No-Fault Case Law

The court considered the defendant's motion to dismiss the complaint based on the doctrine of res judicata or, in the alternative, for summary judgment. The plaintiff, a chiropractic medical center, had commenced an action to recover first-party no-fault benefits for medical services provided to a patient injured in a 2010 automobile incident. The defendant insurer had also filed a declaratory judgment action in Supreme Court, seeking a determination that the plaintiff was not entitled to no-fault benefits for the 2010 collision. The Supreme Court had granted the insurer's motion on default, issuing an order that declared the plaintiff was not entitled to benefits. In the current no-fault action, the defendant insurer moved to dismiss on the grounds that the Supreme Court's order precluded the current action based on res judicata. The plaintiff argued that the default judgment did not have preclusive effect under New York state law and cited various federal and state cases for support. The court held that under res judicata, a disposition on the merits bars litigation of a cause of action between the same parties arising out of the same transaction. The court also clarified that under New York state law, default judgments that have not been vacated are final orders and have preclusive effect. The court distinguished the plaintiff's cited cases and held that the specific declaratory judgment order in this case, which had been granted on default, constituted a conclusive final determination and precluded the current no-fault action. In conclusion, the court granted the defendant's motion to dismiss, holding that the action was dismissed due to the preclusive effect of the Supreme Court's declaratory judgment order.

The court considered the defendant-insurer's motion for summary judgment to dismiss the complaint. The main issue decided was whether the defendant made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely denied the plaintiff's first-party no-fault claims based on a sworn independent examination report (IME) of its examining acupuncturist/chiropractor. The holding of the case was that the defendant-insurer did make a prima facie showing of entitlement to judgment as a matter of law. The court reversed the order of the Civil Court, granted the motion for summary judgment, and dismissed the complaint. The court found that the plaintiff's opposition to the motion for summary judgment did not raise a triable issue, as the affidavit of the plaintiff's principal was not based on an examination of the assignor and did not rebut the findings of the defendant's examining acupuncturist/chiropractor.

The relevant facts considered by the court in this case included an insurance company's motion for summary judgment to dismiss a complaint brought by a medical supply company. The insurance company argued that the medical supply company failed to respond to timely requests for verification, which rendered the underlying no-fault claims premature. The main issue decided by the court was whether the insurance company's verification request for a manufacturer's invoice documenting the cost of the supplies provided to the assignor was justified. The holding of the court was that the insurance company established its prima facie entitlement to summary judgment dismissing the claims, as the medical supply company failed to respond to the verification requests, and no triable issue was raised regarding the insurance company's "good reason" for the verification request. As a result, the court reversed the lower court's order and granted the insurance company's motion for summary judgment, dismissing the complaint.

The relevant facts considered by the court in this case involved an action for a declaratory judgment filed by American Alternative Insurance Corporation, where defendants Hattie M. Washington and Alexander Anglada claimed to have been involved in an accident involving a vehicle insured by the plaintiff. The core claim was that they were pedestrians struck by the vehicle, resulting in injuries caused by falling to the ground. Plaintiff moved for a default judgment against several non-answering defendants, arguing that their assignors, Washington and Anglada, had made fraudulent statements and were not entitled to any coverage or reimbursements. Plaintiff submitted proof in the form of video evidence, subsequent investigation, and witness testimony to support their claim. The main issue decided was whether or not the plaintiff was entitled to a default judgment against the non-answering defendants and to deny coverage and payments to the provider defendants for any no-fault related services for the claims made by Washington and Anglada. Additionally, the court considered whether the claimants were entitled to no-fault benefits and whether the plaintiff had met the burden of proof required for a default judgment. The holding of the case was that the plaintiff's motion for a default judgment was granted, and the plaintiff was directed to serve a copy of the Decision and Order with Notice of Entry upon the defendants within 20 days. The court found that the plaintiff had satisfied the requirements for a default judgment and that the evidence provided was sufficient to create a founded belief that the claims were fraudulent, therefore entitling the plaintiff to deny coverage and payments to the provider defendants.

