No-Fault Case Law

The court considered several key facts, including that the claimants asserted they were passengers in a vehicle involved in an accident on January 9, 2022, and intended to submit no-fault insurance claims. However, the claimants did not respond to the lawsuit, leading the court to grant a default judgment against them. The plaintiff, Unitrin Safeguard Insurance Company, provided evidence that the injuries did not arise from the accident, which included an investigator's affidavit detailing the incident and testimony from occupants of the other vehicle who described the accident as minimal and indicated no visible injuries or damage. The main issues decided included whether the claims were valid based on the circumstances of the accident and the credibility of the claimants’ accounts, ultimately concluding that the claimants' lack of a plausible and supported claim negated any duty to pay. The court held that the plaintiff had no obligation to cover the no-fault claims submitted by the medical providers, confirming the summary judgment in favor of the plaintiff.

In this case, the court considered the issue of whether separate arbitral awards could be treated as a single award for the purposes of establishing subject matter jurisdiction under Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii). The relevant facts included four distinct arbitral awards issued in favor of the defendant, Comfort Choice Chiropractic, for chiropractic services provided to a single individual, each award being less than the $5,000 threshold required for de novo review in court. The main issue was whether the court could aggregate these separate awards to meet the jurisdictional threshold. The court held that the plain language of the statutes did not allow for such aggregation, stating that each award must independently meet the $5,000 requirement. Consequently, the court reversed the lower court's order, dismissed the complaint due to lack of jurisdiction, and granted an award of reasonable attorney's fees to the defendant.

The court considered the arbitration award issued in favor of Comfort Choice Chiropractic, P.C. on February 11, 2022, and the subsequent proceeding initiated by American Transit Insurance Company to vacate that award. The main issues decided included Comfort Choice's request for attorney's fees in connection with enforcing the arbitration award, as specified under 11 NYCRR 65-4.10(j)(4). The Appellate Division reversed the lower court's decision that denied Comfort Choice's cross-motion for attorney's fees and granted that request, ordering the case be remitted to the Supreme Court for a determination of the reasonable attorney's fees owed to Comfort Choice. The ruling reinforced the entitlement to attorney's fees under the specified regulation when a valid claim for no-fault benefits is overdue.

In this case, Burke 2 Physical Therapy, P.C. appealed a Civil Court order that dismissed its complaint seeking no-fault benefits from State Farm Mutual Automobile Insurance Company. The court considered the legitimacy of State Farm's verification requests, which aimed to determine the provider's eligibility for benefits based on licensing requirements, as established by prior case law. The main issues were whether State Farm's requests for documentation were proper and whether the plaintiff's cross-motion for summary judgment and separate motion to dismiss affirmative defenses should have been granted. Ultimately, the court held that State Farm's verification requests were appropriate and affirmed the dismissal of the plaintiff's complaint, denying the plaintiff’s motions as lacking merit.

The court considered whether the defendant, Lancer Insurance Co., met its burden to demonstrate that proper notices for an examination under oath were mailed to the assignor, Ismael Sejour, and whether Sejour failed to appear. The key issues were whether the notices were properly sent and if the defendant could establish personal knowledge of the mailing procedures. The court found that while the defendant successfully demonstrated Sejour's nonappearance through a certified transcript, it failed to conclusively show that the notices had been properly mailed. Consequently, the motion for summary judgment was granted in part, confirming the assignor's failure to appear at the examination, while leaving the question of proper notice mailing to be resolved at trial.

In this case, the Plaintiff, as assignee of a medical treatments provider, sought to recover No-Fault benefits from the Defendant for a treatment rendered. The main issue revolved around the Defendant’s claim that the Assignor had failed to attend two scheduled Examinations Under Oath (EUOs), which the Defendant asserted as grounds for seeking summary judgment. The Court previously denied the Defendant's summary judgment motion, determining that there were issues of fact regarding the Assignor's non-attendance and noting that the Defendant failed to provide sufficient proof that the Assignor did not appear. In the subsequent motion to reargue, the Court found the Defendant's supporting affidavit did not sufficiently demonstrate personal knowledge of the non-appearance, reiterating that mere assertions of absence without presence at the EUO lacked probative value. Ultimately, the Court denied the reargue motion, affirming its earlier decision that the Defendant had not met its burden of proof.

In this case, Dr. Howard M. Rombom, as the assignee of Linda Banks, sought to recover no-fault benefits based on an earlier settlement agreement from 1997, which had been filed as a stipulation of discontinuance but remained unpaid. The trial court initially ruled to vacate a judgment entered in favor of the plaintiff, asserting that the filing of the stipulation in 1998 had terminated the action and deprived the court of jurisdiction. The appellate court found that while the stipulation had been filed, the defendant's failure to pay did not negate the jurisdiction of the court to grant relief under CPLR 5003-a, which allows for the entry of judgment in cases where payments are not made following a settlement agreement. Consequently, the appellate court reversed the lower court's decision to vacate the judgment and remitted the case back to the Civil Court to consider other motions by the defendant.

The court considered the procedural correctness of the plaintiff's submissions and the appropriateness of the defendant's request for additional information to verify the plaintiff's eligibility for no-fault benefits. The main issues decided included whether the defendant could seek verification information regarding the plaintiff's licensing and eligibility before the court and whether the plaintiff's subsequent amended cross-motion for summary judgment was proper. The court held that the defendant's actions were not improper and affirmed the lower court's decision to grant the defendant's summary judgment motion, dismissing the complaint and denying the plaintiff's cross-motion. The decision underscored the importance of compliance with procedural rules and the lack of preclusive effect from a non-final determination in a separate action.

In this case, the court considered the procedural history and substantive adequacy of the claims made by Burke 2 Physical Therapy, P.C. against State Farm Mutual Automobile Insurance Company regarding assigned first-party no-fault benefits. The main issues decided included whether the plaintiff's amended cross-motion for summary judgment was improperly classified as a sur-reply, and whether the defendant's request for verification documents during the claim verification stage was appropriate. The court held that the plaintiff's motions, both initial and amended, failed to establish a triable issue of fact, and that the defendant's request for documents was valid for verifying the plaintiff's eligibility for benefits. Consequently, the court affirmed the lower court's order granting the defendant's summary judgment and denying the plaintiff's cross-motion.

In this case, the court considered the procedural propriety of the plaintiff's submissions and whether the plaintiff had adequately provided the requested verification for no-fault benefits. The main issues involved whether the defendant’s motion for summary judgment should be granted based on the plaintiff's alleged failure to comply with verification requests and whether the Civil Court erred in not considering the plaintiff's amended submissions. The court held that the plaintiff's affidavit did not raise a genuine issue of fact regarding the provision of verification and that the defendant's requests for additional documentation were appropriate. Additionally, the court found that a previous denial in a related declaratory judgment action did not preclude the defendant's summary judgment motion. Ultimately, the court affirmed the order dismissing the complaint and denied the plaintiff's cross-motion for summary judgment.