No-Fault Case Law
Dowd v Allstate Ins. Co. (2019 NY Slip Op 50648(U))
March 11, 2019
The court considered the facts of the case, including the claimant failing to appear for scheduled independent medical examinations (IME) and the denial of the claim based on those missed appointments. The main issue decided was whether the defendant had established a prima facie case as to the mailing of the denial forms and setting the matter down for a hearing on the issue of IME no show. The holding of the case was that the defendant's motion for summary judgment and motion to dismiss were denied, as the defendant failed to establish that it was entitled to summary judgment, and the documentary evidence submitted by the defendant did not conclusively establish a defense as a matter of law. Additionally, the court found that the plaintiff had adequately pled causes of action pursuant to New York's no-fault regulations, and the court was not bound by an arbitration award against a different plaintiff in a separate matter.
Queens-Roosevelt Med. Rehabilitation P.C. v Response Ins. Co. (2019 NY Slip Op 50612(U))
March 8, 2019
The main facts of this case involve a medical rehabilitation center, Queens-Roosevelt Medical Rehabilitation P.C., seeking to recover first-party no-fault benefits from Response Insurance Company. The insurance company filed a motion to strike the complaint and dismiss the action, but the Civil Court denied the motion. The issue decided by the Appellate Term was whether the complaint should be struck and the action dismissed pursuant to CPLR 3126. The holding of the court was that the order of the Civil Court was reversed, and the insurance company's motion to strike the complaint and dismiss the action was granted. This decision was made based on the reasoning and holding of a related case, Queens-Roosevelt Med. Rehabilitation, P.C., as Assignee of Maria Rodriguez v Response Ins. Co.
Queens-Roosevelt Med. Rehabilitation, P.C. v Response Ins. Co. (2019 NY Slip Op 50611(U))
March 8, 2019
The court considered the denial of defendant's motion to strike the complaint and dismiss the action pursuant to CPLR 3126 in an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the denial of the defendant's motion was proper. The court held that the denial was not proper and reversed the order, granting the defendant's motion to strike the complaint and dismiss the action pursuant to CPLR 3126. The decision was based on the reasons stated in another case, Queens-Roosevelt Med. Rehabilitation, P.C., as Assignee of Maria Rodriguez v Response Ins. Co., decided herewith. The decision was concurred by P.J. Pesce, Weston, and Aliotta, JJ.
Queens-Roosevelt Med. Rehabilitation, P.C. v Response Ins. Co. (2019 NY Slip Op 50610(U))
March 8, 2019
The main issue in this case was whether the Civil Court properly denied defendant's motion to strike the complaint and dismiss the action pursuant to CPLR 3126 in an action by a provider to recover assigned first-party no-fault benefits. The relevant facts considered by the court were not explicitly stated in the provided text. The holding of the case was that the order denying defendant's motion was reversed, and defendant's motion to strike the complaint and dismiss the action pursuant to CPLR 3126 was granted. The decision was made by the Appellate Term, Second Department, and the case was decided on March 8, 2019.
Queens-Roosevelt Med. Rehabilitation, P.C. v Response Ins. Co. (2019 NY Slip Op 50609(U))
March 8, 2019
The relevant facts considered by the court were that Queens-Roosevelt Medical Rehabilitation, P.C. was seeking to recover assigned first-party no-fault benefits from Response Insurance Company. The main issue decided by the court was whether the lower court erred in denying the defendant's motion to strike the complaint and dismiss the action pursuant to CPLR 3126. The holding of the case was that the order of the Civil Court denying the defendant's motion was reversed, and the defendant's motion to strike the complaint and dismiss the action pursuant to CPLR 3126 was granted. This decision was made for the reasons stated in another related case, Queens-Roosevelt Med. Rehabilitation, P.C., as Assignee of Maria Rodriguez v Response Ins. Co. The judges presiding over the case all concurred with this decision.
