No-Fault Case Law

The main issue of the case was whether or not the affidavit submitted by the plaintiff's officer was sufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures in order to lay a foundation for the admission of the documents as business records. The court considered the affirmation from plaintiff's counsel, an affidavit by an officer of plaintiff, and various documents annexed thereto. The holding of the court was that the affidavit submitted by plaintiff's officer was insufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures so as to lay a foundation for the admission, as business records, of the documents annexed to plaintiff's moving papers. As a result, plaintiff failed to make a prima facie showing of its entitlement to summary judgment, and therefore, plaintiff's cross motion for summary judgment was properly denied.

The court considered a motion for summary judgment in an action to recover assigned first-party no-fault benefits in which plaintiffs were denied their motion. The denial was based on the failure of the plaintiffs' assignor to comply with properly noticed independent medical examination (IME) requests. The main issue decided was whether the affidavit submitted by the defendant was sufficient to establish that the IME notices were mailed. The holding of the court was that the affidavit submitted by the defendant was indeed sufficient to establish that the IME notices were mailed, and therefore, the order denying plaintiffs' motion for summary judgment was affirmed.

In an action to recover assigned first-party no-fault benefits, the insurer served an untimely answer and the provider then obtained a default judgment. The insurer moved to vacate the default judgment and to compel acceptance of its late answer, arguing that the provider had waived the untimeliness by failing to reject the answer. The record showed that the provider received the answer and did not reject it within the statutory time. The court held that retention of the answer without timely objection waived any objection to its untimeliness and precluded a default judgment. The default judgment was vacated, and the request to compel acceptance of the answer was denied as academic.

The court considered the affidavit of the provider's corporate officer, which stated in a conclusory manner that the attached documents were the provider's business records. The insurer argued that the affidavit failed to lay a foundation for admission of the documents as business records. The court held that the affidavit was insufficient to show that the officer had personal knowledge of the provider's practices and procedures. Because a proper foundation was not laid, the provider failed to make a prima facie showing of entitlement to summary judgment. The order denying the provider's motion for summary judgment was affirmed.

The court considered a motion for summary judgment in an action by a provider to recover assigned first-party no-fault benefits. The motion was supported by an affirmation from the provider's counsel, an affidavit by a corporate officer of the provider, and various documents annexed thereto. However, the affidavit executed by the corporate officer was insufficient to establish that the officer possessed personal knowledge of the provider's practices and procedures so as to lay a foundation for the admission of the documents as business records. As a result, the court denied the provider's motion for summary judgment, holding that the moving papers failed to establish a prima facie case. The main issue decided was whether the provider's motion for summary judgment should be granted, and the holding was that the motion was properly denied due to the insufficiency of the affidavit to establish a prima facie case.

The court considered the fact that the defendant served an untimely answer, and the plaintiff sought and obtained a default judgment. The main issue decided was whether the plaintiff waived the untimeliness of the answer by failing to reject it, and whether this precluded the grant of a default judgment. The court held that a plaintiff's retention of an answer without a timely objection constitutes a waiver of objection as to untimeliness, and such a waiver precludes the grant of a default judgment. Therefore, the default judgment entered against the defendant was vacated, and the defendant's motion was granted to that extent. The court also held that to the extent the defendant sought to compel acceptance of the answer, that branch of the defendant's motion was denied as academic.

The main issues in this case revolve around an action to recover assigned first-party no-fault benefits, where the plaintiff, Vista Surgical Supplies, Inc., sought summary judgment after the denial of their motion by the Civil Court of the City of New York, Kings County. The court considered the fact that the plaintiff established its prima facie entitlement to summary judgment by proof of the submission of a statutory claim form, setting forth the fact and the amount of the loss sustained, and that payment of no-fault benefits was overdue. The defendant's denial was based upon the plaintiff's assignor's nonattendance at independent medical examinations (IMEs), but the defendant failed to establish by proof in admissible form that the IME notifications were mailed and that plaintiff's assignor failed to appear. Therefore, the appellate court reversed the order without costs, granted plaintiff's motion for summary judgment, and remanded the case to the court below for the calculation of statutory interest and an assessment of attorney's fees.

The relevant facts considered by the court in the case of Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. included a dispute over first-party no-fault benefits, with the insurance company denying the claims. The main issue decided was whether the insurance company had timely denied the claims, as required by the 30-day prescribed period. The holding of the court was that the insurance company was precluded from raising most defenses, including lack of medical necessity, fraudulent billing, and excessive fees, due to its failure to pay or deny the claims within the prescribed period. However, the insurance company was not precluded from asserting its defense of an insurance fraud scheme, as it raised a triable issue of fact as to whether there was a lack of coverage. As a result, the lower court's denial of the plaintiff's motion for summary judgment was affirmed by the appellate court.

The plaintiff sued for $4,429.85 in no-fault benefits as assignee of five people injured in five separate accidents, and the insurer moved to sever the claims. The plaintiff argued that four of the claims were denied for lack of medical necessity and sought the same type of treatment, and a fifth had settled. The Appellate Term noted that the denials rested on different peer reviews, which could require testimony from four different doctors. A single trial involving different accidents, injuries and treatment would be unwieldy and confusing. The order was reversed and the motion to sever each assignor's claim into a separate action was granted.

MVAIC appealed a judgment awarding the provider $2,172.18 plus interest and fees, arguing that the provider could not recover because it had not shown that its assignor was a qualified person. The court held that the 30-day period to pay or deny a claim applies to MVAIC as to other insurers and runs from receipt of the claim forms regardless of whether the injured person has been deemed qualified. MVAIC admittedly neither denied the claims within 30 days nor timely requested verification. Its purported requests for information were not shown to have been sent, and its letter to a law firm was neither a valid verification request nor a proper denial on the prescribed form. MVAIC was therefore precluded from raising most defenses, and the judgment was affirmed.