No-Fault Case Law

The main facts considered were that the plaintiff had commenced an action to recover assigned first-party no-fault benefits, and a stipulation required the plaintiff to provide complete responses to defendant's discovery demands by a certain date, or else the complaint would be dismissed. The defendant moved to dismiss the complaint because the plaintiff had failed to comply with the stipulation, and the Civil Court granted the defendant's motion. The main issue decided was whether the stipulation had become absolute due to the plaintiff's failure to comply with the requirement to provide complete responses to discovery demands, and whether the plaintiff had offered a reasonable excuse for its failure to comply. The holding of the court was that the stipulation had indeed become absolute upon the plaintiff's failure to comply, and the Civil Court properly dismissed the action pursuant to the stipulation. Therefore, the order was affirmed.

The main issue in this case was whether the master arbitrator's award, which upheld the denial of Advanced Recovery Equipment & Supplies, LLC's (Advanced) claims to recover assigned first-party no-fault benefits for services rendered on June 11, 2015, should be vacated. The District Court granted Advanced's petition to vacate the master arbitrator's award, holding that there was no rational basis to support it and remitted the matter to the master arbitrator for a new determination. The appellate court affirmed the judgment, finding that there was no rational basis to support the master arbitrator's determination and thus agreeing with the District Court's decision to vacate the award. Therefore, the main holding of the case was that the master arbitrator's award was properly vacated by the District Court and the matter was remitted for a new determination.

The relevant facts considered by the court in this case included a provider's attempt to recover assigned first-party no-fault benefits, and a motion for summary judgment granted by the defendant on the grounds that the plaintiff's claim was submitted more than 45 days after the subject service had been rendered. The main issue decided was whether the plaintiff's claim was submitted in a timely manner, and whether there was a triable issue of fact as to that issue. The holding of the case was that while the defendant had made a prima facie showing that the plaintiff did not timely submit the claim, the affidavit submitted by the plaintiff in opposition to the motion was sufficient to raise a triable issue of fact. Therefore, the defendant's motion for summary judgment dismissing the complaint was denied and the plaintiff's cross-motion for summary judgment was properly denied.

The court considered the case of Heaven & Earth Acupuncture, P.C. appealing the order of the Civil Court which granted the insurance company's motion for summary judgment dismissing the complaint and denied plaintiff's cross-motion for summary judgment. The main issue decided was whether the insurance company had paid the limits of the policy in accordance with regulations and therefore was entitled to summary judgment dismissing the complaint. The holding of the court was that the insurance company failed to prove that it had made any payments under the policy and therefore did not make a prima facie showing of entitlement to summary judgment. The court also held that the plaintiff's cross-motion for summary judgment was properly denied as the affidavit submitted by the plaintiff failed to establish that the claims had not been timely denied or that the insurance company had issued timely denial of claim forms that were without merit as a matter of law. Ultimately, the court modified the order by providing that defendant's motion for summary judgment dismissing the complaint is denied.

The main issue in the case was whether the plaintiff, Absolute Medical Supplies, Inc., had submitted their claim for first-party no-fault benefits in a timely manner. The defendant, Unitrin Advantage Insurance Company, argued that the claim was submitted more than 45 days after the service was rendered, and therefore should be dismissed. The court considered the timing of the claim submission and whether there was a triable issue of fact. The holding of the case was that while the defendant had initially made a prima facie showing that the claim was not timely, the plaintiff's opposition raised a triable issue of fact. As a result, the court denied the defendant's motion for summary judgment dismissing the complaint and affirmed the order with modification.

The court considered the facts surrounding the plaintiff's lawsuit against the defendant insurance company for $2,114.99 in unpaid No-Fault benefits for medical services provided to the plaintiff's assignor after an automobile accident. The main issue in the case was whether the defendant's motion for summary judgment to dismiss the complaint on the ground that the plaintiff failed to provide additional documentary verification within 120 days was valid. The court held that the defendant's motion for summary judgment was denied, as the defendant failed to establish good cause for investigating the plaintiff's alleged noncompliance with licensing and incorporation statutes through admissible evidence. Additionally, the court denied the plaintiff's cross-motion for summary judgment, as the requested verification was still outstanding, and factual issues existed as to the plaintiff's eligibility to receive No Fault benefit payments.

The relevant facts the court considered in American Transit Insurance Company v. Nexray Medical Imaging PC involved the denial of a $1,790.67 No-Fault insurance medical claim for MRIs performed on a policyholder to diagnose injuries from a motor vehicle accident. The main issues that were decided included whether the denials of claim by ATIC were appropriate, whether the MRIs were medically necessary, and whether there was an appropriate Workers' Compensation defense. The decision held that ATIC's petition to vacate the master arbitration award was denied, and that Nexray's cross-petition to confirm the award was granted. The master arbitration award of A. Jeffrey Grob was confirmed, and ATIC was ordered to pay Nexray the principal amount of $1,790.67 plus interest, attorney's fees, and arbitration filing fees.

The main issue in this case was whether a No-Fault insurance master arbitrator correctly affirmed a hearing arbitrator's award that a health service provider had submitted additional verification in "substantial compliance," that an insurer seeking sign-in sheets was not reasonable, and that an insurer seeking information about Workers' Compensation benefits was not necessary. The court heard a petition to vacate the master arbitration award affirming the hearing arbitration award of a claim for No-Fault insurance compensation for chiropractic treatment. The services were provided to a man injured in a motor vehicle accident and the court considered whether the hearing arbitrator's decision was incorrect as a matter of law. The court held that the arbitration award was not irrational and did not vacate the award, determining that the insurer did not prove substantial compliance was unreasonable.

The main issue of this case was whether a No-Fault insurance master arbitration award must be vacated if the master arbitrator failed to address an issue of law asserted by the insurer, but the issue of law was previously decided by the court in a different Article 75 proceeding. The background of this case involved American Transit Insurance Company ("ATIC") seeking to vacate a No-Fault insurance master arbitration award granted to Rutland Medical, PC for various medical services provided to an individual in a motor vehicle accident. The arbitrator awarded Rutland $2,713.58 as compensation for the medical services provided. The court decided that the master arbitration award must be vacated since the master arbitrator failed to address an issue of law that was previously decided by the court, making the award invalid.

In this case, the court examined whether the doctrines of collateral estoppel and res judicata applied to a new action for first-party no-fault benefits initiated by the plaintiff, a medical provider, related to injuries sustained in an automobile accident. The defendant, Avis Car Rental, sought a permanent stay of the action, arguing that a prior declaratory judgment had permanently barred the plaintiff from recovering no-fault payments due to a violation of New York State laws in a previous case. The court determined that the Civil Court had incorrectly applied the earlier declaratory judgment to the current case, which was filed after that judgment and involved different circumstances. The court held that the issue of the plaintiff's entitlement to no-fault benefits for medical treatment given in late 2017 and early 2018 was not identical to the previous determination, thereby concluding that collateral estoppel did not apply. As a result, the court reversed the lower court's order granting the stay and denied the defendant's motion.