No-Fault Case Law
Government Empls. Ins. Co. v Picone (2025 NY Slip Op 06604)
November 26, 2025
In this case, the court considered the defendant's claim for no-fault lost wage benefits following an arbitration award in his favor, as well as his counterclaims for breach of contract and unfair claims settlement practices against the plaintiff, an insurance company. The main issues addressed included whether the plaintiff was liable for the claimed lost wages and whether the counterclaims were valid. The court found that the plaintiff provided sufficient evidence to demonstrate that the defendant's tax returns and deposition testimony contained inconsistencies that undermined his claims for lost wages. Consequently, the court affirmed the lower court's judgment, declaring that the plaintiff was not liable for payment of any lost wages and dismissing the defendant's counterclaims, including that of unfair claims settlement practices, due to lack of a private right of action under the relevant statute.
Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC (2025 NY Slip Op 06054)
November 5, 2025
In this case, the court considered the procedural aspects surrounding the arbitration awards related to a no-fault insurance claim involving Bay Ridge Surgi-Center, LLC and American Transit Insurance Company. The main issues included whether Bay Ridge properly substantiated its request for additional attorney's fees under 11 NYCRR 65-4.10(j)(4) and whether a hearing was necessary prior to the court's decision on the fee amount. The court ultimately decided to affirm the lower court's judgment, which had granted Bay Ridge an additional $250 in attorney's fees while confirming the master arbitration award in favor of Bay Ridge. The ruling clarified that Bay Ridge's failure to provide adequate documentation regarding the fees and the lack of a request for a hearing did not warrant revising the awarded amount, thus supporting the discretion of the Supreme Court in determining reasonable attorney's fees.
Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC (2025 NY Slip Op 06055)
November 5, 2025
The court considered the procedural context of a case in which Bay Ridge Surgi-Center, LLC sought to vacate a master arbitration award favorable to it, while also cross-petitioning for additional attorney's fees under a specific regulation (11 NYCRR 65-4.10(j)(4)). The primary issues included the validity of the arbitration award and the assessment of reasonable attorney's fees related to the no-fault insurance claim. Ultimately, the Supreme Court awarded Bay Ridge additional attorney's fees amounting to $1,100, despite Bay Ridge's claim for $4,450, determining that the lower amount was reasonable given the circumstances. The Appellate Division affirmed the Supreme Court's decision, noting that the court acted within its discretion in both adjudicating the fee award and not requiring a hearing before ruling on the matter.
Matter of American Tr. Ins. Co. v Pfeffer (2025 NY Slip Op 06056)
November 5, 2025
In this case, the court considered the arbitration award that was affirmed in favor of Michelle Pfeffer, as well as her request for additional attorney's fees under 11 NYCRR 65-4.10(j)(4). The main issues were whether the Supreme Court properly confirmed the master arbitration award and if it acted within its discretion in granting Pfeffer an additional $500 in attorney's fees without a hearing. The court held that the Supreme Court indeed acted within its discretion, noting that Pfeffer failed to provide sufficient documentation to support a larger fee claim and did not request a hearing regarding the attorney's fees. Consequently, the judgment awarding her the additional fees was affirmed.
Matter of American Tr. Ins. Co. v Scob, LLC (2025 NY Slip Op 06057)
November 5, 2025
The court considered a master arbitration award that had initially favored SCOB, LLC, and subsequent motions related to the recovery of additional attorney's fees following a proceeding brought under CPLR article 75. The main issues decided included whether SCOB was entitled to further attorney's fees in connection with its claim and the amount of those fees. The court held that SCOB was entitled to an award of $1,100 in additional attorney's fees pursuant to 11 NYCRR 65-4.10(j)(4), despite SCOB's request for a higher amount of $4,550. The court determined it had discretion in setting the fee, and SCOB's failure to request a hearing did not impact this decision. Ultimately, the judgment awarding the additional fees was affirmed.
