No-Fault Case Law

The main issue in this case was whether the insurer, New York Central Mutual Insurance Company, properly denied a claim for No-Fault benefits submitted by A.M Medical, P.C. Plaintiff argued that the denials were untimely and insufficient to raise a triable issue of fact, as they were based on an inadmissible "Low Impact Study." Defendant contended that the injuries did not arise from a covered accident and relied on a report prepared by a private consultant, which concluded that the speed of the assignor's vehicle was not sufficient to cause persistent injury. The court held that the defendant's denials were untimely and insufficient, as they were based on an inadmissible report and failed to establish that the accident was deliberate or part of an insurance fraud scheme. The plaintiff's motion for summary judgment was granted, and the plaintiff was given leave to enter judgment against the defendant in the sum of $7,562.00 plus statutory attorneys' fees and interest.

The court considered the fact that the plaintiff, a health care provider and assignee of no-fault benefits, submitted a claim to the defendant, the insurer of the assignor, to recover first party No Fault Law benefits. The defendant's denial of the claim was dated December 2, 2002, which was more than 30 days after the claim was received. The main issue decided was whether the defendant's late denial of the claim precluded them from asserting an affirmative defense. The holding of the case was that the defendant's late denial of the claim precluded them from asserting an affirmative defense, and the plaintiff's motion for summary judgment was granted in the amount of $1,758.40, plus interest and attorneys' fees.

The court considered an appeal from an order denying a motion for leave to reargue summary judgment on a first cause of action to recover no-fault benefits. The plaintiffs, Mount Sinai Hospital and others, appealed from the order, claiming that the Supreme Court had overlooked controlling law and sought leave to reargue the motion. The court held that the appeal was actually one for leave to reargue, not for leave to renew, and that the denial of reargument was not appealable. The appellants did not provide new facts or a change in the law that would alter the prior determination, so the motion for leave to reargue was not granted. Therefore, the appeal was dismissed, and the Supreme Court's order denying reargument was upheld.

The main issue in this case was whether Mary Immaculate Hospital and two other hospitals, as assignees of certain insurance claimants, were entitled to recover no-fault medical payments under certain insurance contracts. The defendant, Allstate Insurance Company, appealed from a judgment in favor of the hospitals, which had been granted summary judgment on their first, fourth, fifth, and seventh causes of action. The defendant argued that the evidence provided by the plaintiff hospitals did not show their entitlement to judgment as a matter of law. However, the court found that the hospitals had made a prima facie showing of their entitlement by providing evidentiary proof that the statutory billing forms had been mailed and received, and that payment of no-fault benefits was overdue. The court also found that the defendant's submissions in opposition were insufficient to raise an issue of fact as to whether it timely issued a partial denial of the claim or paid the claim asserted by the hospitals. Therefore, the judgment in favor of the plaintiff hospitals was affirmed.

The court considered the fact that the plaintiff, S & M Supply Inc., was suing 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 be granted. The court held that the plaintiff's motion for summary judgment is granted for the principal sum of $1,018.47, and remanded the matter to the court below for a calculation of statutory interest and an assessment of attorney's fees. The court found that the defendant's submission of only a portion of an unsworn letter from its medical expert did not set forth a factual basis and medical rationale for the rejection of coverage on the ground that it was not medically necessary, and therefore, the plaintiff's motion should be granted.

The court considered an appeal from the denial of a motion for partial summary judgment in a case to recover first-party no-fault benefits. The main issue decided was whether the plaintiff had established a prima facie case for summary judgment by proving the fact and amount of the loss sustained. The court held that the denial of the claim on the ground that certain treatments were medically unnecessary was justified based on peer reviews and the results of an independent medical examination. The matter was remanded to the court for further proceedings on the claims.

The relevant facts considered by the court were that the plaintiff sought to recover first-party no-fault benefits for medical supplies provided to an injured assignor, and that the defendant did not pay or deny the claims within 30 days. The main issue decided was whether the plaintiff was entitled to summary judgment, and the court held that the plaintiff had established its prima facie entitlement to summary judgment by showing that it had submitted complete proofs of claims to the defendant which the defendant did not pay or deny within 30 days. The holding of the case was that the plaintiff's motion for summary judgment was granted in the principal sum of $1,685.31, and the matter was remanded to the court below for a calculation of statutory interest and an assessment of attorney's fees.

The relevant facts considered by the court in S & M Supply v Kemper Auto & Home Ins. Co. were that the plaintiff sued to recover first-party no-fault benefits for medical supplies it provided to the injured assignor. The main issue decided was whether the plaintiff's motion for summary judgment should be granted. The court held that the plaintiff's motion for summary judgment should be granted for the principal sum of $1,018.47, and the matter was remanded to the court below for a calculation of statutory interest and an assessment of attorney's fees. The court found that the plaintiff's moving papers established a prima facie case for summary judgment. Additionally, the defendant's submission in opposition to the plaintiff's motion did not set forth a factual basis and medical rationale for rejecting coverage on the ground that it was not medically necessary. Therefore, the court granted the plaintiff's motion and remanded the matter for further assessment.

The main issue in this case was whether or not a defendant who purchases an index number in Civil Court can recover that money either by making a motion or in a judgment issued at the end of the litigation. The Court considered the constitutionality of the current system and determined that it violates due process and equal protection rights of individuals. It was found that the system creates two classes of litigants: paying and non-paying customers, and this is a clear violation of the equal protection clause of the New York State Constitution. The Court also addressed the issue of whether the defendant is entitled to reimbursement and concluded that the defendant is entitled to be reimbursed for the expenses incurred in each action. The holding was that the defendant's motion in each action was granted to the extent that the plaintiff is directed to reimburse the defendant the sum of $45.00 in each of the actions, and the application for sanctions was dismissed.

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".