No-Fault Case Law

The court considered the facts surrounding an insurance dispute arising from an accident in which Melito Bonilla was injured as a passenger in a parked car. Plaintiffs, Liberty Mutual Insurance Company and LM General Insurance Company, sought a declaratory judgment that they did not owe no-fault coverage for Bonilla's medical fees because he failed to appear for an examination under oath (EUO) as required by his insurance policy. Two of Bonilla's medical providers, who are defendants in the case, also brought eight separate actions seeking payment for treatment of Bonilla's injuries from Liberty. The main issue decided was whether the plaintiffs' motion to consolidate Bonilla's case with the eight separate Civil Court actions was improvidently denied. The holding of the court was that it was an improper exercise of discretion to deny the motion to consolidate, as the issue of Bonilla's failure to submit to the EUO and whether that entitled Liberty to disclaim coverage would affect the outcome of each case, and there was a risk of inconsistent verdicts and multiple trials if the actions were not consolidated.

The court considered the lower arbitrator's award in favor of Refill Rx Pharmacy, Inc., as assignee of Kimberly Rosas, against Country-Wide Insurance Company, in the amount of $2,715.48, and denied respondent's cross motion for attorneys' fees. The main issue decided was whether the lower arbitrator exceeded his power by issuing an award exceeding the contractual limit for the subject no-fault coverage policy of $50,000, and whether the master arbitrator erred in affirming. The holding of the court was that vacatur of the award was warranted under CPLR 7511 (b) (1) (iii) as the lower arbitrator exceeded his power by issuing an award exceeding the contractual limit for the subject no-fault coverage policy of $50,000. Moreover, the court found that Country-Wide properly exhausted the policy prior to the underlying arbitration, and Refill was not entitled to attorneys' fees.

The court considered the appeal from an order of the Civil Court of the City of New York, Kings County, which denied the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the action by the provider to recover assigned first-party no-fault benefits was barred by the statute of limitations. The holding of the court was that the order denying the defendant's motion for summary judgment was affirmed, with $25 costs. The court affirmed the order based on the reasons stated in New Millennium Med. Imaging, P.C. v GEICO, and the justices concurred with the decision.

The main issue in this case was whether the defendant insurer was entitled to summary judgment dismissing the complaint filed by the plaintiff chiropractic healthcare provider, who sought to recover first-party no-fault benefits. The court considered the fact that the insurer had twice demanded the plaintiff to appear for examinations under oath (EUOs), and that the plaintiff had twice failed to appear, as well as the timely denials of the claims issued by the insurer. The court found that the insurer had established its prima facie entitlement to summary judgment, and that the only remaining issue for trial was the reasonableness of the insurer's EUO requests. The holding of the case was that the order denying the insurer's motion for summary judgment was reversed, and the insurer's motion for summary judgment dismissing the complaint was granted. The court found that the plaintiff had failed to raise a triable issue of fact, and therefore the insurer was entitled to summary judgment.

The court considered a motion to dismiss a declaratory judgment action and a motion for a protective order in a case where plaintiffs sought to make a declaration regarding the eligibility of defendants to recover no-fault benefits under relevant policies. The main issues decided were whether proper causes of action for declaratory judgment had been stated and whether the court should exercise its discretion to dismiss the claims, grant a protective order, or sever the claims into separate actions. The court held that plaintiffs had stated proper causes of action for declaratory judgment and that their request for a declaration regarding the eligibility of defendants to recover no-fault benefits constituted a justiciable controversy. The court also held that it properly declined to dismiss the claims, grant a protective order, or sever the claims, and declined to dismiss the claims that had also been asserted by the defendants in separate Civil Court actions.

