No-Fault Case Law

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.

The court considered the facts of the case. Plaintiff commenced the action to recover assigned first-party no-fault benefits on March 30, 2006. After a motion for summary judgment was denied, plaintiff moved to compel defendant to appear for examination before trial, and provide responses to the interrogatories served. The Civil Court held that plaintiff had unreasonably delayed the resolution of the case and held that plaintiff would not accrue no-fault statutory prejudgment interest between the date the action had been commenced and the date the notice of trial had been filed. The main issue was whether no-fault statutory prejudgment interest should accrue upon overdue first-party no-fault benefits. The holding was that the plaintiff is entitled to no-fault statutory prejudgment interest from the commencement of the action on March 30, 2006 through January 27, 2008. The judgment was reversed and remitted to the Civil Court for a recalculation of the interest to include the no-fault statutory prejudgment interest which accrued from March 30, 2006 through January 27, 2008, and for the entry of an appropriate amended judgment thereafter.

The court considered an appeal from an order denying a motion for summary judgment to dismiss a complaint, where the defendant-insurer sought to establish that an automobile insurance policy had been properly rescinded in accordance with Florida law, thus there was no coverage available to the plaintiff's assignor. The main issue decided was whether the insurer's motion for summary judgment should have been granted, and the court held that the insurer had established prima facie evidence of proper rescission of the policy and that there was no triable issue of fact as to the validity of the retroactive rescission of the policy. As a result, the court reversed the order, granted the insurer's motion, and dismissed the complaint.

The court considered the fact that Oleg's Acupuncture, P.C. sought unpaid first-party no-fault benefits for services rendered between May 7, 2014, and July 16, 2014. The main issue decided was whether defendant Hereford Insurance Co. was required to establish that it had timely denied the claims in order to preserve its fee schedule defense. The court found that, under 11 NYCRR 65-3.8 (g) (1) (ii); (2), no payment was due for claimed medical services that exceeded the charges permissible under Insurance Law sections 5108 (a) and (b) and the regulations promulgated thereunder for services rendered by medical providers. The holding of the court was that defendant was not required to establish that it had timely denied the claims in order to preserve its fee schedule defense, and therefore, the judgment was reversed, plaintiff's motion for summary judgment was denied, and defendant's cross-motion for summary judgment dismissing the complaint was granted.

The court considered the appeal from an order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment. The case involved an action seeking recovery of assigned first-party no-fault benefits. The main issue decided was that the action was not ripe for summary disposition, as the proof submitted by the defendant was insufficient to establish that the amounts charged by the plaintiff for the services provided exceeded the rates set forth in the fee schedule. The holding of the court was that the defendant's motion for summary judgment was denied and the complaint was reinstated, as the new arguments raised in the defendant's reply papers failed to eliminate all triable issues of fact and revealed additional matters in dispute.

The main issue in the case was whether the defendant, Hereford Insurance Company, was required to pay the plaintiff, Precious Acupuncture Care, P.C., for medical services rendered between December 2013 and April 2014. The defendant argued that the plaintiff sought to recover amounts exceeding the workers' compensation fee schedule, and supported their argument with an affidavit by a certified medical coder and biller. The plaintiff moved for summary judgment, and the defendant cross-moved for summary judgment dismissing the complaint. The court held that the defendant was not required to establish that it had timely denied the claims in order to preserve its fee schedule defense, as the services were provided between December 2013 and April 2014. As a result, the court reversed the judgment, vacated the order, denied the plaintiff's motion for summary judgment, and granted the defendant's cross motion for summary judgment dismissing the complaint.

The court considered a dispute between One To One Rehab PT, P.C. and Allstate Insurance Company over the recovery of assigned first-party no-fault benefits. Plaintiff moved for summary judgment, but defendant submitted an affidavit from an employee stating that there was no coverage by defendant for the vehicle in question on the date of the accident. The court found that the defendant's affidavit was sufficient to demonstrate that plaintiff's claims did not arise out of a covered incident. As the plaintiff failed to raise a triable issue of fact in opposition to defendant's cross motion, the Civil Court properly denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant provided insurance coverage for the vehicle in question on the date of the accident. The holding was that the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint was affirmed.

The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits from an accident that occurred on April 19, 2010. The defendant argued that the action was barred by the doctrine of res judicata based on a previous court order. The main issue decided was whether the prior court order had collateral estoppel effect and whether the subsequent order corrected the date of the accident. The holding of the case was that the April 3, 2013 court order did not have res judicata effect as it was vacated by a subsequent order. The court also held that the subsequent order, which corrected the accident date, was a conclusive final determination, and res judicata applied. The court affirmed the previous order granting the defendant's cross motion for summary judgment.