Hereford Ins. Co. v 21 Century Chiropractic Care (2025 NY Slip Op 06022)
October 30, 2025
The court considered multiple relevant facts, including the failure of defendants Cross Bay Orthopedic Surgery and others to provide subscribed transcripts from examinations under oath (EUOs), which are required under the terms of a no-fault insurance policy. The main issues decided were whether the defendants' argument regarding the nature of the subscription failure constituted a violation of a condition precedent to contract performance or coverage, and whether the timing of the insurer's demand for subscriptions was proper. The court ruled that the defendants' arguments were unpreserved for lack of prior assertion in the lower court, and also found that the failure to subscribe the EUO transcripts violated a condition precedent to coverage, voiding the insurance policy ab initio. Consequently, the court affirmed the granting of the plaintiff's summary judgment cross-motion against the defendants.
Matter of American Tr. Ins. Co. v Big Apple Pain Mgt., PLLC (2025 NY Slip Op 05948)
October 29, 2025
The court considered the sequence of events surrounding a motor vehicle accident involving Carlos Nieto and subsequent medical services provided by Big Apple Pain Management, PLLC. Big Apple submitted claims to American Transit Insurance Company for reimbursement, which were denied, prompting Big Apple to seek arbitration. An arbitrator awarded Big Apple the claimed amount, which was later confirmed by a master arbitrator. American Transit then petitioned to vacate this confirmation, resulting in a ruling by the Supreme Court to grant the petition and deny Big Apple's motion. However, on appeal, the court reversed the lower court's decision, determining that American Transit did not present any valid statutory grounds for vacating the master arbitrator's award, leading to the confirmation of that award in favor of Big Apple.
Matter of Oasis Med. & Surgical Wellness v New Jersey Mfrs. Ins. Co. (2025 NY Slip Op 05952)
October 29, 2025
The court considered relevant facts including that Oasis Medical and Surgical Wellness sought no-fault insurance benefits from New Jersey Manufacturers Insurance Company (NJM) for medical services related to a motor vehicle accident in New York, although the care was provided in New Jersey to an insured. NJM denied the claim, leading Oasis to initiate an arbitration in New York, which was dismissed by the arbitrator based on the doctrine of forum non conveniens. Oasis then appealed this dismissal to a master arbitrator, who affirmed the decision. The main issues decided included whether the arbitration award could be vacated on the grounds that the arbitrator exceeded their authority and whether there was sufficient justification for the award. Ultimately, the court held that Oasis failed to provide clear and convincing evidence to vacate the award and affirmed the Supreme Court's order denying the petition.
Matter of South Nassau Community Hosp. v Avis Budget Group, Inc. (2025 NY Slip Op 05954)
October 29, 2025
The court considered relevant facts including the petitioner’s attempt to recover costs for medical services provided following a motor vehicle accident and the respondent’s defenses concerning lack of medical necessity and standing due to absence of an assignment of benefits from the injured party. The main issues decided included whether the arbitrator's decision was arbitrary or capricious and whether the respondent had waived its standing defense. The master arbitrator vacated the initial arbitration award by concluding that the petitioner lacked standing, leading to the petitioner seeking to vacate this decision. Ultimately, the court upheld the master arbitrator's decision, determining that it was not irrational or arbitrary and capricious, thereby affirming the denial of the petition to vacate the award.
American Tr. Ins. Co. v Hackensack Surgery Ctr., LLC (2025 NY Slip Op 05787)
October 22, 2025
In this case, the court examined the plaintiff's pursuit of no-fault insurance benefits under Insurance Law § 5106(c) after the defendant moved to dismiss the complaint for failure to state a cause of action. The initial order from the Supreme Court granted the defendant's motion to dismiss the complaint, with subsequent proceedings addressing the plaintiff's attempt to reargue this decision and the defendant’s request to correct the record to reflect that the dismissal was granted on default. The main issues decided included whether the initial decision should be corrected and if the appeal from the February order should be dismissed as superseded. The court affirmed the March order, concluding that the lower court properly corrected its prior order and that the appeal from the February order was appropriately dismissed since it had been superseded. The court also noted that the plaintiff's arguments made during the appeal were improperly raised for the first time.