The main issue in this case was whether the provider was entitled to recover first-party no-fault benefits, despite failing to appear for scheduled examinations under oath (EUOs). The court considered the fact that the defendant had filed a motion for summary judgment, arguing that the plaintiff had failed to appear for the EUOs and had therefore forfeited their right to the benefits. The court also considered the plaintiff's cross motion for summary judgment. The court held that the defendant's motion failed to establish that the claims had been timely denied after the assignor's failure to appear for the EUOs. Therefore, the defendant's motion for summary judgment was denied. However, the plaintiff also failed to demonstrate their entitlement to summary judgment, as they did not establish that the claims had not been timely denied, or that the denial of claim forms issued by the defendant were without merit. Therefore, the court modified the order to deny the defendant's motion for summary judgment, but also denied the plaintiff's cross motion for summary judgment.

The relevant facts considered in this case were that MSB Physical Therapy, P.C. was seeking to recover assigned first-party no-fault benefits from Nationwide Ins. The main issue decided was whether defendant was entitled to summary judgment dismissing the complaint on the ground that plaintiff had failed to appear for scheduled examinations under oath (EUOs). The holding of the case was that the defendant had failed to establish that it had timely denied plaintiff's claims after plaintiff's failure to appear for an EUO, and therefore defendant's motion for summary judgment dismissing the complaint was properly denied. The court also found that the defendant's papers were insufficient to demonstrate that there is a triable issue of fact as to its EUO no-show defense, and therefore plaintiff's cross motion for summary judgment was affirmed.

The main issue in the case was whether the insurance policy in question was fraudulently procured by the plaintiff's assignor. The court also had to decide if the amounts being sought for recovery exceeded the amounts permitted by the workers' compensation fee schedule. The court held that the defendant failed to demonstrate as a matter of law that the alleged material misrepresentation in procuring the insurance policy was actually material. They also held that the plaintiff's cross-motion for summary judgment should be denied because the proof submitted failed to establish that the defendant failed to timely deny the claims at issue or that the defendant issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law. Therefore, the order was modified to deny the branch of defendant's motion seeking summary judgment dismissing the complaint on the ground of fraudulent procurement of the insurance policy and remit the matter to the Civil Court for a determination of the alternate ground that the amounts being sought exceeded the amounts permitted by the workers' compensation fee schedule.

The court considered the no-fault insurance-coverage action brought by Country-Wide Insurance Company against defendants Lifeline Medical Imaging, P.C., Autumn PT, P.C., and 334 Grand Concourse Medical, P.C. all of whom were medical-provider assignees of the eligible injured person, Steven Henderson. Country-Wide sought a declaration of no coverage on the ground that Henderson failed twice to appear for scheduled examinations under oath (EUOs), vitiating coverage for himself and for his assignees. The main issue decided was whether Country-Wide had a specific objective justification for requesting the EUOs, as required by governing regulations. The court held that Country-Wide's justifications for seeking Henderson's EUO were insufficient, as they failed to provide a clear basis for the request and did not identify the source of their knowledge for the lapse of time asserted in their affidavit. The court also held that Country-Wide's summary-judgment motion was premature, as they had not provided the discovery being sought by the opposing defendants. The court denied Country-Wide's motion for summary judgment without prejudice, including against defendant Autumn PT, and ordered Country-Wide to serve a copy of the order on the relevant parties.

The court considered the plaintiff, Country-Wide Insurance Company's, motion for default judgment against non-appearing defendants Quality Custom Medical Supply, Inc., Atlas Radiology P.C., Zhong Qing Zhou L.A.C., and Guy Brewer Pharmacy, Inc., and a separate motion for summary judgment against appearing defendants Chohayea Duff and the remaining medical-provider assignees. The main issues were whether Country-Wide had established proper service, default, and the facts constituting its claims against the defaulting defendants, and whether Country-Wide had established that Duff and the remaining medical-provider assignees failed to appear for an independent medical examination (IME) justifying a summary judgment motion. The holding of the court was that Country-Wide's default judgment and summary judgment motions were granted, as Country-Wide had established proper service and that its requests for IMEs were timely and proper, as well as that the opposing defendants failed to raise a dispute of material fact warranting trial.