Queens-Roosevelt Med. Rehabilitation, P.C. v Response Ins. Co. (2019 NY Slip Op 50608(U))
March 8, 2019
The main issue in the case was whether the plaintiff had failed to comply with discovery demands and whether the actions of the plaintiff's owner, Dr. John McGee, constituted a violation of state licensing requirements. The court considered the facts that the plaintiff had refused to answer certain questions during a deposition, that certain claims had already been dismissed based on noncompliance with discovery, and that Dr. McGee had already been deposed twice. The court held that the questions at issue were material and necessary to the defense of the action, and that the plaintiff's refusal to answer the questions may be presumed to be willful and contumacious. As a result, the court reversed the lower court's decision and granted the defendant's motion to strike the complaint and dismiss the action pursuant to CPLR 3126.
Pain Mgt. Ctr. of N.J., P.C. v Travelers Prop. & Cas. Ins. Co. (2019 NY Slip Op 50607(U))
March 8, 2019
The relevant facts of the case included a provider seeking to recover first-party no-fault benefits for services rendered to an assignor. The defendant sought to amend its answer to assert the affirmative defense of collateral estoppel and for summary judgment dismissing the complaint, based on an arbitrator's decision in April 2014 that found the plaintiff was not eligible to recover benefits because it was not a licensed professional medical corporation in the State of New York.
The main issues decided were whether the defendant should be granted leave to amend its answer and whether summary judgment should be granted based on the doctrine of collateral estoppel. The court ultimately affirmed the order, determining that the plaintiff had not demonstrated prejudice or surprise as a result of the proposed amendment to the answer and had presented no basis to disturb the branch of defendant's motion seeking summary judgment dismissing the complaint based on collateral estoppel.
The holding of the case was that the defendant was granted leave to amend its answer and summary judgment was granted based on the doctrine of collateral estoppel, resulting in the affirmation of the order by the court.
New Horizon Surgical Ctr., L.L.C. v Travelers Ins. (2019 NY Slip Op 50283(U))
March 8, 2019
The main issue in this case is whether the provider's action to recover assigned first-party no-fault benefits was premature because the plaintiff had failed to provide requested verification. The court considered the fact that the defendant had appealed from an order of the Civil Court that denied the branch of the defendant's motion seeking summary judgment dismissing the complaint. The court decided that the branch of the defendant's motion seeking summary judgment dismissing the complaint should be granted. The holding of this case is that the order, insofar as appealed from, is reversed, and the branch of defendant's motion seeking summary judgment dismissing the complaint is granted.
New Horizon Surgical Ctr., L.L.C. v Travelers Ins. (2019 NY Slip Op 50282(U))
March 8, 2019
The main issues that were decided in this case were whether the defendant's motion seeking summary judgment dismissing the complaint should be granted, and whether the action was premature due to the plaintiff's alleged failure to provide requested verification. The court considered the fact that the action was brought by a provider to recover assigned first-party no-fault benefits. The holding of the case was that the order, insofar as appealed from, was reversed and the branch of defendant's motion seeking summary judgment dismissing the complaint was granted. The court reversed the denial of the branch of defendant's motion and granted summary judgment dismissing the complaint.
New Horizon Surgical Ctr., L.L.C. v Travelers Ins. (2019 NY Slip Op 50281(U))
March 8, 2019
The main issues in the case were whether the plaintiff had provided all requested verification in an action to recover assigned first-party no-fault benefits, and whether the action was premature due to the failure to provide requested verification. The court considered the fact that the defendant had timely mailed initial and follow-up verification requests, and that the plaintiff submitted an affidavit stating that all verification requested was provided. However, plaintiff failed to provide a signed informed consent form executed by the assignor, as requested by the defendant. The holding of the court was that the plaintiff failed to raise an issue of fact as to whether it had provided all of the requested verification, and therefore the branch of defendant's motion seeking summary judgment dismissing the complaint was granted.