No-Fault Case Law

The relevant facts the court considered in this case were that the plaintiff was seeking to recover first-party no-fault benefits for medical services provided to its assignor. The plaintiff submitted claims, setting forth the fact and the amounts of the losses sustained, and payment of no-fault benefits was overdue. The main issue decided was whether the defendant was obligated to pay or deny the claim, and if the plaintiff and its assignor had failed to respond to timely requests for verification. The holding of the case was that since the plaintiff and its assignor did not respond to verification requests, the period within which the defendant was required to respond to plaintiff's claims did not begin to run, and any claim for payment was premature. As a result, the defendant's cross motion for summary judgment was granted, and the complaint was dismissed.

The relevant facts considered by the court in this case include an action to recover first-party no-fault benefits for medical services rendered to the plaintiffs' assignor. The issue decided was whether plaintiffs' assignor was required to appear for examinations under oath (EUOs) as part of the insurance policy and if the failure of plaintiffs' assignor to appear for EUOs constituted grounds for denial of no-fault benefits. The holding of the court was that defendant failed to establish that the insurance policy contained an endorsement authorizing EUOs, and therefore the failure of plaintiffs' assignor to appear for EUOs cannot constitute grounds for denial of no-fault benefits. The court also held that the defendant's submissions are insufficient to raise triable issues of fact pertaining to its defense of fraud. As a result, plaintiffs' motion for summary judgment was granted and the matter was remanded for the calculation of statutory interest and an assessment of attorney's fees.

The court considered an appeal from an order granting the plaintiff's motion for summary judgment in a first-party no-fault benefits action. The main issue was whether the plaintiff provider had established a prima facie entitlement to summary judgment by proof of submission of statutory claim forms to the defendant. The court held that the plaintiffs failed to establish that they submitted the claim forms to the defendant, as there were discrepancies between the claim forms attached to the plaintiff's moving papers and the defendant's denial of claim forms, which were not explained on the record. Therefore, the court reversed the order and denied the plaintiff's motion for summary judgment. A judge concurred with the result but disagreed with certain propositions of law set forth in cases cited in the majority opinion.

The court considered the fact that in this action to recover first-party no-fault benefits, the plaintiff had submitted a completed proof of claim and that payment of no-fault benefits was overdue. The main issue decided was whether the defendant was precluded from raising defenses due to not denying the claim within the 30-day prescribed period. The holding of the court was that the plaintiff's motion for summary judgment was granted and the matter was remanded for the calculation of statutory interest and assessment of attorney's fees pursuant to Insurance Law § 5106 and the regulations promulgated thereunder. The court emphasized that the defendant had failed to clearly and unequivocally meet even the simplest of burdens placed upon them by regulations and the courts, and that they persistently failed to meet timely deadlines and specific denials.

The main issue in this case was whether an insurance carrier was entitled to recoup first-party no-fault basic economic loss payments from defendants, allegedly non-covered persons, after the three-year statute of limitations for personal injuries had passed. The court considered whether the insurance carrier was entitled to the toll on the running of the statute of limitations provided by Insurance Law § 5104 (b). The court held that the defendants' motion to dismiss the action was properly denied because they presented insufficient evidence to establish that the action was excluded from the ambit of Insurance Law § 5104 (b). The court also noted that the defendants could raise the claim that the action was barred by the statute of limitations again if they could provide sufficient evidence that the plaintiff's subrogors had instituted a prior action against them, which would take the instant action outside of the tolling provisions set forth in Insurance Law § 5104 (b).

