No-Fault Case Law

The main facts considered by the court were that an insurance company had twice demanded an Examination Under Oath (EUO) from a provider, who had failed to appear both times, and the insurer had issued a timely denial of the claims. The main issue decided was whether the insurer was entitled to summary judgment dismissing the complaint, which the court ultimately decided in favor of the insurer. The holding of the case was that the insurer had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, as well as the provider's failure to appear for the EUOs, and therefore the insurer's motion for summary judgment was granted.

The court considered an order from the Civil Court of the City of New York denying the defendant's motion to sever a cause of action seeking to recover upon a claim for services rendered to Fatima Powell from the remaining causes of action. The defendant argued that the causes of action had arisen out of different accidents and that multiple defenses had been interposed in the answer. However, the Civil Court denied the motion, stating that the defendant had failed to establish that the claims involved different questions of fact and law. The main issue decided was whether the defendant's motion to sever the cause of action seeking to recover upon a claim for services rendered to Fatima Powell from the remaining causes of action should be granted. The holding of the court was that the order denying the defendant's motion to sever the cause of action seeking to recover upon a claim for services rendered to Fatima Powell from the remaining causes of action was affirmed.

The main issue in the case was whether the provider, Healthway Medical Care, P.C., was entitled to summary judgment to recover assigned first-party no-fault benefits from American Commerce Insurance Company. The court considered the fact that Healthway failed to appear for duly scheduled examinations under oath (EUOs), and that defendant had issued timely denial of claim forms. The court held that Healthway failed to make a prima facie showing of its entitlement to summary judgment, but also found that the initial EUO request had been sent more than 30 days after the defendant had received the claims at issue, making the requests nullities as to those claims. Therefore, the court modified the order to deny defendant's cross motion for summary judgment dismissing the complaint.

The court considered the issue of whether plaintiff had failed to appear for duly scheduled examinations under oath. Plaintiff argued as to defendant's practices and procedures regarding the mailing of the denial of claim form, but the court found that this argument lacks merit. Plaintiff's remaining argument, being raised for the first time on appeal, was not properly before the court and was declined to be considered. The court affirmed the order granting defendant's motion for summary judgment dismissing the complaint, with $25 costs. The holding of the case was that the order granting defendant's motion for summary judgment was affirmed.

The court considered a motion to sever a cause of action in a case brought by City Chiropractic, P.C. seeking to recover first-party no-fault benefits for services rendered to two assignors. Defendant argued for severance based on the assertion that the causes of action arose from two different accidents and that multiple defenses had been interposed in the answer. The issue decided was whether the claims involving services rendered to two different individuals should be severed into separate causes of action. The court held that the denial of defendant's motion to sever the cause of action seeking to recover upon a claim for services rendered to Victoria A. Lliguichuzhca from the remaining cause of action was an exercise of judicial discretion and should not be disturbed on appeal, as the record did not establish that the denial was an improper exercise of discretion. The order to deny defendant's motion to sever was affirmed.

The court considered a motion by the plaintiff to award summary judgment in an action to recover assigned first-party no-fault insurance benefits, as well as a cross-motion by the defendant seeking dismissal of the case on the basis that the plaintiff's assignor failed to appear for an examination under oath (EUO). The main issue was whether the defendant had failed to deny the claims within the requisite 30-day period or issued timely denials that were conclusory, vague, or without merit as a matter of law. The court held that the plaintiff did not establish that the defendant had failed to deny the claims within the requisite 30-day period, or that the denials issued were conclusory, vague, or without merit as a matter of law. Additionally, the defendant failed to submit competent proof that the assignor failed to appear for the EUO, therefore, both the plaintiff's motion and the defendant's cross-motion were denied as both parties failed to establish entitlement as a matter of law.

The plaintiff, Global Liberty Insurance Company, filed a motion for summary judgment seeking a declaration of non-coverage for no-fault benefits as defendant New Century Acupuncture, P.C., as assignor of defendant Heather Davis. They cited Davis' failure to appear for two scheduled independent medical examinations (IMEs) as a condition precedent to coverage, as well as their attempts to provide notice of the rescheduled IME. According to the plaintiff, they sent letters to Davis and her attorney, but the letter to Davis was sent to the wrong address. The court found that the plaintiff failed to demonstrate that it provided adequate notice reasonably calculated to apprise Davis of her required appearance at an IME, and consequently denied the motion for summary judgment. The main issue in this case was whether the plaintiff, Global Liberty Insurance Company, had provided adequate notice to the defendant, Heather Davis, regarding the rescheduled IME appointments, as a condition precedent to coverage for no-fault benefits. The court found that the plaintiff had failed to demonstrate adequate notice, and therefore upheld the decision to deny the motion for summary judgment. The holding of the case was that the plaintiff, Global Liberty Insurance Company, did not provide adequate notice to Heather Davis regarding the rescheduled IME appointments, and consequently was denied their motion for summary judgment seeking a declaration of non-coverage for no-fault benefits.

The court considered the plaintiff's claim for reimbursement of first-party no-fault benefits for medical services rendered to the plaintiff's assignor after an automobile accident. The main issue decided was whether the plaintiff's failure to attend two scheduled Examinations Under Oath (EUO's) breached a condition precedent for payment under the defendant's no-fault insurance policy, thereby voiding the policy. The court held that the defendant insurer had demonstrated by proof in admissible form that it had properly scheduled and mailed the notices for the EUO's and that the plaintiff's assignee failed to appear at both scheduled EUO's without excuse or timely notice. Therefore, the court granted the defendant's motion for summary judgment dismissing the complaint.

The relevant facts of the case are that T & S Medical Supply Corp. filed a complaint against Ocean Harbor Casualty Insurance Company to recover assigned first-party no-fault benefits. The insurance policy in question had been issued in Florida, and the defendant claimed that it had rescinded the policy ab initio due to a material misrepresentation in the insurance application. This was based on a discovery that the insured did not reside at the Florida address listed on the application and that the insured vehicle was not being garaged in Florida as stated on the application. The main issue was whether the defendant properly rescinded the insurance policy. The court considered the application of substantive law of Florida, but that New York procedural laws control. In order to properly rescind a motor vehicle insurance policy ab initio, an insurer must demonstrate that it had given notice of the rescission to the insured and that it had returned or tendered all premiums paid, in accordance with Florida law. The holding of the court was that the defendant failed to establish its entitlement to summary judgment, as its motion papers did not prove the notice of rescission and the refund check had been mailed to the insured. Therefore, the order was reversed, and defendant's motion for summary judgment dismissing the complaint was denied.

The court considered the issue of whether Hereford Insurance Company has a duty to pay no-fault medical provider claims for individuals who failed to appear for independent medical examinations (IMEs) following a motor vehicle accident. Hereford argued that it did not owe a duty to pay the claims because of the claimants' failure to attend the IMEs. The court granted Hereford's motion for summary judgment, declaring that it had no obligation to pay the no-fault medical provider claims of the defendants. The court found that the insurance company was entitled to judgment as a matter of law because it had sent notices scheduling the IMEs prior to the receipt of each of the claims, and the failure to attend the medical exams constituted a breach of a condition precedent vitiating coverage. Therefore, the insurance company was not required to demonstrate that the claims were timely disclaimed, as the failure to attend medical exams was an absolute coverage defense.