No-Fault Case Law
Atlantic Chiropractic, P.C. v Utica Mut. Ins. Co. (2019 NY Slip Op 50173(U))
February 8, 2019
The court considered whether the insurer should be allowed to amend its answer to include the affirmative defense of res judicata and to seek summary judgment dismissing the complaint on the ground that the plaintiff's action was barred based on that doctrine. The main issue decided was whether the insurer had waived its res judicata defense by submitting its answer in the Civil Court after it had commenced the declaratory judgment action. The holding of the court was that the order denying the insurer's motion was reversed, and the insurer's motion for leave to amend its answer to include the res judicata defense and to deem the answer served nunc pro tunc was granted. The court also held that, under the doctrine of res judicata, the plaintiff's action was barred based on the previous declaratory judgment entered by the Supreme Court.
Dynamic Balance Acupuncture, P.C. v State Farm Ins. (2019 NY Slip Op 50171(U))
February 8, 2019
The court considered the motion for summary judgment filed by defendant in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had established the timely and proper mailing of the examinations under oath (EUO) scheduling letters and the denial of claim forms, as well as the plaintiff's failure to appear for the EUOs. The holding of the court was that to establish its entitlement to summary judgment dismissing the complaint, the defendant insurer had demonstrated, 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 court further found that the plaintiff's argument that the defendant's EUO requests were unreasonable lacked any basis and that defendant's motion for summary judgment dismissing the complaint was granted.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50099(U))
January 18, 2019
The court considered a case in which Lotus Acupuncture, P.C. as the assignee of Jose Corsino sued Country-Wide Ins. Co. for first-party no-fault benefits. The judgment awarded the plaintiff $7,755 after a non-jury trial. The main issue decided was that the judgment must be reversed, as no testimony was taken as to the specific action, and a new trial should be held.
The holding of the court was that the judgment was reversed and the matter was remitted to the Civil Court for a new trial. The court found that as no testimony was taken specifically for this action, a new trial must be held in order to make a fair and just ruling.
Healthy Way Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50098(U))
January 18, 2019
The main issue in the case was whether the judgment awarding a healthcare provider first-party no-fault benefits should be reversed and remanded for a new trial. The court considered the fact that no testimony was taken as to this specific action, and that a new trial should be held. The holding of the case was that the judgment was reversed and the matter was remitted to the Civil Court for a new trial. Therefore, the decision was to reverse the judgment and order a new trial to be held.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50097(U))
January 18, 2019
The court considered a case in which Lotus Acupuncture, P.C., as the assignee of Contreras Venecia, sought to recover first-party no-fault benefits from Country-Wide Ins. Co. The case was consolidated with five other actions for a nonjury trial. After testimony was taken in one of the six cases, the Civil Court found in favor of the plaintiff and awarded them $5,325. However, the defendant argued that no testimony was taken specifically for this action and that a new trial should be held. The court agreed with the defendant and reversed the judgment, remitting the matter to the Civil Court for a new trial. Therefore, the holding of the case was that the judgment in favor of the plaintiff was reversed and a new trial was ordered.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50096(U))
January 18, 2019
The main issue in the case was whether Lotus Acupuncture, P.C. was entitled to recover assigned first-party no-fault benefits from Country-Wide Ins. Co. After a nonjury trial, the Civil Court awarded the plaintiff the principal sum of $7,855. However, the Appellate Term, Second Department found that no testimony was taken in this particular action and that a new trial should be held. Therefore, the judgment was reversed and the matter was remitted to the Civil Court for a new trial. The relevant facts considered included the consolidation of this action with five others for the purposes of a nonjury trial, and the lack of testimony specifically related to this case. The holding of the case was that the judgment awarding the plaintiff the principal sum of $7,855 was reversed and a new trial was ordered.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50095(U))
January 18, 2019
The relevant facts the court considered were that Lotus Acupuncture, P.C. brought an action to recover first-party no-fault benefits and was awarded the principal sum of $4,915 after a nonjury trial. The main issue decided was whether the judgment in favor of the plaintiff should be reversed, as no testimony was taken in this action and a new trial should be held. The holding of the case was that the judgment was reversed and the matter was remitted to the Civil Court for a new trial, as no testimony was taken as to this action and a new trial should be held.
Healthy Way Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50094(U))
January 18, 2019
The relevant facts considered by the court in this case were that Healthy Way Acupuncture, P.C. was seeking to recover first-party no-fault benefits as the assignee of Nieves Jason. The case involved seven claims, totaling $6,940, and was consolidated for a nonjury trial with five other actions. The main issues decided were whether the plaintiff had established its prima facie case for the seven claims and whether the defendant had properly and timely denied three of the claims on the ground that the assignor had failed to appear for independent medical examinations (IMEs). The holding of the case was that the judgment award was reduced to the principal sum of $5,695, as the defendant had proven that the assignor had violated a condition precedent to coverage and the plaintiff was not entitled to recover on those specific bills. The matter was remitted to the Civil Court for a recalculation of statutory interest and the entry of an appropriate amended judgment.
Midwood Total Rehab, P.C. v GEICO Ins. Co. (2019 NY Slip Op 50087(U))
January 17, 2019
The court considered the fact that the plaintiff had commenced an action in March 2011 to recover assigned first-party no-fault benefits and the defendant served a 90-day written demand pursuant to CPLR 3216 in November 2016. The main issue was whether the plaintiff's delay in responding to the defendant's 90-day notice was willful or contumacious, and whether it evidenced an intent to abandon the action. The holding of the case was that the court reversed the order and granted the defendant's motion to dismiss the complaint pursuant to CPLR 3216, based on the reasons stated in a similar case.
Yin Yang Harmony Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 50086(U))
January 17, 2019
The court considered the fact that the plaintiff had commenced the action to recover no-fault benefits in March 2011 and that the defendant had interposed an answer in April 2011. In November 2016, over five years later, the defendant served a 90-day written demand pursuant to CPLR 3216 (b) (3). Despite this, the plaintiff did not serve the defendant with a notice of trial until March 29, 2017. The main issue decided was whether the defendant's motion to dismiss the complaint pursuant to CPLR 3216 should be granted. The holding of the case was that the order of the District Court denying the motion was reversed, and the defendant's motion to dismiss the complaint pursuant to CPLR 3216 was granted. Therefore, the plaintiff's delay in responding to the 90-day notice was found to be sufficient to grant the defendant's motion to dismiss the complaint.