No-Fault Case Law

The main issue being decided in this case was whether the defendant, Garden Medical Care, P.C., failed to adequately respond to post-examination under oath (EUO) document demands from the plaintiffs, State Farm Mutual Automobile Insurance Company and State Farm Fire & Casualty Company. The plaintiffs sought a declaratory judgment that the defendant has no right to receive payment for hundreds of no-fault claims for medical treatment. Following the defendant's EUO, the plaintiffs served demands seeking further information and documents, alleging that the defendant did not adequately comply with these requests. The Supreme Court, New York County, determined that the plaintiffs' motion for default judgment should be denied due to the lack of proof provided by the plaintiffs to support their claim. The court stated that without the EUO transcript, post-EUO demands, defendant's responses and objections, or document production from the defendant, they could not assess whether the defendant failed to adequately respond to the plaintiffs' verification requests. The court ordered that if the plaintiffs do not bring a renewed default judgment motion within 30 days, the action will be dismissed. The court also required the plaintiffs to serve a copy of the order on the defendant.

The court considered the affidavit of defendant's employee as sufficient evidence to establish a presumption that the examination under oath scheduling letters and denial of claim forms as to the claims had been timely mailed. Plaintiff's appeal was limited to the issue of summary judgment dismissing the first and second causes of action, and the court found that plaintiff had not demonstrated any basis to disturb the order granting the branches of defendant's motion seeking summary judgment and denying plaintiff's cross-motion seeking summary judgment. Therefore, the order was affirmed, and the appeal was dismissed. The main issue decided was whether the defendant's evidence was sufficient to establish a presumption of timely mailing of the examination under oath scheduling letters and denial of claim forms, and the court held that it was.

The court considered the facts that defendant moved for summary judgment dismissing the first through fifth and seventh causes of action on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs), and also dismissing the sixth cause of action on the ground that it was barred by a declaratory judgment issued by the Supreme Court in an action commenced by defendant against plaintiff in regard to the same accident. Plaintiff opposed the motion and cross-moved for summary judgment. The main issue decided was whether the plaintiff's failure to appear for EUOs and the declaratory judgment issued by the Supreme Court barred their claims for first-party no-fault benefits. The court held that the plaintiff's claim was barred under the doctrine of res judicata by virtue of the declaratory judgment and also that the EUO scheduling letters and denial of claim forms had been timely mailed, so plaintiff's claims were properly dismissed. The holding of the case was that the court affirmed the order, granting defendant's motion for summary judgment on the grounds that the plaintiff had failed to appear for scheduled EUOs and that the sixth cause of action was barred by a declaratory judgment. Therefore, plaintiff's claims were properly dismissed.

The relevant facts in the case involved a provider seeking to recover assigned first-party no-fault benefits, and the defendant's (State Farm Mutual Automobile Insurance Company) motion for summary judgment dismissing the complaint on the ground that the provider failed to provide requested verification. The Court considered the proof submitted by the defendant, which demonstrated that they had timely mailed initial and follow-up verification requests and that they had not received the requested verification. The main issue decided was whether the plaintiff's owner's statement that he had mailed the requested verification "to the extent such responses were proper and in his possession" raised a triable issue of fact. The holding of the court was that the plaintiff's owner's statement did not raise a triable issue of fact, and that the order denying defendant's motion for summary judgment was reversed, with costs, and defendant's motion for summary judgment dismissing the complaint was granted.

This case involved Liberty Mutual Insurance Company's denial of no-fault-benefits claims for a person injured in an accident on the grounds that the injured person had materially misrepresented the insured vehicle's garaging address and the identity of the vehicle's operators. The plaintiffs moved for a default judgment under CPLR 3215 against non-answering defendants but it was ultimately denied. The main issue was whether Liberty Mutual's denials of the no-fault claims were timely, as it is required by law that these claims be paid or denied within 30 days after proof of the claim is received. Liberty Mutual failed to establish that its denials were timely and therefore, the court ruled in favor of denying the motion for default judgment, stating that the action would be dismissed if a renewed default-judgment motion was not filed within 30 days.

The court considered whether the defendant's motion for summary judgment and to dismiss the plaintiff's complaint on the basis that the plaintiff's assignor failed to appear for four scheduled examinations under oath (EUO) should be granted. The main issue decided was whether the denial of the claim by the defendant was timely, even though it exceeded the 30-day time period from the second EUO no-show. The court held that the defendant's motion for summary judgment was granted in its entirety, and the plaintiff's cross motion was denied. The court found that the defendant demonstrated its prima facie entitlement to judgment as a matter of law by showing that the scheduling letters were timely and properly mailed, and that the assignor failed to appear on each of the four scheduled dates. Therefore, the plaintiff's complaint was dismissed.

The plaintiff initiated legal action against the defendant insurance company in order to recover no-fault insurance benefits for lost wages. The defendant sought to disqualify the plaintiff's counsel, as the principal of the plaintiff's legal representation had previously represented the defendant in hundreds of no-fault actions. The Supreme Court granted the defendant's motion to disqualify counsel for the plaintiff based on the existence of a prior attorney-client relationship, the substantially related issues involved in both representations, and the materially adverse interests of the present client and former client. The plaintiff appealed this decision, however, the appellate court affirmed the decision to disqualify counsel for the plaintiff. The court held that the disqualification of an attorney is at the discretion of the court, and in this case, the Supreme Court properly exercised its discretion in granting the defendant's motion to disqualify the plaintiff's attorney.

The relevant facts the court considered were that the plaintiff had served discovery demands on the defendant in an action to recover no-fault insurance benefits for lost wages arising from a 2016 motor vehicle accident. The defendant provided responses, and the plaintiff then moved to compel the defendant to respond to the discovery demands. The main issue decided was whether the Supreme Court properly denied the plaintiff's motion to compel discovery, and the holding was that the court did not improvidently exercise its discretion in denying the motion without prejudice to renew. The court determined that the motion papers were missing copies of the discovery demands served on the defendant and details about what discovery remained outstanding, and therefore the denial was proper.

The relevant facts of the case included a provider seeking to recover assigned first-party no-fault benefits, with the defendant appealing from an order granting the plaintiff's motion to vacate the dismissal of the action and to restore the action to the trial calendar. The main issue decided was whether the plaintiff demonstrated a reasonable excuse for its default and had a meritorious cause of action. The holding of the case was that the Civil Court did not improvidently exercise its discretion in finding that the plaintiff had demonstrated a reasonable excuse for its default, as the plaintiff's witness was out of the country at the time of the trial. Additionally, the plaintiff demonstrated that it has a meritorious cause of action. Therefore, the order to vacate the dismissal of the action was affirmed.

The court considered the circumstances under which plaintiff was denied motion for medical expenses. The plaintiff was involved in an accident resulting in multiple injuries, and was insured by the defendant up to $50,000 for no-fault coverage and up to $50,000 for additional personal injury protection (APIP) coverage. She settled with the responsible parties' insurance carriers for $100,000 each due to the injuries sustained, but the defendant refused to pay out any additional money under the APIP coverage and placed a lien on the $7,292.85 already paid to the plaintiff. The main issue decided was whether the defendant was required to pay the remainder of the APIP coverage for the plaintiff's medical expenses and if the defendant had the right to a lien on the amount already paid to the plaintiff. The holding of the case was that the denial of plaintiff's motion was not warranted and the basis should have been that the motion was premature, therefore the complaint must be reinstated.