No-Fault Case Law

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.

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.

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.

The relevant facts considered by the court were that the defendant, Park Insurance Company, was appealing an order denying their motion for summary judgment to dismiss a complaint by Advanced Recovery Equipment and Supplies, LLC, as Assignee of Yvrose Joseph, seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had established, as a matter of law, an exhaustion of the coverage limits of the insurance policy at issue. The court held that the defendant did not demonstrate that the policy had been exhausted at the time the claim at issue was complete, and therefore, did not establish their entitlement to summary judgment dismissing the complaint. The court affirmed the order denying the defendant's motion for summary judgment.

The court considered a petition filed by Progressive Advanced Insurance Company to vacate an arbitration award by New York City Transit Authority (NYCTA). NYCTA sought reimbursement for workers' compensation benefits paid to an employee who was involved in a collision with an insured vehicle by Progressive. The arbitrator determined that a 20% no-fault offset did not apply to the benefits paid by NYCTA due to a one-third offset already being applied. Progressive argued that this interpretation was arbitrary and capricious. The court held that the arbitrator's determination was based on a reasonable hypothesis and was not arbitrary or capricious, affirming the Supreme Court's denial of the petition to vacate the arbitration award.

The court considered the fact that the provider had previously submitted claims to arbitration following a motor vehicle accident involving the same assignor. The arbitrator found that the provider had failed to prove its standing to sue, and dismissed the claim without prejudice to the right to initiate a new arbitration with supplementary proofs. Despite this, the provider commenced an action in the Civil Court to recover assigned first-party no-fault benefits. The main issue decided was whether the provider had waived its right to commence an action to litigate its claims by electing to arbitrate them. The court held that the provider had waived its right, and that the Civil Court properly granted summary judgment dismissing the complaint. Therefore, the order entered May 18, 2015 was affirmed, and the appeal from the order entered May 26, 2016 was dismissed.

The court considered the fact that the plaintiff, a provider, was seeking to recover assigned first-party no-fault benefits from the defendant. The defendant had moved for summary judgment to dismiss a portion of the complaint, claiming it was premature because the plaintiff had failed to provide requested verification. The main issue decided was whether the defendant had properly mailed verification requests and whether the plaintiff had received the requested verification. The court decided that there was a triable issue of fact as to whether the portion of the action seeking to recover the sum of $3,399.51 was premature, and therefore reversed the order and denied the branch of defendant's motion seeking summary judgment to dismiss that portion of the complaint.

The relevant facts considered by the court were that Charles Deng Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from Zurich American Insurance Company. The main issue decided was whether Zurich American Insurance Company had issued an insurance policy covering the loss in question. The holding of the court was that the proof submitted by the defendant was sufficient to demonstrate that they had not issued a policy covering the loss in question. As a result, the court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The order was affirmed with costs.

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). The court found that to establish its entitlement to summary judgment, the insurer must demonstrate, as a matter of law, that it had twice duly demanded an EUO from the provider, that the provider had twice failed to appear, and that the insurer had issued a timely denial of the claims. The plaintiff in this case did not challenge that the defendant demonstrated its prima facie entitlement to summary judgment, but rather argued that the plaintiff raised a triable issue of fact in opposition. However, the court found that the plaintiff's argument lacked merit and therefore granted defendant's motion for summary judgment, dismissing the complaint. The holding of the court was that the order of the Civil Court, insofar as appealed from, is reversed and defendant's motion for summary judgment dismissing the complaint is granted.

The court considered the facts that Island Life Chiropractic, P.C. was seeking to recover first-party no-fault benefits and that State Farm Mutual Automobile Insurance Co. had denied the claims on the grounds that the plaintiff's assignor had failed to appear for scheduled examinations under oath. State Farm had mailed initial and follow-up letters scheduling the examinations and the plaintiff's assignor had failed to appear on either date. The main issue decided was whether State Farm's motion for summary judgment dismissing the complaint should be granted. The holding of the case was that as the plaintiff failed to raise a triable issue of fact in opposition to State Farm's motion, State Farm was entitled to summary judgment dismissing the complaint. Therefore, the order was reversed and State Farm's motion for summary judgment dismissing the complaint was granted.