No-Fault Case Law

The relevant facts considered in this case were that American Transit Insurance Company sought to vacate an arbitration award in favor of Marta Medical Supply, Corp, A/A/O Sandra Gomes, for medical expenses paid to Sandra Gomes following a motor vehicle accident. The petitioner denied the claim, and the respondent sought reimbursement through arbitration. The main issue decided was whether the arbitration award in favor of the respondent was arbitrary or capricious. The court held that the evidentiary submissions and legal reasoning of the petitioner did not make a prima facie showing that the arbitration award was arbitrary or capricious, and therefore denied the petition to vacate the award and dismissed the petition.

The main issue in this case was whether the defendant was entitled to compel the plaintiff to comply with their discovery requests, specifically for production of the entire claim file and SIU file. The court considered the plaintiff's objection to the defendant's discovery demands, where the plaintiff argued that the demands were irrelevant, overly broad, and privileged. The court weighed the need for discovery against the burden on the opposing party, and ultimately held that the plaintiff must produce the entire claim file to the defendant within 60 days. The court did not grant the defendant's motion to compel in regards to the SIU file and certain information related to other actions or arbitrations, as it was deemed overly broad and burdensome to the plaintiff. Therefore, the court granted the defendant's motion in part and denied it in part.

The court considered the allegations made by the plaintiff, Jeffrey Thrall, that he had purchased an automobile insurance policy from State Farm Mutual Automobile Insurance Company and alleged that State Farm denied his insurance benefits based on a medical examination report that was cursory and incomplete. Thrall alleged that State Farm engaged in a larger conspiracy to defraud accident victims. In response to this action, State Farm sought to dismiss several causes of action in the amended complaint and sought to dismiss Thrall's claims for consequential and punitive damages. The main issue decided by the court was whether Thrall sufficiently pleaded the claims of bad faith breach of contract and consequential damages, and the court held that the allegations were sufficient for Thrall to satisfy his pleading requirement and that a determination of whether such damages were, in fact, foreseeable should await a fully developed record.

The court considered this case when a provider sought to recover assigned first-party no-fault benefits. Plaintiff appealed after the lower court granted defendant's motion for summary judgment dismissing the complaint and denied plaintiff's cross motion for summary judgment. The main issue decided was whether the provider could recover assigned first-party no-fault benefits, and the court ultimately affirmed the lower court's decision to grant the defendant's motion for summary judgment and dismiss the complaint. Therefore, the holding of this case is that the lower court's decision was affirmed, and the provider was not entitled to recover assigned first-party no-fault benefits.

The court considered the case of New York Manual, P.T., P.C. as the appellant and Nationwide Affinity Insurance Company of America as the respondent. The main issue decided in the case was whether the defendant had timely mailed initial and follow-up requests for verification, and if the plaintiff had failed to provide the requested verification. The court held that the defendant had demonstrated, prima facie, that it had timely mailed initial and follow-up requests for verification and that it had not received all of the requested verification. The court also found that the plaintiff had failed to establish a triable issue of fact by demonstrating that it had provided the requested verification or had set forth a reasonable justification for the failure to comply with defendant's verification requests. Therefore, the court affirmed the order of the Civil Court, which granted defendant's motion for summary judgment dismissing the complaint and denied plaintiff's cross motion for summary judgment.

The main issue in the case was whether the defendant's payment to the plaintiff was timely according to the terms of a stipulation of settlement. The court considered conflicting evidence regarding the terms of the stipulation of settlement, with the plaintiff providing a signed copy stating that the payment was due within 21 days, and the defendant providing a signed copy with a handwritten notation stating that the payment was due within 45 days. The court held that there was an apparent factual dispute regarding the terms of the settlement and the defendant's compliance, and therefore it was an error for the Civil Court to grant the defendant's motion without holding a hearing to determine the disputed issues of fact. As a result, the order was reversed, the default judgment was reinstated, and the matter was remitted to the Civil Court for a new determination, following a hearing, of defendant's motion to vacate the default judgment.

The relevant facts considered by the court included a settlement agreement entered into by the plaintiff and the defendant, as well as a judgment entered in 2017 in favor of the plaintiff. The main issue decided was whether the plaintiff's motion to recalculate the interest awarded in the 2017 judgment from a simple rate to a compound rate was moot. The holding of the court was that the plaintiff's motion was no longer moot, and that the former regulations providing for compound interest applied to the claim. The court also found that the defendant's argument that the plaintiff's motion should be denied due to a delay in entering the judgment after the settlement was without merit. Therefore, the court reversed the lower court's order and granted the plaintiff's motion to recalculate the interest awarded in the judgment.

The issue in this case was whether the causes of action brought by Ahmed Medical Care, P.C. against State Farm Mutual Automobile Ins. Co. were barred by the doctrine of res judicata due to a prior declaratory judgment action brought by State Farm against Ahmed. The court considered the dates of services provided by Ahmed to its assignor, Sigmund October, and the date of the motor vehicle accident that resulted in the injuries. State Farm argued that the causes of action were precluded by the prior declaratory judgment, which declared that Ahmed had no right to receive payment from State Farm for any claims set forth in the chart attached to the Supreme Court complaint. The court held that the causes of action (1), (2), (3), (4) and (6) were indeed barred under the doctrine of res judicata, concluding that any judgment in favor of Ahmed in this action would destroy or impair rights or interests established by the prior declaratory judgment. Therefore, the court affirmed the decision of the Civil Court to grant State Farm's motion for summary judgment dismissing those causes of action.

The case involves a dispute between Ahmed Medical Care, P.C. (Ahmed) and State Farm Mutual Automobile Ins. Co. (State Farm) over $892.14 in assigned first-party no-fault benefits for services provided to their assignor, Celeste October, after a motor vehicle accident. State Farm moved for summary judgment to dismiss certain causes of action, claiming they were barred by the doctrine of res judicata and/or collateral estoppel due to a previous declaratory judgment issued by the Supreme Court. The court granted State Farm's motion to dismiss causes of action (1), (2), (4) and (6), and also granted Ahmed's cross motion for summary judgment with respect to causes of action (3) and (5). Ahmed appealed the decision, but the Appellate Term affirmed the lower court's decision, citing a similar case with Sigmund v State Farm Mut. Auto. Ins. Co. as precedent.

The court considered a dispute involving a no-fault insurance arbitration award. The central issue revolved around the interpretation of the phrase "incorrect as a matter of law" in 11 NYCRR 65-4.10(a)(4) within the context of substantive versus evidentiary matters. The court held that this phrase should be limited to substantive issues, excluding evidentiary considerations. It emphasized that procedural or factual errors during arbitration were not grounds for review under this provision. The court discussed relevant case law, distinguishing between issues of law and matters related to the admissibility or evaluation of evidence. Ultimately, the court denied the petitioner's request to vacate the arbitration award, finding no grounds such as corruption, fraud, or procedural defects.