No-Fault Case Law
County Line Pharmacy v Geico Ins. Co. (2018 NY Slip Op 50573(U))
April 13, 2018
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.
Active Care Med. Supply Corp. v Amica Mut. Ins. Co. (2018 NY Slip Op 50500(U))
April 6, 2018
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.
SZ Med., P.C. v Allstate Ins. Co. (2018 NY Slip Op 50497(U))
April 6, 2018
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.
Maidstone Ins. Co. v Medical Records Retrieval, Inc. (2018 NY Slip Op 50556(U))
April 4, 2018
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.
Matter of Allstate Ins. Co. v Travelers Cos., Inc. (2018 NY Slip Op 02163)
March 28, 2018
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.
Laga v Allstate Ins. Co. (2018 NY Slip Op 50416(U))
March 23, 2018
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.
Arnica Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50415(U))
March 23, 2018
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.
Pro-Align Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 50341(U))
March 15, 2018
The relevant facts of the case included an action for the payment of no-fault benefits and an allegation that the claims were not paid by the defendant, despite being submitted in accordance with the relevant fee schedule. The main issue of the case was the defendant's motion seeking an order for summary judgment and dismissal of the action, based on the argument that they had paid the claims according to the fee schedule and therefore established its fee schedule defense. The holding of the case was that the defendant's motion for summary judgment was granted, with the court stating that failure to deny or pay a claim as required by statutory schedule precluded the defendant from interposing a statutory exclusion defense. Similarly, compliance with the technical requirements of the no-fault law were held as preconditions for payment to a medical provider.
Acupuncture Now, P.C. v Hereford Ins. Co. (2018 NY Slip Op 50316(U))
March 9, 2018
The court considered the fact that Acupuncture Now, P.C. was seeking to recover assigned first-party no-fault benefits from Hereford Insurance Co. following a motor vehicle accident. Hereford Insurance Co. moved for summary judgment to dismiss the complaint on the basis that the insurance policy for the vehicle involved in the accident had been cancelled prior to the accident, and the court upheld this. The main issue decided was whether the cancellation of the insurance policy was effective, and the court held that it was. The court found that the vehicle involved in the accident was a "for hire" vehicle and that the policy insuring the vehicle had been properly and validly cancelled in compliance with Vehicle and Traffic Law. The sending of a notice by the insurance company informing the policyholder of the intended cancellation did not render the cancellation ineffective. Therefore, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.
TAM Med. Supply Corp. v Travelers Ins. Co. (2018 NY Slip Op 50315(U))
March 9, 2018
The main issue of the case was whether the plaintiff, TAM Medical Supply Corp., had timely submitted its bills to defendant, Travelers Insurance Company, in an action to recover assigned first-party no-fault benefits. The court considered the defendant's motion for summary judgment to dismiss the complaint on the grounds that the plaintiff had failed to provide requested verification. The court held that while it is the plaintiff's burden at trial to prove its prima facie case, it is the defendant's burden at trial to show it has a meritorious defense and that such a defense is not precluded. Therefore, the court determined that it was improper for plaintiff to have to prove whether it fully complied with defendant's verification requests. The court ultimately affirmed the order with modification and declined plaintiff's request to make a finding in its favor.