No-Fault Case Law

The court considered an application made by State Farm Mutual Automobile Insurance Company to stay arbitration of respondent Colleen Dowling's underinsured motorist claim. The main issue decided was whether the application to stay arbitration was properly denied on the grounds that it was not made within 20 days after service of respondent's demand. The court held that the application to stay arbitration was properly denied and that it was not made within the required time frame. Respondent had notified the insurer of the accident immediately after it happened, and could not have known prior to the grant of summary judgment in the personal injury action that she had a viable underinsurance claim against the insurer. As such, the court held that the grant of summary judgment in the personal injury action marked the commencement of respondent's obligation to give written notice of claim "as soon as practicable".

The court considered a motion for summary judgment by plaintiffs seeking first-party no-fault benefits for medical services rendered to their assignor, as well as statutory interest and attorney's fees. The court also considered defendant's cross-motion for consolidation and summary judgment dismissing the complaint based on an affidavit submitted by one of the plaintiffs. The main issue decided was whether the affidavit submitted by Bella Safir was sufficient to establish entitlement to judgment as a matter of law. The holding of the court was that the affidavit submitted by Safir did not establish a prima facie showing of entitlement to judgment as a matter of law, and even if it did, the defendant raised a triable issue of fact as to fraud. As a result, the court affirmed the order denying both motions.

The main issues in this legal case were whether A.B. Medical Services PLLC, as the assignee of Kanzada McGreath, had the right to recover first-party no-fault benefits from State Farm Automobile Insurance Company. The court considered evidence provided by the plaintiff to establish that they submitted the necessary forms to prove "the fact and amount of loss sustained" and were entitled to the benefits. The court held that the plaintiff had established its entitlement to most of the benefits, for which defendant's failure to timely deny the claims precluded most defenses. However, the preclusion rule did not apply to a defense based on a claim of fraud, and the defendant provided proof that included significant discrepancies in the assignors' accounts and allegations of fraud in the medical services provided. Based on this evidence, the court held that there were triable issues as to whether the accident was deliberate, as well as the necessity of certain medical services, and therefore the plaintiff's motion for summary judgment was properly denied.

The court considered the case of Advanced Medical Rehabilitation, P.C. v Travelers Property Casualty Insurance Company and Travelers Indemnity Company, where the plaintiff sought to recover first party no-fault benefits provided to their assignor, David Briggs, pursuant to the No-Fault provision of his insurance policy. The main issue decided was whether the assignment of benefits form was admissible, and if the medical bills were admissible as evidence. The court held that both the assignment of benefits form and the medical bills were inadmissible as evidence. The court found that the assignment of benefits form was not a business record made in the regular course of business by a person with a business duty to report, and it was not properly authenticated or dated. Additionally, the court found that the witness was not qualified to testify as to the record-keeping practices of the entity that prepared and mailed the medical bills, and therefore, the plaintiff failed to prove the essential elements of their case. As a result, the court dismissed the action.

This case involved an action brought by three hospitals to recover unpaid no-fault benefits from the defendant insurance company, Progressive Casualty Insurance Company. The plaintiffs moved for summary judgment, which was granted by the Supreme Court for two of the five causes of action. The remaining three requested causes of action were dismissed. Progressive appealed, and the appeals court reversed the judgment, granting summary judgment to the defendant on two of the causes of action. The court held that the hospitals were not entitled to recover the unpaid benefits for these specific claims. The court also stated that analyzing if the claims were properly joined was not necessary, as this had not been raised in the lower court.

The relevant facts considered by the court included a motion for summary judgment by the plaintiffs to recover first-party no-fault benefits for medical services rendered to their assignor, as well as statutory interest and attorney's fees. The plaintiffs submitted an affidavit that was deemed insufficient to establish that the claim forms were properly completed, as it did not specify for which plaintiff the affiant was acting as the billing manager. The main issue decided was whether the affidavit provided sufficient evidence for the plaintiffs' entitlement to summary judgment. The court held that the affidavit was insufficient to establish that the claim forms were properly completed, and therefore the plaintiffs failed to make out their prima facie entitlement to summary judgment. The order denying the plaintiffs' motion for summary judgment was affirmed.

The court considered the fact that the plaintiff Hospital for Joint Diseases as assignee of its patient had alleged that the defendant no-fault insurer was liable for unpaid claims due to the plaintiff's patient. The main issue decided in this case was whether the defendant was liable under the no-fault provisions of the Insurance Law as the plaintiff alleged. The holding of the court was that the plaintiff's complaint was based on the defendant's failure to pay or deny the claims within 30 days of receipt, however, the defendant established that it previously issued timely denials for identical claims submitted by the plaintiff. Therefore, the defendant was properly granted summary judgment dismissing the complaint.

In the case of Ocean Diagnostic Imaging P.C. v Nationwide Mut. Ins. Co., the plaintiff was seeking to recover $2,670.40 in first-party no-fault benefits for health services provided to its assignor. The plaintiff moved for summary judgment on the grounds that the defendant's denial of its claim was not made within the statutory 30-day period as required by Insurance Law § 5106. The court below denied the motion, but the appellate court reversed the decision, granting summary judgment to the plaintiff for the principal sum of $2,670.40, and remanded the matter to the court below for the calculation of statutory interest and an assessment of attorney's fees. The court determined that the defendant's request to examine the assignor under oath did not toll the statutory period, and that the letters sent by the defendant did not constitute a proper request for verification, therefore, the defendant was precluded from raising defenses and the plaintiff was entitled to summary judgment.

The court considered the fact that plaintiff was seeking to recover first-party no-fault benefits, plus statutory interest and attorney's fees, for medical services rendered to its assignor, pursuant to Insurance Law § 5101 et seq. The main issue decided was whether plaintiff was entitled to partial summary judgment for the claims submitted to the defendant. The court held that plaintiff was entitled to partial summary judgment in the sum of $7,643.18, as it had submitted complete proofs of claims to defendant in 2001, which were not timely paid or denied, and that defendant had not shown a triable issue of fact. The court also held that plaintiff was not entitled to summary judgment for certain claims that were properly denied by the defendant, and remanded the case for the calculation of statutory interest, an assessment of attorney's fees, and further proceedings on the remaining claims.

The court considered the fact that plaintiff sued to recover first-party no-fault benefits for medical supplies provided to an injured assignor. The main issue decided was whether the plaintiff's motion for summary judgment should have been granted. The court held that the plaintiff's motion for summary judgment should have been granted, as the eligible injured person was not required to appear for an examination under oath at the time when the medical supplies were provided. Therefore, the court reversed the order denying the plaintiff's motion for summary judgment, granted the motion in the principal sum of $795, and remanded the matter for a calculation of statutory interest and an assessment of attorney's fees.