No-Fault Case Law

The relevant facts the court considered in the case of Maria S. Masigla, P.T., as Assignee of Jackson, Vicki, v. Windhaven Insurance Company, included the plaintiff's attempt to recover assigned first-party no-fault benefits in the amount of $2,738.52. The main issues decided in the case were whether the Civil Court had subject matter jurisdiction, personal jurisdiction, and whether the defendant's policy provided no-fault coverage as required by Insurance Law § 5107. The holding of the case was that the order denying the defendant's motion for summary judgment dismissing the complaint was affirmed. The court determined that the action fell within the subject matter jurisdiction of the Civil Court, and that the defendant had waived all personal jurisdiction defenses by failing to raise them in a timely manner. Additionally, the defendant did not demonstrate that its policy did not provide no-fault coverage, and therefore did not demonstrate its entitlement to judgment as a matter of law.

The court considered a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issues decided were whether the provider had failed to provide requested verification, and if there was a triable issue of fact as to whether the verification had been provided. The holding of the case was that the provider's affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the insurance company, creating a triable issue of fact. As a result, the court modified the order by denying the insurance company's motion for summary judgment dismissing the complaint.

The court considered an action by a medical supply provider to recover assigned first-party no-fault benefits, in which the defendant moved for summary judgment dismissing the complaint based on lack of medical necessity. The Civil Court granted the defendant's motion, leading to an appeal by the plaintiff. The defendant's proof was found to be sufficient to establish a presumption that the denial of claim form had been properly mailed, and the peer review report submitted by the defendant provided a factual basis and medical rationale for the determination of a lack of medical necessity for the supplies at issue. The plaintiff failed to submit any medical evidence to rebut the conclusions of the peer review report. As a result, the judgment granting the defendant's motion for summary judgment was affirmed.

The relevant facts considered by the court were that the plaintiff, New Millennium Medical Imaging, P.C., was seeking to recover assigned first-party no-fault benefits from the defendant, Charter Oak Fire Insurance Company. The defendant filed a motion for summary judgment dismissing the complaint, arguing that it had not issued an insurance policy covering the subject loss. The main issue decided by the court was whether the defendant had issued a policy covering the subject loss. The holding of the court was that the proof submitted by the defendant was sufficient to demonstrate that it had not issued a policy covering the subject loss, and therefore the defendant's motion for summary judgment was granted and the plaintiff's cross motion for summary judgment was denied. The court affirmed the order of the Civil Court, with costs.

The court considered the denial of the plaintiff's motion for summary judgment on multiple causes of action and the granting of the defendant's cross motion for summary judgment on certain causes of action. The main issues decided were whether the plaintiff had failed to appear for examinations under oath and whether the action was premature due to a lack of requested verification. The holding of the case was that the defendant had demonstrated that the action was premature and that the plaintiff had failed to establish its entitlement to judgment as a matter of law. As a result, the order denying the plaintiff's motion and granting the defendant's cross motion was affirmed.

The court considered the defendant's motion for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to appear for scheduled examinations under oath (EUOs). The relevant facts included the proof submitted by the defendant, which gave rise to the presumption that the denial of claim form had been timely mailed and demonstrated that the plaintiff had failed to appear for the EUOs. The main issue decided was whether the defendant's proof was sufficient to establish its entitlement to summary judgment. The holding of the court was that the defendant had met the legal requirements to establish prima facie entitlement to summary judgment, and the plaintiff had not provided any basis to disturb the Civil Court's order. Therefore, the court affirmed the order granting the defendant's motion for summary judgment.

The court considered whether an insurance company's motion for summary judgment dismissing a complaint filed by a medical supply company to recover assigned first-party no-fault benefits should be granted. The main issue was whether the medical supply company had failed to appear for duly scheduled examinations under oath (EUOs) as required by the insurance company. The court held that the insurance company had sufficiently established the medical supply company's failure to appear for the scheduled EUOs, and that the medical supply company's arguments that the motion should be denied due to incomplete discovery and lack of reasonable basis for the EUOs were without merit. Therefore, the court affirmed the order granting the insurance company's motion for summary judgment, with costs.

The court considered the denial of defendant's motion for summary judgment to dismiss the complaint in this action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the insurer would not have issued the policy if it had known the facts misrepresented by the plaintiff's assignor. The court held that the insurer failed to establish as a matter of law that it would not have issued the policy in question and did not demonstrate that the misrepresentation by the plaintiff's assignor was material. Therefore, the order denying the defendant's motion for summary judgment was affirmed.

The main issue in the case was whether the insurer's denial of claim forms had been timely mailed, and whether the claims at issue had been timely denied. The court found that the insurer's papers failed to establish, as a matter of law, that the denial of claim forms had been timely mailed, and therefore, the insurer did not demonstrate that it is not precluded from asserting its proffered defenses. However, the court also found that the plaintiff failed to establish that the claims at issue had not been timely denied, or that the insurer had issued timely denials of claim that were conclusory, vague or without merit as a matter of law. As a result, the court modified the lower court's order to provide that the insurer's cross motion for summary judgment dismissing the complaint is denied, and affirmed the order as modified.

The relevant facts in the case are that the appellant, Apple Massage Therapy, was seeking to recover assigned first-party no-fault benefits from 21st Century Ins. Co. The defendant, 21st Century Ins. Co., filed a motion for summary judgment dismissing the complaint, which was granted by the Civil Court. The main issue decided in this case was whether the proof submitted by the defendant was sufficient to demonstrate that the denial of claim forms had been properly mailed and to show that the defendant had properly used the workers' compensation fee schedule to determine the amount plaintiff was entitled to receive. The holding of this case was that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed. The court found that the defendant's proof was sufficient to establish a presumption that the denial of claim forms had been properly mailed and that the defendant had properly used the fee schedule.