The issue in the case was a claim for first-party no-fault benefits by A.B. Medical Services PLLC in the sum of $3,971.20. The defendant in the case, GEICO Casualty Insurance Co., timely denied the claims in the respective sums of $1,972.08 and $1,999.12 on the grounds of failure to establish medical necessity. The court found that the specific reason for denying the claims were negative peer review reports. The court found that the denial of claim forms failed to set forth with sufficient particularity the factual basis and medical rationale for its denial based on a lack of medical necessity, and it is therefore precluded from asserting said defense. A.B. Medical thus had a prima facie entitlement to partial summary judgment in the sum of $3,971.20. On the other hand, the dissenting opinion of Golia, J. stated that the claimant waited six months to request the reports, but just two months to bring the action and that the failure of GEICO Casualty Insurance Co. to submit a sworn copy of the peer review report in opposition to the claimant's motion for summary judgment should not be fatal. Therefore, the court modified the order by providing that plaintiff's motion for summary judgment is granted to the extent of awarding plaintiff partial summary judgment in the sum of $3,971.20 and the matter was remanded to the court below for the calculation of statutory interest and assessment of attorney's fees thereon and for further proceedings on the remaining claim.

The case involved a dispute for first-party no-fault benefits for medical services rendered to the plaintiffs' assignors. The plaintiffs moved for partial summary judgment in the sum of $5,460.79, but limited their claim to $5,427.09 on appeal. The court held that the defendant's denial of the claims based on lack of medical necessity was unavailing, as it failed to attach the necessary peer reviews on which the denials were based. The court also addressed the defense of fraudulent procurement of the insurance policy, holding that it could be asserted against the plaintiffs' providers in the action seeking to recover assigned no-fault benefits. The court found that the defendant's submissions in support of this defense raised issues of fact as to whether the insurance policy was fraudulently procured, and thus denied plaintiffs' motion for partial summary judgment. Therefore, the order was affirmed without costs.

The court considered the plaintiff's motion for a two-pronged Order, directing the Court Clerk to seal its records and enjoining the defendant and its counsel from disclosing any documents or information obtained. The relevant facts were that the plaintiff, a medical service provider, sought to recover assigned "No Fault" automobile insurance benefits and the defendant denied the claim, leading to the court case. The main issue was the plaintiff's request for file sealing and a gag order, citing privacy reasons, and the defendant's opposition based on First and Sixth Amendments requiring public and press access to court proceedings. The holding was that the court granted a modified temporary sealing order for privacy reasons, while denying any further relief, and also denied the defendant's request for an injunction. The court also noted that the file would be sealed for 14 days, after which the plaintiff would submit a redacted file to protect identification numbers and patient information, and the injunction request was denied due to the court's limited equitable powers.

The case involved a dispute between two automobile insurance companies over a motor vehicle accident in July 2001. Respondent sought compulsory arbitration with an arbitration service. After the arbitrator's decision, petitioner filed an action to vacate the arbitration award, arguing that it was uncertain and based on errors. The Supreme Court agreed and vacated the initial arbitration award. The Appellate Division upheld the lower court's decision, ruling that the arbitrator's decision was internally inconsistent and failed to present a coherent, rational determination, which warranted vacating the award. The issues decided were whether the Supreme Court correctly vacated the arbitration award and whether the rights and liabilities of the parties would be directly affected by the appellate court's decision. The holding was that the Supreme Court had properly vacated the initial arbitration award and that the appeal was justiciable and denied the motion to dismiss.

The court considered a dispute over first-party no-fault benefits for acupuncture services between Power Acupuncture P.C. and State Farm Mutual Automobile Insurance Company. The main issue was whether a licensed acupuncturist is entitled to recover based on the prevailing fee charged by acupuncturists for licensed services, or based on the fee provided for payment of acupuncture services rendered by a physician. The court held that, under the No-Fault Law, a licensed acupuncturist is entitled to be paid based upon the prevailing fee charged by acupuncturists for licensed services and awarded judgment to Power Acupuncture for $800.24, plus interest and attorney fees, and costs, rejecting State Farm's argument that licensed acupuncturists should be limited to the fee identified for scheduled services absent a showing of unusual procedures or unique circumstances. Additionally, the court expressed concern about the excessive litigation in the context of no-fault first-party benefits and suggested that broader-scoped proceedings in Supreme Court may be a more appropriate forum for resolution of similar disputes.