No-Fault Case Law

The court considered the case of A.B. Medical Services PLLC, D.A.V. Chiropractic P.C., and Lvov Acupuncture P.C. suing Allstate Insurance Company for $6,523.32 in first-party no-fault benefits for medical services rendered to their assignor. The health care providers moved for partial summary judgment in the sum of $6,326.52, which was comprised of various claims for each provider. The main issue decided was whether the health care providers were entitled to the requested sum, and the court held that the providers were entitled to partial summary judgment in the aggregate amount of $6,334.98. The court found that the providers established a prima facie entitlement to partial summary judgment by showing that they submitted claims setting forth the fact and the amount of the loss sustained, and that payment of no-fault benefits was overdue. The burden then shifted to the defendant to show a triable issue of fact, but the defendant failed to establish by competent evidence that its denial of claim forms were timely mailed within the requisite 30-day period to pay or deny the claims. Therefore, the court granted the provider's motion for partial summary judgment and remanded the case for a calculation of statutory interest and an assessment of attorney's fees on the aggregate sum of $6,334.98.

The relevant facts were that the plaintiff, Great Wall Acupuncture, P.C., sought to recover $789.10 in first-party No-Fault benefits from defendant GEICO General Insurance Co. for acupuncture treatment provided to June Jackson. The defendant had reimbursed only $380.90 for the treatment, arguing that the fee billed exceeded the permissible charges for similar procedures under existing fee schedules. The main issue was whether acupuncture performed by a licensed acupuncturist should be reimbursed at a rate higher than what was considered permissible for chiropractors. The court held that plaintiff's motion for summary judgment was denied, as they failed to establish that a licensed acupuncturist should receive higher fees, and the fact that a licensed acupuncturist's services are similar to that of a chiropractor was not resolved. The only remaining issue for trial was whether the defendant had properly reduced the amount billed.

The court considered that defendant insurer had moved for summary judgment dismissing the complaint. The main issue was whether the record established, as a matter of law, that the plaintiff failed to submit proof of his claims for medical expenses and lost wages within the applicable time limitations. The court held that the Supreme Court erred in granting the defendant insurer's motion for summary judgment dismissing the complaint. The record did not establish, as a matter of law, that plaintiff failed to submit proof of his claims for medical expenses and lost wages within the applicable time limitations. The existing record also did not establish the defense of seeking a double recovery as a matter of law. Finally, the plaintiff was not precluded from asserting the claims at bar based on an assignment of benefits executed more than six years prior to the accident.

The court considered a case where Ocean Diagnostic Imaging P.C. sought summary judgment in a dispute with Allstate Insurance Company over the payment of a claim for diagnostic imaging services. The main issue decided was whether the court erred in ordering an assessment of damages after awarding summary judgment in favor of the plaintiff. The holding of the case was that the court did err in setting the matter down for an assessment of damages, as the plaintiff had met the burden of proof for their claim and the calculation of interest and attorney's fees was prescribed by statute. The court remanded the matter for a calculation of statutory interest and an assessment of attorney's fees in accordance with the relevant laws and regulations, and did not address any other issues.

The court considered the fact that plaintiff commenced the action to recover no-fault benefits as the assignee of 11 injured individuals, with claims arising from separate accidents. Defendant moved to sever the assigned claims into separate actions, which the court previously denied. The main issue decided was whether the claims of each assignor should be severed into separate actions. The holding of the case was that the appellate court reversed the previous denial, granted the defendant's motion to sever the claims of each assignor into separate actions, and found that the particular facts relating to each claim are likely to raise few, if any, common issues of law or fact, even if the assignors' insurance policies are identical.

The main issue in this case was whether the trial court properly denied the motion to sever the 47 causes of action to recover unpaid no-fault benefits asserted by the plaintiff. The defendant insurer contended that the claims at issue were being prosecuted by a single assignee against a single insurer but arose from 47 different automobile accidents on various dates and involved unrelated assignors with diverse injuries and medical treatment, as well as different reasons for the denial of benefits and varied defenses. The court ultimately held that it was an improvident exercise of discretion to deny the motion to sever, as a single trial of all the claims would be unwieldy and potentially confuse the trier of fact. Therefore, the appellate division reversed the order, granted the motion, and severed the causes of action to recover no-fault benefits.

The plaintiff New York and Presbyterian Hospital filed a suit to recover unpaid no-fault insurance medical benefits from the defendant AIU Insurance Company. The Supreme Court granted the plaintiff's motion for summary judgment on the first cause of action and denied the defendant's cross motion for summary judgment. The defendant appealed this ruling and also moved for leave to renew that branch of the plaintiff's prior motion which was for summary judgment on the first cause of action. However, the defendant failed to establish its entitlement to summary judgment dismissing the complaint based on the intoxication exclusion. The court awarded one bill of costs to the defendant and reversed the order and judgment, denying the plaintiff's motion for summary judgment. The court vacated the decision entered in June and the order entered in August.

The court considered the plaintiff's motion for summary judgment for recovery of unpaid no-fault benefits and statutory interest and attorney's fees. The plaintiff's assignor was injured in an automobile accident, and the plaintiff submitted the claim to the defendant, who failed to pay within the required 30-day period. The defendant's denial of the claims was found to be untimely, and the defendant failed to provide sufficient evidence to support their defense. As a result, the court granted summary judgment in favor of the plaintiff, awarding the unpaid benefits, interest, attorney's fees, and costs and disbursements. The court held that the defendant breached the contract and was liable for the unpaid no-fault benefits.

The main issue in this case was to recover first-party no-fault benefits for medical services rendered to the plaintiff's assignors. Plaintiff Ocean Diagnostic Imaging P.C. sought summary judgment based on their proof of submitting claims and the overdue payment of no-fault benefits, while defendant New York Central Mutual Fire Insurance Company contended that the claims were denied due to the assignors' failures to attend independent medical examinations (IMEs). The court held that the plaintiff was entitled to summary judgment, as defendant failed to establish proper mailing of the pre-claim IME requests for two of the assignors, and the claim for services rendered to another assignor was not timely denied. As a result, the matter was remanded to the court below for the calculation of statutory interest and an assessment of attorney's fees. The dissenting opinion disagreed with the majority's decision, finding that the defendant's timely denials of all the plaintiff's claims on the grounds of nonattendance at requested pre-claim IMEs warranted denial of the plaintiff's motion for summary judgment.

The main issues in this case revolved around a plaintiff's motion for summary judgment in a first-party no-fault benefits claim against an insurance company. The plaintiff sought to recover statutory interest and attorney's fees, as well as medical expenses for services rendered to their assignor. The court considered whether the plaintiff had made a prima facie showing of entitlement to judgment as a matter of law and whether the insurance company had failed to pay or deny the claim within the statutory 30-day period. The court held that the plaintiff's motion for summary judgment was denied as they failed to make a sufficient showing of entitlement to judgment, and their submissions did not constitute evidentiary proof in admissible form. Therefore, there were issues of fact requiring a trial, and summary judgment was unwarranted.