Therefore, the court held that the health services provider's claims for compensation for CPT and sNCT were denied.

The main issue in the case is whether the "no-prejudice" rule applies and whether the requirement for timely notice was satisfied. American Transit Insurance Company sought a judgment declaring that it did not have to defend or indemnify the insureds or the victim, arguing that neither the insureds nor the victim provided timely notice of litigation, and that a showing of prejudice was not required before it could disclaim on this basis. Leong cross-moved to dismiss American Transit's complaint, claiming that American Transit's motion was premature and that he had given it timely notice. The court held in favor of the victim, finding that American Transit had timely knowledge of the accident and was well aware of Leong's counsel's involvement in the matter, and it would not permit American Transit to manipulate its own notice requirements to deny coverage to a victim.

The court considered the facts that a plaintiff had submitted claims for first-party no-fault benefits, that payment of these benefits was overdue, and that the defendant had denied the claims. The main issue decided was whether the plaintiff provider had established a prima facie entitlement to summary judgment, and whether the defendant's denials of the claims were timely made within the 30-day statutory period. The holding of the court was that while the plaintiff had established entitlement to summary judgment, the defendant's denial of the claims were not untimely, and therefore, the plaintiff's motion for summary judgment was denied. The court also held that the defendant was not precluded from asserting the defense that the collision was in furtherance of an insurance fraud scheme, despite its untimely denial of the claims.

The relevant facts considered by the court in this case were that New York and Presbyterian Hospital was seeking to recover no-fault benefits under an insurance contract with Allstate Insurance Company. The main issue decided was whether the hospital was entitled to summary judgment on the first cause of action and whether the insurer's cross motion for summary judgment dismissing that cause of action should be granted. The holding of the court was that the Supreme Court should have denied the hospital's motion for summary judgment as it failed to establish entitlement to judgment as a matter of law. Additionally, the insurer's cross motion for summary judgment dismissing the first cause of action should have been granted as it was shown that the policy's coverage limits had been exhausted before the obligation to pay the hospital's claim arose. The court found that the insurer had made a prima facie showing through the affidavits of its claims representatives, denial of claim forms, and payment log that it had complied with 11 NYCRR 65-3.15, and the hospital failed to raise a triable issue of fact in opposition. Therefore, the first cause of action was dismissed.

The main issue in this case was whether the plaintiff, Staten Island Chiropractic Assoc., P.C., was entitled to recover $8,388.13 in first-party no-fault benefits for health care services provided to their assignor. Plaintiff had moved for summary judgment, but the court denied the motion. The court considered the fact that the defendant, Long Island Insurance Company, denied receiving the claims from the plaintiff. The plaintiff's only proof that it submitted its claims was a provider's statement that failed to prove a standard office practice or procedure designed to ensure that items are properly addressed and mailed. The court also considered that although plaintiff proved a claim denial form used by the defendant, the form admitted receipt of no specific claim and cannot be construed to concede that defendant received the specific claims at issue. In the end, the court affirmed the decision to deny plaintiff's motion for summary judgment.

The case involved an action to recover $7,762.98 in assigned first-party no-fault benefits from a motor vehicle accident. The provider of health care services, the plaintiff, established their entitlement to summary judgment by submitting statutory claim forms indicating the fact and amounts of the losses sustained. The burden then shifted to the defendant to create a triable issue of fact. The claim denial form issued by the defendant was found to be untimely, except for a few claims, and was also found to be fatally defective due to the omission of numerous items of requested information, making it incomplete. As a result, the court granted the plaintiffs' motion for summary judgment and remanded the matter to the court for a calculation of statutory interest and an assessment of attorney's fees.

The relevant facts that the court considered in Rigid Med. of Flatbush, P.C. v New York Cent. Mut. Fire Ins. Co. were that the plaintiff health care provider sought to recover no-fault benefits for medical services rendered to its assignor, and established a prima facie entitlement to summary judgment by proving that it submitted the statutory claim form and that payment was overdue. The main issue in this case was whether the defendant's denial based on the assignor's failure to attend examinations under oath was proper and timely. The holding of the case was that the defendant failed to establish that the insurance policy contained an endorsement authorizing examinations under oath, and therefore any post-claim examination under oath request could not toll the 30-day period within which the defendant was required to pay or deny the claim. As a result, the plaintiff's motion for summary judgment was properly granted.

The court considered the motion by State Farm Mutual Automobile Insurance Company to vacate a default judgment in an action to recover assigned first-party no-fault benefits. The main issue decided was whether State Farm Mutual Automobile Insurance Company had established a reasonable excuse for its default and a meritorious defense to the action. The holding of the court was that upon a review of the record, there was no basis to disturb the lower court's finding that the defendant had indeed established both a reasonable excuse for its default and a meritorious defense to the action. Therefore, the lower court's order granting the defendant's motion to vacate the default judgment was affirmed.