No-Fault Case Law

The main issue in the case was whether the provider was entitled to recover assigned first-party no-fault benefits from the insurance company. The court considered the denial of the plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment. The court affirmed the lower court's decision to deny the plaintiff's motion and grant the defendant's cross motion, dismissing the complaint. The holding of the case was that the insurance company was not obligated to provide no-fault benefits to the provider, and therefore the lower court's decision was affirmed.

The court considered the denial of the defendant's motion for summary judgment in a case brought by a medical provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment should be granted or denied. The holding of the case was that the order denying the defendant's motion for summary judgment was affirmed, with the court concurring. The specific reasons for the decision were not provided in the summary.

The case involved a dispute between Gentlecare Ambulatory Anesthesia Services and GEICO Insurance Company regarding the failure of Gentlecare to appear for scheduled examinations under oath (EUOs) as part of a claim for first-party no-fault benefits. The Civil Court denied Gentlecare's motion for summary judgment and granted GEICO's cross-motion for summary judgment dismissing the complaint. The main issue decided was whether GEICO's proof was sufficient to demonstrate that Gentlecare had failed to appear for the EUOs and whether GEICO was required to set forth objective reasons for requesting the EUOs. The court held that the proof submitted by GEICO was sufficient to establish that Gentlecare had failed to appear for the EUOs and that GEICO was not required to set forth objective reasons for requesting the EUOs in order to establish its entitlement to summary judgment. As a result, the court affirmed the order, with $25 costs.

The main issue in this case was whether the defendant, GEICO Ins. Co., had properly used the workers' compensation fee schedule applicable to chiropractors to reimburse the plaintiff, BQE Acupuncture, P.C., for the acupuncture services it had rendered. The court considered the evidence presented by both parties and determined that the defendant had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The court found that the defendant had established its entitlement to judgment as a matter of law and granted the defendant's motion for summary judgment, dismissing the complaint. The court also noted that one of the plaintiff's contentions was not properly before the court as it was being raised for the first time on appeal and declined to consider it. Therefore, the court affirmed the order in favor of the defendant, GEICO Ins. Co.

The relevant facts considered by the court were that Active Care Medical Supply Corp. was seeking to recover assigned first-party no-fault benefits from American Transit Insurance Company. American Transit had mailed examination under oath (EUO) scheduling letters to Active Care, but Active Care failed to appear for the scheduled EUOs. American Transit was granted summary judgment dismissing the first and third causes of action by the Civil Court. The main issue decided was whether American Transit had established that the EUO scheduling letters had been timely mailed and whether Active Care had failed to appear for the scheduled EUOs. The holding of the case was that the court affirmed the order granting American Transit's motion, as they had shown that the EUO scheduling letters were timely mailed and that Active Care had failed to appear for the scheduled EUOs.

The relevant facts in this case involved a dispute between Chapa Products Corp., as Assignee of Isabel Corniel, and 21st Century Insurance Company. Chapa Products Corp. sought to recover assigned first-party no-fault benefits, but the defendant argued that the plaintiff had not timely submitted the claim underlying the first cause of action and had failed to provide requested verification as to the claim underlying the second cause of action. The main issue decided by the court was whether the plaintiff had timely submitted the claims and verification as required, and whether the defendant had received the verification at issue. The holding of the court was that while the defendant had demonstrated that the claim underlying the first cause of action had not been timely submitted and that the defendant had not received the verification at issue, the proof submitted by the plaintiff was sufficient to give rise to a presumption that the claim form and verification had been timely mailed. Therefore, on this record, neither party was entitled to summary judgment.

The relevant facts the court considered in this case were that Solution Bridge, Inc. was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. State Farm moved for summary judgment dismissing the first cause of action on the grounds that Solution Bridge failed to provide requested verification. The main issue decided was whether Solution Bridge provided sufficient evidence to show that the requested verification had been mailed to, and received by, State Farm. The holding of the case was that the affidavit submitted by Solution Bridge was sufficient to give rise to a presumption that the verification had been provided, creating a triable issue of fact. Therefore, the court reversed the order and denied State Farm's motion for summary judgment.

The court considered the circumstances underlying the action, in which the plaintiff sought to recover a balance of $10,906.14, which was claimed due as a loss of earnings for attendance at an examination under oath in the context of a first-party no-fault insurance claim. The issue decided was whether the additional $2,604,942 claimed by the plaintiff could be rightfully considered in the formula for calculation of lost earnings pursuant to 11 NYCRR 65-3.5 (e). The court held that while there is no disagreement about the formula used to determine the loss of earnings incurred as a result of the plaintiff's appearance at the examination under oath, the focus should be on the actual monetary loss incurred, and the parties failed to provide evidence of why the plaintiff's unavailability for an undisclosed number of hours on that date caused earnings loss. Therefore, both the defendant's motion and plaintiff's cross motion for summary judgment were denied.

The court considered a case in which Global Liberty Insurance Co. sought to vacate an award in favor of Dr. Mark S. McMahon, who was an assignee of Rudy Corniel. Global had only partially approved a payment for arthroscopic surgery performed on its insured, and McMahon sought payment for the balance. The lower arbitrator awarded the balance to McMahon, but did not consider a reference to the American Medical Association's CPT Assistant newsletter that Global relied on. The master arbitrator affirmed this decision, and the Supreme Court also denied Global's petition to vacate the award. The Appellate Division reversed this decision, holding that CPT Assistant, which is referenced in the Official New York Workers' Compensation Medical Fee Schedule, should have been considered in the arbitration process. Consequently, the matter was remanded for a new arbitration.

The court in this case considered whether defendant Sloan Tyrell failed to appear at properly noticed medical examinations, which would constitute a failure of a condition precedent to receiving insurance benefits for a motor vehicle accident. Plaintiff sought a declaration of noncoverage and an amendment to add additional defendants who allegedly provided the same claimant with services in connection with the same accident. The main issue decided was whether plaintiff provided the insured with proper notice of the location of the scheduled examinations. The court determined that plaintiff did not proffer sufficient evidence to establish prima facie that proper notice was provided and denied plaintiff's motion for summary judgment against defendants-respondents and a default judgment against the remaining defendants. However, the court granted the motion for leave to amend the complaint to add the proposed additional defendants, finding that permissive joinder was appropriate and leave to amend should have been freely granted.