No-Fault Case Law

The relevant facts considered by the court in this case include a provider's motion for summary judgment to recover first-party no-fault benefits. The defendant did not oppose the motion with an affidavit or an attorney's affirmation in the Civil Court, but presented orders of the Supreme Court, Nassau County, in a declaratory judgment action initiated by the defendant. The Supreme Court orders granted the defendant's motion for summary judgment and a separate motion for a default judgment against plaintiff's assignor, concluding that there was no coverage for no-fault benefits due to an alleged staged incident. Subsequently, the Civil Court denied the plaintiff's motion for summary judgment based on the orders in the Supreme Court declaratory judgment action. The main issue decided in this case was whether the defendant had a duty to provide coverage for the accident at issue and if plaintiff's motion for summary judgment should be granted. The holding of the case was that the Civil Court's denial of the plaintiff's motion for summary judgment was affirmed, and upon a search of the record, defendant was awarded reverse summary judgment, dismissing the complaint. This was based on the finding that the defendant had established its entitlement to judgment as a matter of law.

The relevant facts considered in this case include an action by a provider to recover assigned first-party no-fault benefits, where the plaintiff moved for summary judgment and the defendant cross-moved for summary judgment dismissing the complaint on the ground that the plaintiff's assignor was not a member of the policyholder's household. The main issue decided was whether the plaintiff's assignor was an eligible injured person who was entitled to reimbursement of first-party no-fault benefits. The holding of the case was that defendant's cross motion for summary judgment dismissing the complaint was denied, as the affidavit of defendant's no-fault litigation supervisor was conclusory in nature and unsupported by competent evidence. Additionally, as the accident occurred in Pennsylvania and the NF-2 form stated that plaintiff's assignor resides in Bronx County, defendant failed to establish, as a matter of law, that plaintiff's assignor was not an eligible injured person. Therefore, plaintiff's motion for summary judgment was properly denied, and the order was modified accordingly.

The main issue in this case was whether the plaintiff was entitled to recover first-party no-fault benefits for medical supplies provided to the plaintiff's assignor on January 6, 2011 and March 15, 2011. The court considered the medical necessity of the supplies at issue, and the defendant appealed from an order of the Civil Court as denied the branches of defendant's cross motion seeking summary judgment dismissing the complaint. The court held that the order was reversed, and the branches of defendant's cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for medical supplies provided to plaintiff's assignor on January 6, 2011 and March 15, 2011 are granted.

The relevant facts of the case were that County Line Pharmacy was seeking to recover first-party no-fault benefits from GEICO Insurance Company for prescription drugs provided to Earline Vaughns on December 1, 2010 and December 30, 2010. GEICO Insurance Company filed a cross motion seeking summary judgment to dismiss that part of the complaint, arguing that there was a lack of medical necessity for the prescription drugs at issue. The main issue decided was whether there was a medical necessity for the prescription drugs provided to Vaughns on the specified dates. The holding of the case was that the court reversed the order and granted the branches of defendant's cross motion seeking summary judgment dismissing the part of the complaint that sought to recover for prescription drugs provided to Vaughns on December 1, 2010 and December 30, 2010, as plaintiff failed to rebut defendant's prima facie showing of lack of medical necessity.

The main issue in this case was whether the plaintiff was entitled to recover assigned first-party no-fault benefits. The court considered the defendant's motion for summary judgment based on the doctrine of res judicata, as well as the plaintiff's cross motion for summary judgment. The court found that the defendant failed to demonstrate its entitlement to summary judgment dismissing the complaint based on res judicata, as the plaintiff was not named or served in a prior declaratory judgment action and was not in privity with the injured party. The court also found that there was a triable issue of fact in opposition to the plaintiff's cross motion for summary judgment, and therefore, the Civil Court should have denied the plaintiff's cross motion. As a result, the judgment was reversed, and the plaintiff's cross motion for summary judgment was denied.

The court considered the fact that the action to recover first-party no-fault benefits was commenced in 2002, and that the case was scheduled for trial for the first time in 2013. Plaintiff's counsel appeared on July 31, 2013 seeking an adjournment, but the court denied the request and dismissed the action. The main issue decided was whether the dismissal of the action could be vacated, and the court held that the plaintiff failed to demonstrate a reasonable excuse for the default and a meritorious cause of action. The court affirmed the denial of plaintiff's motion to vacate the dismissal.

The main issue in the case was whether the arbitration award, which found that the respondent was entitled to compensation for services performed and rejected the petitioner's fee schedule defense, should be vacated. The court considered the grounds for vacating an arbitration award, which includes instances of fraud, corruption, bias, or occasions where the arbitrator exceeded his or her power. The court also considered whether the decision of the arbitrator was rational or had a plausible basis. Ultimately, the court held that the arbitration awards were supported by a rational and plausible basis, and were not contrary to clear precedent. Therefore, the petition to vacate the arbitration award was denied, and the Master Arbitration Award was confirmed.

The main issue of the case was whether an arbitration award, in which Travelers sought to recover $25,000 from Allstate after Allstate paid Travelers' insured $50,000, should be confirmed or vacated. Allstate contended the award should be vacated, however the court determined the arbitrators' decision was rationally based on relevant statutes and regulations. The court held that the award should be confirmed, as an award in a compulsory arbitration must be supported by evidence and cannot be arbitrary or capricious. This ruling was upheld by the Supreme Court, and the court dismissed Allstate's appeal. Only one bill of costs was awarded to Travelers Companies, Inc. The case was Appealed and affirmed.

The relevant facts considered by the court were that the plaintiff, acting as an assignee, was seeking to recover first-party no-fault benefits from the defendant insurance company. The main issue before the court was whether the defendant was entitled to summary judgment dismissing the complaint. The court ultimately held that the defendant's motion for summary judgment was denied, as their moving papers failed to establish, as a matter of law, that the denial of claim forms had been timely mailed. Consequently, the defendant did not demonstrate that it is not precluded from asserting its proffered defenses, and thus was not entitled to summary judgment. The court reversed the order of the Civil Court and denied the defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that Arnica Acupuncture, P.C. was seeking to recover first-party no-fault benefits from Allstate Insurance Company in the amount of $167.04, as well as an allegedly unpaid balance of remaining claims. Allstate Insurance Company had moved for summary judgment to dismiss the complaint, which was granted by the Civil Court, and Arnica Acupuncture, P.C. cross-moved for summary judgment, which was denied. The main issue decided was whether Allstate Insurance Company had timely denied the claim forms, and whether Arnica Acupuncture, P.C. had established its entitlement to summary judgment. The holding of the case was that Allstate Insurance Company's motion for summary judgment to dismiss the complaint was denied, and the order was affirmed as modified, without costs.