No-Fault Case Law

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.

The relevant facts of the case involved an action to recover first-party no-fault benefits for medical equipment provided to the plaintiff's assignors. The plaintiff filed a cross motion for summary judgment after the defendant moved for summary judgment as well. The court denied both motions, stating that the supporting affidavit submitted by the plaintiff was defective because it contained legal arguments even though the affiant was not an attorney. The main issue was whether the plaintiff's cross motion for summary judgment should have been granted, and the holding was that the plaintiff's cross motion sufficed to establish a prima facie cause of action, shifting the burden to the defendant to demonstrate the existence of a material issue of fact. As such, the court granted the plaintiff's cross motion for summary judgment and remanded the case for a calculation of statutory interest and an assessment of attorney's fees.

The court considered the fact that the plaintiff had submitted a completed claim to the defendant for first-party no-fault benefits and had not received payment or denial within the required 30 days. The main issue was whether the defendant had timely sent a verification request to the plaintiff, which would have tolled the 30-day period for denial or payment. The holding of the court was that the plaintiff established its entitlement to summary judgment by showing that the claim was submitted and acknowledged by the defendant, and the burden then shifted to the defendant to show a triable issue of fact, which it failed to do. Therefore, the plaintiff's motion for summary judgment was granted in the principal sum of $517, and the matter was remanded for the calculation of statutory interest and attorney's fees.

The court considered the fact that the plaintiff, Amaze Medical Supply Inc., had filed a motion for summary judgment, which was denied by the Civil Court. The main issue decided was whether the plaintiff had provided proper proof of claim for the recovery of no-fault benefits and if the additional documents submitted by the plaintiff raised a triable factual issue. The holding of the case was that the denial of the plaintiff's motion for summary judgment was affirmed, as the inclusion of additional documents for the first time raised a triable factual issue as to whether certain of the no-fault benefits sought were for equipment that was not part of the prescribed course of treatment or for equipment other than what the patient actually received.