No-Fault Case Law

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.

The relevant facts considered by the court included a motion by the defendant to vacate a default judgment entered after the defendant failed to proceed at trial. In support of its motion, the defendant submitted an affidavit by the plaintiff's assignor admitting that the accident for which the plaintiff was seeking no-fault benefits had been staged. Additionally, the defendant provided an order from the Supreme Court, New York County, in a declaratory judgment action, finding that the defendant had no duty to pay any no-fault benefits to the plaintiff and its assignor. The main issue decided by the court was whether the defendant demonstrated a reasonable excuse for its failure to proceed at trial and a meritorious defense. The court ultimately held that the defendant's motion should have been granted, as it did demonstrate a reasonable excuse for its failure to proceed at trial and a meritorious defense. Therefore, the order denying the defendant's motion to vacate the default judgment was reversed, and the defendant's motion to vacate the default judgment was granted.

The main issue in this case was whether the decision of the Civil Court to dismiss the complaint was proper, as the plaintiff had allegedly defaulted by failing to comply with a condition set by the court for the granting of an adjournment of the trial. The Appellate Term held that although no appeal lies from a judgment entered on the default of the appealing party, an appeal from such a judgment brings up for review those matters which were the subject of contest below. The Appellate Term determined that the Civil Court had acted within its discretion in conditioning the granting of an adjournment of the trial upon the plaintiff's providing proof of the funeral that its witness had allegedly been attending, but found that the Civil Court improvidently exercised its discretion in not allowing plaintiff's witness to testify in order to try to provide the required proof. Therefore, the judgment was reversed, and the matter was remitted to the Civil Court for a new determination, following a hearing, of whether plaintiff had satisfied the condition for the granting of an adjournment and for any and all further proceedings.