The relevant facts the court considered were that Ameriprise Insurance Company sought a preliminary injunction or stay of all pending and future lawsuits for uninsured/underinsured no-fault insurance benefits to the defendants. The case arose from an incident in which Ameriprise Insurance Company sought a declaratory judgment that the vehicle in the incident was not a product of a covered event as it was the result of an intentional and/or staged occurrence. The main issue was whether the incident was an accident, and therefore eligible for no-fault coverage. The holding was that the court granted Ameriprise Insurance Company's motion for a preliminary injunction, finding that the incident was not an accident and therefore not eligible for no-fault coverage. The court held that Ameriprise had provided sufficient evidence to support its determination that the incident was intentional and not eligible for no-fault coverage.

The relevant facts that the court considered were that the defendant, a medical provider, failed to appear for scheduled examinations under oath for thirteen individuals who were allegedly injured in various motor vehicle accidents. The main issues decided included whether the failure to appear for the examinations under oath was a breach of a condition precedent to coverage under the No-Fault regulations and whether a request for examinations was based on objective standards and sufficiently justified. The holding of the case was that the defendant's motion for summary judgment and defendant's cross-motion to dismiss were denied, but the defendant's cross-motion seeking an order compelling discovery was granted. The court also found that the failure to appear for scheduled examinations under oath constituted a breach of a condition precedent to coverage, vitiating coverage.

The relevant facts that the court considered were whether the defendant had timely denied the claims, and whether the plaintiff had established its prima facie case. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint, and whether the plaintiff was entitled to summary judgment and costs. The holding of the case was that the defendant was not entitled to summary judgment dismissing the complaint because their moving papers failed to establish that they had timely mailed their denial of claim forms. The plaintiff's cross motion for summary judgment and costs was also denied, as they did not establish that the defendant had failed to timely deny the claims or that the defendant had issued timely denial of claim forms that were conclusory, vague, or without merit as a matter of law.

The case focused on a dispute involving Allstate Insurance Company and North Shore University Hospital regarding a de novo determination of claims for no-fault insurance benefits following a motor vehicle accident. Jude M. Blanc was injured in the accident and received hip surgery at the hospital, leading the hospital to submit a claim to Allstate. The insurer denied the claim, and after arbitration, the arbitrator awarded the hospital $16,134.83 in no-fault compensation. Allstate then commenced an action seeking a de novo determination of the hospital's claims and succeeded in entering a default judgement when the hospital failed to appear or answer the complaint. The issues considered included whether the hospital's default should be vacated, and whether they demonstrated a reasonable excuse for the default and a potentially meritorious defense to the action. The court held that the hospital did demonstrate a reasonable excuse for the default and a potentially meritorious defense, reversing the prior decision and granting the hospital's motion to vacate its default.

The court considered the issue of whether the defendant was entitled to depose plaintiff Yan Moshe in relation to a dispute over the amount of loss of earnings for Moshe's appearance at an examination under oath in the context of a first-party no-fault insurance claim. The plaintiffs alleged that the defendant remitted an amount significantly lower than the loss of earnings claimed by Moshe, and sought to recover the unpaid balance. The main issue decided was whether the defendant was entitled to a second deposition to address the calculation of the unpaid balance. The court held that the defendant's failure to address the loss of earnings issue in the initial deposition constituted a waiver of their right to depose Moshe in the current plenary action, and awarded a protective order against the deposition of Yan Moshe, but allowed the defendant to serve interrogatories upon plaintiffs.

The main facts of the case were that Dr. George F. Josephson filed suit against State Farms Insurance Company in 2016 to recover assigned first-party no-fault benefits in what was presumably an insurance dispute with that company. The complaint was granted based on State Farm's failure to appear at a calendar call for the case on June 30, 2008, and failed to enter the default judgment within a year. State Farm filed a motion to vacate the default judgment and dismiss the complaint under CPLR 3215(c). The main issue was whether the Civil Court of the City of New York, Queens County had erred in granting the motion. The holding was that the Civil Court did not abuse its discretion in granting State Farms' motion to vacate the default judgment and dismiss the complaint under the rules of CPLR 3215(c) because the plaintiff had not taken proceedings for the entry of a judgment within one year of State Farm's calendar default.