No-Fault Case Law

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.

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.