No-Fault Case Law

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.

The court considered several relevant facts, including that the plaintiff, Trinity Medicine, P.C., was seeking first-party no-fault benefits for medical services provided to its assignor due to a motor vehicle accident. The defendant, National General Insurance Company, failed to serve its answer after being served the summons and complaint in December 2020. Upon the plaintiff's attempt to obtain a default judgment, the defendant moved to open its default, claiming a reasonable excuse for the delay due to a clerical oversight and asserting a meritorious defense based on a previous declaratory judgment that indicated no coverage was owed due to the nature of the accident. The main issues were whether the defendant had a reasonable excuse for its default and whether it had a potentially meritorious defense. The court held that the defendant provided a reasonable excuse for its default and demonstrated a potential meritorious defense related to res judicata, affirming the lower court's decision to allow the defendant to file a late answer and denying the plaintiff's motion for summary judgment.

The court considered the case where Quick Health Pharmacy Corp. sought to vacate a master arbitrator's award denying its claim for first-party no-fault benefits of $1,454.70. The initial judgment awarded Quick Health a sum including interest and a specific amount for attorney's fees, but the appellant argued that this fee was inadequate given the circumstances. The main issues decided included whether the awarded attorney's fees complied with regulatory requirements and if they accurately reflected the fees incurred during the arbitration and subsequent court proceedings. The holding reversed the previous judgment, determining that the calculation of attorney's fees was incorrect due to an improper application of a cap, and remitted the matter to the District Court for a new judgment to determine the reasonable attorney's fees entitled to Quick Health without the regulatory cap.

The court considered several relevant facts, including that the plaintiff established a prima facie case for recovery of first-party no-fault benefits, and that the defendant had timely denied the claim based on a lack of medical necessity. It was also stipulated that the insurance policy limits were exhausted after the denial due to the defendant's subsequent payments on other claims. The main issue decided was whether the defendant could rely on the exhaustion of policy limits from subsequent payments to avoid liability for the claim denied. The court held that the defendant's argument was without merit, affirming the judgment in favor of the plaintiff and awarding the claimed amount.

The court considered facts surrounding a motor vehicle collision on April 15, 2019, in which the individual defendants, allegedly without reported injuries and no citations issued, sought medical treatment from the defendant medical providers. The plaintiffs, as no-fault insurance providers, denied claims for reimbursement made by the medical providers, which were assignees of the individual defendants, asserting that the individual defendants failed to complete required examinations under oath (EUOs) as a condition for coverage. The main issues decided included the justification for the EUOs and whether the defendants' noncompliance voided the insurance policy. The court held that the plaintiffs were justified in requesting the EUOs and that the individual defendants' failure to comply constituted a breach of a condition precedent to coverage, thereby affirming the denial of reimbursement claims.

The court considered the facts surrounding a no-fault benefits claim made by Trapezius Diagnostic Chiropractic, P.C. for medical services allegedly rendered due to injuries from a motor vehicle accident on November 4, 2017. Adirondack Insurance Exchange contended that the claim was barred by a prior declaratory judgment in which a different accident on November 14, 2017 was declared a "staged accident," relieving them of the obligation to provide coverage for related services. The primary issues decided included whether res judicata applied to bar the current claim and whether the evidence presented justifiably supported each party's motions for summary judgment. The court held that Adirondack failed to demonstrate that the current action was barred by res judicata, but also found that there was a material factual dispute regarding the date of the accident, thus denying Trapezius's cross-motion for summary judgment while affirming the denial of Adirondack's summary judgment motion.

The court considered several key facts in this case, including the timely mailing of examination under oath (EUO) scheduling letters by the defendant, State Farm, and the plaintiffs' failure to appear for two scheduled EUOs. The main issues decided included whether the defendant's denial of claims was timely and if the plaintiff had effectively rebutted the defendant's arguments regarding the denial of one particular bill, which was denied after a missed EUO. The court held that the defendant's denial was indeed timely, as the time to deny remained tolled due to the pending EUO request when subsequent bills were submitted. As a result, the court granted the defendant's cross-motion for summary judgment, denied the plaintiff's motion, and dismissed the case with prejudice.