No-Fault Case Law

The provider sought partial summary judgment of $1,617.60 in no-fault benefits against MVAIC, and the Civil Court denied the motion. The Appellate Term found that the provider made a prima facie showing by evidence that the statutory billing forms were mailed and received and that payment was overdue. In opposition, MVAIC relied on an unsworn chiropractor's report to support a lack of medical necessity defense. That report was not in admissible form and had to be excluded, so no triable issue was raised. The order was reversed and the provider's motion granted.

The court considered the evidence presented in the form of an affirmation from plaintiff's counsel, an affidavit by a corporate officer of plaintiff, and various supporting documents. The main issue was whether plaintiff's motion for summary judgment in a case to recover assigned first-party no-fault benefits should be granted. The court held that the affidavit executed by plaintiff's corporate officer was insufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures to lay a foundation for the admission of the documents annexed to plaintiff's moving papers as business records. Therefore, the court affirmed the denial of plaintiff's motion for summary judgment.

The court considered the appeal from an order of the Civil Court of the City of New York, Kings County, which had granted the plaintiff's motion for summary judgment and denied the defendant's cross motion for summary judgment. The main issue in this action to recover assigned first-party no-fault benefits was whether the defendant had established timely mailing of its denial forms. The holding of the court was that the defendant failed to establish timely mailing of its denial forms, as the affidavit of its claims processor did not provide a sufficiently detailed description of the standard office mailing procedure to give rise to the presumption of mailing. Additionally, the defendant's additional affidavits produced for the first time in its papers submitted in reply to the plaintiff's opposition were disregarded by the court and may not be considered on appeal, thus defendant was precluded from raising the defense asserted. Therefore, the order of the Civil Court of the City of New York, Kings County, was affirmed without costs.

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.

In this case, Long Island Radiology commenced an action against several insurance companies to recover assigned no-fault benefits for MRIs provided to patients injured in motor vehicle accidents pursuant to prescriptions from physicians and/or medical providers. The defendants moved for summary judgment on the issue of whether they may raise lack of medical necessity as a basis to deny reimbursement claims to radiologists for MRIs. The Supreme Court denied the defendants' motion, and instead granted the plaintiff's cross motion which asked for a determination that the defense of lack of medical necessity is not available against radiologists performing MRIs pursuant to prescriptions. The appellate division reversed the decision, and held that a radiologist who accepts assignments of no-fault benefits stands in the shoes of the injured party and thus the defense of lack of medical necessity is available to the defendants against such radiologists. In summary, the main issue decided was whether the defense of lack of medical necessity is available to deny reimbursement claims by radiologists for MRIs provided to no-fault patients pursuant to prescriptions. The holding of the case was that the defense of lack of medical necessity is indeed available against radiologists who accept assignments of no-fault benefits, allowing the defendants to raise this defense to deny claims for reimbursement to radiologists seeking payment for MRIs.

The court considered the motion for summary judgment by Bath Medical Supply, Inc. to recover assigned first-party no-fault benefits. The court below denied the motion on the grounds that the plaintiff's moving papers failed to allege personal knowledge of the mailing of the claims. On appeal, the defendant raised the argument that the affidavit by plaintiff's corporate officer failed to lay a proper foundation for the documents annexed to plaintiff's moving papers. The court found that the affidavit submitted by plaintiff's corporate officer was insufficient to establish personal knowledge of plaintiff's practices and procedures, leading to a failure to make a prima facie showing. Therefore, the court affirmed the denial of the motion for summary judgment, holding that plaintiff failed to establish a prima facie case. The main issues decided in this case were whether the plaintiff's moving papers alleged personal knowledge of the mailing of the claims and whether the affidavit by plaintiff's corporate officer laid a proper foundation for the documents annexed to plaintiff's moving papers. The court's holding was that plaintiff's motion for summary judgment was properly denied due to the failure to establish a prima facie case.

The relevant facts in this case were that Plaintiff was seeking to recover first-party no-fault benefits as the assignee of five different individuals involved in four separate accidents. The main issue in question was whether the Plaintiff was fraudulently incorporated and therefore ineligible for reimbursement of no-fault benefits. The court decided that the plaintiff's cross motion for summary judgment was premature pending the completion of discovery, as the opposition papers had raised issues about who really operated and controlled the plaintiff. Defendant's opposition papers also raised the issue of whether plaintiff was fraudulently incorporated, making the completion of discovery necessary. Therefore, the decision held that Plaintiff's cross motion for summary judgment was denied without prejudice to renewal upon the completion of discovery. Additionally, the court held that defendant's motion to sever the causes of action was also denied, as there was no showing of prejudice to a substantial right by having the five claims tried together.

The provider sued for $1,791.81 in no-fault benefits for cervical and lumbar MRIs, and the parties stipulated to the prima facie case and timely denial, leaving only medical necessity, on which the insurer bore the burden. The insurer's expert, who had not examined the assignor and reviewed only the MRI reports and treating physician's reports, testified that the MRIs were not necessary. He did not state that the MRIs were inconsistent with generally accepted medical practice, and he conceded his opinion might differ with fuller records. The court found his opinion conclusory and unsupported and gave the peer review minimal weight. The insurer failed to meet its burden, and judgment was awarded to the provider with interest, costs and attorney's fees.

The court considered the evidence presented in a case involving Delta Medical Supplies seeking recovery of first party no-fault benefits from NY Central Mutual Insurance Co. for medical services rendered to its assignor after an automobile accident. The main issue was whether or not the insurance company established the defense of lack of medical necessity for the medical supplies in question. The court found that the insurance company failed to meet its burden of proving lack of medical necessity, as the doctor's testimony was deemed insufficient and biased, and there was no evidence to show that the prescribed supplies were inconsistent with generally accepted medical practices. As a result, judgment was entered in favor of the plaintiff for the amount at issue, plus statutory interest, costs, and attorney's fees.

The relevant facts of this case were that Mega Supply & Billing, Inc. was seeking to recover assigned first-party no-fault benefits, and their motion for summary judgment was denied by the Civil Court of the City of New York, Kings County. Mega Supply's motion was supported by an affirmation from their counsel, an affidavit by a corporate officer, and various documents. However, the affidavit executed by the corporate officer was found to be insufficient in establishing that they possessed personal knowledge of the company's practices and procedures, so as to lay a foundation for the admission of the documents as business records. The main issue decided was whether Mega Supply had established a prima facie case for summary judgment, which the court found they had not. The holding of the case was that Mega Supply's motion for summary judgment was properly denied, as they failed to make a prima facie showing of their entitlement to summary judgment.