No-Fault Case Law

The court in this case considered the motion filed by American Transit Insurance Company (defendant) to stay the action pending a determination from the Workers' Compensation Board on whether Chiropractic Testing Services of New York (plaintiff) could be paid for the treatment of Nelson De La Cruz (assignor) under workers' compensation. The defendant claimed that since the assignor was injured in the course of employment, his claims should be covered by workers' compensation and not personal injury protection, and therefore should be adjudicated by the Board before reaching the court. Plaintiff argued that for the court to stay the proceeding, the defendant needed to establish the existence of an employer-employee relationship, which defendant in turn argued that they needed only to show "potential merit" to its claim in order to trigger a determination by the Board. Ultimately, the court granted the motion to stay, pending a determination by the Workers' Compensation Board, and ordered the plaintiff to file a proof of application to the Board within 90 days of the order, or else face summary judgment in favor of the defendant dismissing the complaint.

The court considered a motion for a default judgment against certain defendants by the Unitrin Advantage Insurance Company on its first and/or second causes of action for a declaratory judgment. The main issue decided was whether the plaintiff was entitled to a default judgment against the defaulting defendants. The holding of the court was that the plaintiff had established its entitlement to a default judgment against the defaulting defendants, except for one defendant for whom there was no affidavit of nonmilitary service in the record. The court granted the motion as to numerous defendants and declared that they had no right to no-fault benefits from the plaintiff with respect to a September 19, 2014 motor vehicle accident. The decision was unanimously modified to grant the plaintiff's motion in part and deny it in part, and the Clerk was directed to enter judgment accordingly.

The court considered whether Unitrin Advantage Insurance Company had a duty to pay no-fault benefits to defendant Andrew J. Dowd, M.D., in connection with a collision. The main issue involved was whether Unitrin had provided sufficient evidence to determine if the notices it served on Dr. Dowd for the examinations under oath (EUO) satisfied the timeliness requirements. The court found that the scheduling letter for the first and second dates of medical services was not timely, and therefore Unitrin had no duty to pay benefits for those dates. The scheduling letters for the third and fourth dates of medical services were timely, but the reasons for denial on the denial of claim form were not clear enough to apprise the provider of the reason for denial. The court held that the final claim was timely and properly denied. Therefore, the judgment was unanimously modified to deny summary judgment and vacate the declaration as to the certain dates of medical services, and otherwise affirmed.

The case involved Eagle Surgical Supply, Inc. seeking to recover assigned first-party no-fault benefits in 2006. After a nonjury trial, the Civil Court found in favor of the plaintiff and awarded it the principal sum of $2,763.17. The defendant made an oral application to toll the accrual of no-fault statutory prejudgment interest based on the plaintiff's delay in prosecuting the action, but the Civil Court denied the requests and entered a judgment awarding the plaintiff the principal sum of $2,763.17 and prejudgment interest from August 17, 2006. The main issue decided in the appeal was whether the defendant should be allowed to toll the accrual of no-fault statutory prejudgment interest, and the decision was that the judgment in favor of the plaintiff, including the prejudgment interest, was affirmed.

The court considered the case of Eagle Surgical Supply, Inc. v Country-Wide Ins. Co., in which the plaintiff sought to recover assigned first-party no-fault benefits from the defendant. After a nonjury trial, the Civil Court found in favor of the plaintiff and awarded it the principal sum of $1,462.33, as well as no-fault statutory prejudgment interest from June 21, 2007. The defendant made an oral application to toll the accrual of no-fault statutory prejudgment interest based on the plaintiff's delay in prosecuting the action, but the Civil Court denied the request. The main issue decided was whether the defendant was entitled to toll the accrual of no-fault statutory prejudgment interest based on the plaintiff's delay in prosecuting the action. The holding was that the judgment, insofar as appealed from, was affirmed, and the defendant was not entitled to toll the accrual of no-fault statutory prejudgment interest.

The court was faced with the issue of whether defendant was entitled to toll the accrual of no-fault statutory prejudgment interest based upon plaintiff's delay in the prosecution of the action. The main issue decided was that the Civil Court denied defendant's requests to toll the accruing of interest or to submit a post trial brief on the tolling issue. The holding of the case was that the judgment, insofar as appealed from, was affirmed, awarding plaintiff no-fault statutory prejudgment interest from January 29, 2006. The court considered the fact that the plaintiff commenced the action to recover assigned first-party no-fault benefits in 2006 and that after a nonjury trial, the Civil Court found in favor of plaintiff and awarded it the principal sum of $831.25.

The relevant facts considered by the court in the case of Eagle Surgical Supply, Inc. v Country-Wide Ins. Co. were that the plaintiff commenced the action to recover assigned first-party no-fault benefits on January 8, 2007 and was awarded the principal sum of $1,131.68 after a nonjury trial. Defendant made an oral application to the court to toll the accrual of no-fault statutory prejudgement interest based upon plaintiff's delay in the prosecution of the action, but the Civil Court denied defendant's requests. The main issue decided was whether the defendant adequately demonstrated the reason for the protracted delay in the case and if it was the plaintiff which had "unreasonably delayed" the action, therefore justifying the tolling of the accrual of no-fault statutory prejudgment interest. The holding of the case was that as there was no basis for the Civil Court to toll the accrual of no-fault statutory prejudgment interest, the judgment, insofar as appealed from, was affirmed by the Appellate Term, Second Department.

Facts: This is an action for the payment of no-fault insurance benefits for medical treatment. The plaintiff seeks payment of medical treatment expenses for injuries sustained in a motor vehicle accident, as per the insurance policy requirements. Upon trial, the court issued a decision directing a judgment in favor of the plaintiff, which was executed and entered. Issues: The defendant moved to modify the judgment and reduce the amount to zero, claiming that Lessie had exhausted the relevant policy. The defendant argued that they were aware of this fact prior to the judgment but failed to raise it at trial. Holding: The court denied the defendant's motion, citing that an insurer is not obligated to pay a claim when the policy limits have been exhausted. The court stated that even when a judgment is issued requiring the insurer to pay medical expenses under the no-fault provisions of its insurance policy, if the insurer has exhausted the amount for which it is liable under the policy, the judgment cannot be enforced. Therefore, based on these grounds, the defendant's motion was denied.

The case Freligh v Government Empls. Ins. Co. was brought to the Appellate Division after defendant's motion for summary judgment to dismiss the complaint was denied. The main issue at hand was whether the defendant was provided with proper verification of the plaintiff's claim for lost wages. The court found that an insurer must pay or deny only a verified claim, whereas the defendant had not received a completed NF-6 form (employer's wage verification report) from the plaintiff's intended employer. The principal of the intended employer testified that he did not believe that he ever received the NF-6 form to complete, and counsel for plaintiff had already provided defendant with plaintiff's employment application to the intended employer and a signed employment offer providing details of the proffered work. Since there were triable questions of fact as to whether the plaintiff's claim was properly verified, the court affirmed that the defendant was not entitled to summary judgment dismissing the complaint on that basis.

The relevant facts the court considered were that the plaintiff filed an action in 2006 to recover assigned first-party no-fault benefits, and the defendant defaulted in answering. More than seven years later, the plaintiff moved for the entry of a default judgment, and the defendant cross-moved to dismiss the complaint as abandoned. The main issue was whether the delay in initiating a proceeding for the entry of a default judgment could be excused by a history of settlement discussions and if the complaint was meritorious. The holding of the court was that the plaintiff failed to establish a reasonable excuse for the delay and did not demonstrate the meritorious nature of the complaint, so the defendant's cross-motion to dismiss the complaint was granted.