No-Fault Case Law
Island Life Chiropractic Pain Care, PLLC v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51595(U))
November 9, 2018
The court considered that the plaintiff, Island Life Chiropractic Pain Care, PLLC, was seeking to recover assigned first-party no-fault benefits from the respondent, State Farm Mutual Automobile Ins. Co. The main issue decided was that the defendant's motion for summary judgment to dismiss the complaint was granted on the grounds that the plaintiff had failed to appear for duly scheduled examinations under oath. The holding of the case was that the order to grant the defendant's motion for summary judgment dismissing the complaint was affirmed, and the plaintiff was ordered to pay $25 in costs. The court cited a similar case, Island Life Chiropractic Pain Care, PLLC, as Assignee of Cooper, Kadeem v State Farm Mut. Auto. Ins. Co., in support of its decision.
Island Life Chiropractic Pain Care, PLLC v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51594(U))
November 9, 2018
The court considered a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issue at hand was whether the insurance company's motion for summary judgment, which was granted, dismissing the provider's complaint on the grounds of the provider's failure to appear for duly scheduled examinations under oath (EUOs), was appropriate. The court held that the insurer had provided sufficient proof demonstrating the provider's failure to appear for the EUOs, and that the insurer was not required to provide objective reasons for requesting the EUOs in order to establish its entitlement to summary judgment. As a result, the court affirmed the order granting the insurer's motion for summary judgment dismissing the complaint.
All Healthy Style Med., P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51592(U))
November 9, 2018
The case involved a dispute over an insurance claim for first-party no-fault benefits, in which the plaintiff appealed an order granting the defendant's motion for summary judgment dismissing the complaint. The defendant argued that the plaintiff's assignor had made a material misrepresentation regarding his place of residence when procuring the insurance policy in question. The main issue decided was whether the misrepresentation was material, as the insurer would not have issued the policy if it had known the true facts. The court held that the defendant failed to establish as a matter of law that it would not have issued the policy in question if the correct information had been disclosed, and therefore did not demonstrate that the misrepresentation was material. As a result, the court reversed the order and denied the defendant's motion for summary judgment.
Active Care Med. Supply Corp. v Hartford Ins. Co. (2018 NY Slip Op 51591(U))
November 9, 2018
The court considered the fact that the Workers' Compensation Board had awarded workers' compensation benefits to the plaintiff's assignor for injuries sustained in the accident, leading to the claims at issue. The main issue decided was whether the lack of coverage defense could be raised without regard to the propriety or timeliness of an insurer's denial of claim form. The court held that the lack of coverage defense could be raised without regard to any issue as to the propriety or timeliness of an insurer's denial of claim form, citing previous case law to support this decision. Ultimately, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint, as the plaintiff failed to demonstrate the existence of a triable issue of fact.
Active Care Med. Supply Corp. v Hartford Ins. Co. (2018 NY Slip Op 51590(U))
November 9, 2018
The court considered the facts that the defendant had been awarded workers' compensation benefits for injuries sustained in an accident. The main issue decided was whether the defendant was entitled to coverage for no-fault benefits, given the workers' compensation award. The holding of the court was that the defendant had demonstrated there was no coverage for no-fault benefits due to the workers' compensation award, and therefore affirmed the dismissal of the complaint and denial of the plaintiff's cross motion for summary judgment.
LVOV Acupuncture, P.C. v Hereford Ins. Co. (2018 NY Slip Op 51589(U))
November 9, 2018
The court considered the facts of an action by healthcare providers seeking to recover first-party no-fault benefits, wherein the defendant insurance company had moved for summary judgment dismissing the complaint on the grounds that the insured vehicle was not involved in the accident. The main issue in the case was whether the insured vehicle was involved in the accident for which the plaintiffs were seeking benefits. The court ultimately affirmed the order granting the defendant's motion for summary judgment and denying the plaintiffs' cross-motion for summary judgment, holding that the insured vehicle was not involved in the alleged accident and therefore the plaintiffs were not entitled to the benefits they were seeking.
Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2018 NY Slip Op 51588(U))
November 9, 2018
The case involved a medical service provider seeking first-party no-fault benefits from an insurance company. The plaintiff filed a motion for summary judgment, while the defendant filed a cross-motion for summary judgment, claiming lack of medical necessity. The court found that the defendant's submission of a sworn peer review report was enough to presume that the denial of claim form had been timely mailed. The plaintiff's opposition failed to sufficiently rebut the conclusions set forth in the peer review report. The court upheld the denial of the plaintiff's motion and granting of the defendant's cross motion. However, the court vacated an award of fees to the defense counsel, as the opportunity to be heard was not provided, and modified the order accordingly.
Jamaica Wellness Med., P.C. v Hereford Ins. Co. (2018 NY Slip Op 51587(U))
November 9, 2018
The court considered an order from the Civil Court that granted the defendant's motion for summary judgment dismissing the complaint filed by the providers to recover assigned first-party no-fault benefits. The order also denied the plaintiff's cross motion for summary judgment. The main issue before the court was whether the insured vehicle had been involved in the alleged accident on February 13, 2013. The court affirmed the order, stating that for the reasons given in another case, the defendant's motion for summary judgment was granted. The decision was held in favor of the defendant, Hereford Insurance Company, affirming the order from the lower court.
Jamaica Wellness Med., P.C. v Hereford Ins. Co. (2018 NY Slip Op 51586(U))
November 9, 2018
The main issues in this case involved the recovery of assigned first-party no-fault benefits by a medical provider. The court considered the transcript of the examination under oath (EUO) of the insured, who testified that the insured vehicle had not been involved in the alleged accident. The court granted the defendant's motion for summary judgment, dismissing the complaint, and denied the plaintiff's cross motion for summary judgment. The holding of the court was that the defendant's insured's testimony in the EUO was sufficient to demonstrate that the alleged injury did not arise out of an insured incident. The court affirmed the order, with costs, as plaintiff failed to raise a triable issue of fact in opposition to defendant's motion.
Active Care Med. Supply Corp. v American Tr. Ins. Co. (2018 NY Slip Op 51584(U))
November 9, 2018
The court considered a case in which Active Care Medical Supply Corp. was seeking to recover first-party no-fault benefits from American Transit Insurance Company. Active Care Medical Supply Corp. moved for summary judgment, and American Transit Insurance Company cross-moved for summary judgment dismissing the complaint, citing that Active Care failed to appear for duly scheduled examinations under oath and that there was a lack of medical necessity for the supplies in question. The Civil Court denied Active Care's motion and granted American Transit's cross motion. The Appellate Term, Second Department affirmed the decision, stating that the defendant's proof established the proper mailing of the EUO scheduling letters, and the plaintiff's failure to rebut the conclusions set forth in the IME report. Therefore, the court held in favor of American Transit Insurance Company.