No-Fault Case Law

The court considered the fact that Lvov Acupuncture, P.C. had filed a complaint seeking to recover first-party no-fault benefits, but defendant Hereford Insurance Co. had granted a motion for summary judgment dismissing the complaint on the basis that Lvov Acupuncture had failed to appear for scheduled examinations under oath. The main issue decided was whether the provider had failed to appear for duly scheduled examinations under oath, and therefore was not entitled to recover first-party no-fault benefits. The holding of the court was that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed. The court cited a similar case, Allay Med. Servs., P.C., as Assignee of Harrison, Henry v Travelers Ins. Co., and found that the reasons stated in that case applied to the present case as well. Therefore, the order was affirmed.

The court considered the facts that the plaintiff commenced an action to recover assigned first-party no-fault benefits in 2010, and over five years later, the defendant served a 90-day written demand pursuant to CPLR 3216 (b) (3). The plaintiff failed to comply with the demand by filing a notice of trial within 90 days or move to vacate the demand or extend the 90-day period. The main issue decided was whether the plaintiff had a justifiable excuse for its delay and the existence of a meritorious cause of action. The holding of the case was that the defendant's motion to dismiss was properly granted as the plaintiff made no attempt to demonstrate an excuse for its failure to comply with the 90-day notice, and therefore, the order was affirmed.

The court considered the fact that the plaintiff, Allay Medical Services, P.C., was seeking to recover first-party no-fault benefits as an assignee of Henry Harrison. The main issue in the case was whether the defendant, Travelers Insurance Company, was entitled to summary judgment dismissing the complaint on the basis that the assignor had failed to appear for duly scheduled examinations under oath (EUOs). The court held that the defendant had established that the EUO scheduling letters and denial of claim form had been timely mailed and that the plaintiff had failed to appear for the scheduled EUOs. As a result, the court affirmed the order granting the defendant's motion for summary judgment and dismissing the complaint. Any remaining arguments raised by the plaintiff for the first time on appeal were not considered by the court.

The court considered a prior action in which defendant had been granted summary judgment dismissing the same claims related to the same accident and assignor, Valdez Vallon, as the claims at issue. Defendant moved for summary judgment dismissing the complaint, arguing that plaintiffs' present action was barred by the doctrine of res judicata. The main issue decided was whether the doctrine of res judicata precluded plaintiffs from asserting the same causes of action in the present case as in the prior action. The holding of the court was that plaintiffs were precluded from asserting the same causes of action in this case under the doctrine of res judicata, and therefore, defendant's motion for summary judgment dismissing the complaint was granted.

The court considered a case in which a surgeon performed surgery on a patient who had been injured in a bicycle accident. The patient assigned his no-fault insurance claims to the surgeon, who submitted the claims for arbitration after the insurance carrier denied the claims. An initial arbitrator ruled in favor of the surgeon, but a master arbitrator vacated that award and issued a new award in favor of the insurance carrier. The main issue decided was whether the master arbitrator exceeded his powers by conducting a de novo review of the medical evidence. The holding of the court was that the master arbitrator did exceed his authority by impermissibly performing a de novo review of the medical evidence, and, therefore, the order granting the petition to vacate the award of the master arbitrator and confirming the award of the initial arbitrator was affirmed.

The relevant facts the court considered were that the plaintiff, BQE Acupuncture, P.C., sought to recover assigned first-party no-fault benefits from the defendant, GEICO Ins. Co. The main issue decided in this case was whether the defendant was entitled to summary judgment dismissing the complaint. The holding of the court was that the order denying the defendant's cross motion for summary judgment dismissing the complaint was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted. The decision was based on reasons stated in a similar case, Acupuncture Now, P.C., as Assignee of Lozano, Cleotilde v Global Liberty Ins., and the judges PESCE, P.J., ALIOTTA, and SIEGAL concurred with the decision.

The relevant facts considered by the court were that the plaintiff, Sovera Medical Supply Corp., was seeking to recover first-party no-fault benefits from the defendant, 21st Century Insurance Company. The defendant moved for summary judgment to dismiss the complaint, stating that there was a lack of medical necessity for the supplies in question. The plaintiff cross-moved for summary judgment, but both motions were denied by the Civil Court of the City of New York, Kings County. The main issue decided by the court was whether there was a lack of medical necessity for the supplies in question, as stated by the defendant. The court found that the peer review report submitted by the defendant sufficiently set forth a factual basis and medical rationale for the determination of a lack of medical necessity. The plaintiff's submission of an affidavit from a doctor failed to meaningfully address or rebut the conclusions set forth in the peer review report. The holding of the case was that the order of the Civil Court granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment was affirmed. The court concluded that there was a lack of medical necessity for the supplies in question, as supported by the peer review report, and therefore, the defendant was entitled to summary judgment dismissing the complaint.

The court considered the facts in a case where a provider was seeking to recover first-party no-fault benefits assigned to them. The main issue decided was whether the defendant's cross motion to hold the action in abeyance pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law should be granted. The holding of the court was that the defendant's defense that the assignor is eligible for workers' compensation benefits is subject to preclusion, as they failed to demonstrate that they had timely denied the plaintiff's claims on the ground that the assignor was injured in the course of his employment. As a result, the defendant's cross motion was properly denied and the order was affirmed.

The relevant facts considered by the court were that the plaintiff, GC Chiropractic, P.C., was seeking to recover first-party no-fault benefits from the defendant, Integon National Ins. Co. The defendant moved for summary judgment to dismiss the complaint on the grounds of lack of medical necessity, while the plaintiff argued that the defendant had failed to respond to discovery demands, and that those responses were necessary to oppose the motion. The court decided that the defendant was not entitled to summary judgment dismissing the complaint because the plaintiff had requested but not received the medical records relied upon by the defendant's peer reviewer in time to oppose the motion. As a result, the court reversed the order, denied the defendant's motion for summary judgment, and granted the plaintiff's cross motion to compel discovery.

The court considered the fact that Psychology YME, P.C. was seeking to recover assigned first-party no-fault benefits from Travelers Insurance. The main issue decided was whether defendant's motion for summary judgment dismissing the complaint should be granted based on plaintiff's failure to provide requested verification within 120 days of the initial verification request, and whether plaintiff's cross motion for summary judgment should be granted. The holding of the case was that defendant's motion for summary judgment dismissing the complaint was granted, and plaintiff's cross motion for summary judgment was denied. The court found that defendant's proof was sufficient to demonstrate that it had timely mailed initial and follow-up verification requests, had not received the requested verification, and had timely denied the claim on that ground, and that plaintiff failed to raise a triable issue of fact in opposition.