No-Fault Case Law
Zayas Physical Therapy, P.C. v Auto One Ins. Co. (2018 NY Slip Op 50038(U))
January 12, 2018
The main issue in this case was whether the defendant, Auto One Ins. Co., had grounds sufficient to set aside a stipulation that they had entered into with the plaintiff, Zayas Physical Therapy, P.C. The defendant had failed to submit written opposition to the plaintiff's motion for summary judgment, and as a result, the Civil Court had granted the motion upon the consent of both parties and entered a judgment in favor of the plaintiff. The defendant then moved to vacate the order and judgment, arguing that they had a reasonable excuse for their default and a meritorious defense to the action. However, the Civil Court denied the defendant's motion on the ground that they had failed to offer a reasonable excuse for their failure to submit written opposition to the plaintiff's motion for summary judgment. The Appellate Term, Second Department affirmed the decision, holding that the defendant had failed to make a sufficient showing to set aside the stipulation and judgment.
Trimed Med. Supply, Inc. v GEICO Ins. Co. (2017 NY Slip Op 51957(U))
December 29, 2017
The main issue in this case was whether the testimony of the defendant's expert medical witness, who was not the expert who had prepared the peer review report upon which the defendant's denial of the plaintiff's claim form was based, should have been permitted in a nonjury trial held to determine the lack of medical necessity of the supplies at issue. The defendant's notice of appeal from the decision to preclude the testimony of the expert witness was deemed a notice of appeal from the judgment entered. The court held that the defendant's expert medical witness should have been permitted to testify as to her opinion on the lack of medical necessity of the supplies at issue, limited to the basis for the denial as set forth in the original peer review report. Therefore, the judgment was reversed and the matter was remitted to the Civil Court for a new trial.
Ameriprise Ins. Co. v Kensington Radiology Group, P.C. (2017 NY Slip Op 51911(U))
December 22, 2017
The main issue decided in this case was whether the $50,000 policy limit of the insurance policy had been exhausted before the petitioner became obligated to pay the respondent's claim for unpaid no-fault benefits. The court held that when an insurer has paid the full monetary limits set forth in the policy, its duties under the contract of insurance cease. The court also determined that a defense that the coverage limits of the policy have been exhausted may be asserted by an insurer despite its failure to issue a denial of the claim within the 30-day period. The court found that the petitioner-insurer's submissions raised triable issues as to whether the $50,000 policy limit had been exhausted by payments of no fault benefits to the respondent and other providers, and remanded the matter to Civil Court for a framed issue hearing on that issue.
Acupuncture Healthcare Plaza I, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51903(U))
December 22, 2017
The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment. The main issue was whether the plaintiff was entitled to recover $2,361.87 in first-party no-fault benefits, and whether the defendant's defense that the amounts sought to recover were in excess of the workers' compensation fee schedule was valid. The holding of the case was that the defendant did not sufficiently demonstrate that the denial of claim form had been timely mailed, and therefore was not entitled to summary judgment dismissing the portion of the complaint seeking to recover the sum of $2,361.87. As a result, the order was modified to deny the branch of the defendant's cross motion seeking summary judgment dismissing that portion of the complaint.
Active Care Med. Supply Corp v American Tr. Ins. Co. (2017 NY Slip Op 51902(U))
December 22, 2017
The court considered the fact that the plaintiff, a medical supply company, was seeking to recover assigned first-party no-fault benefits from the defendant, an insurance company. The main issue decided was whether the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs) as required. The holding of the court was that the defendant's proof sufficiently established proper mailing of the EUO scheduling letters and that the plaintiff had indeed failed to appear for the scheduled EUOs. As a result, the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint.
Greenway Med. Supply Corp. v American Tr. Ins. Co. (2017 NY Slip Op 51901(U))
December 22, 2017
The court considered the fact that the plaintiff, as an assignee of Molina, Jose, was seeking to recover first-party no-fault benefits from the defendant, American Transit Ins. Co. The main issue at hand was that the defendant argued that the plaintiff had failed to appear for scheduled examinations under oath (EUOs), while the plaintiff argued that the EUO scheduling letters were not properly mailed. The court ultimately affirmed the order of the Civil Court, granting the defendant's motion for summary judgment and dismissing the complaint, while also denying the plaintiff's cross motion for summary judgment. The holding was that the defendant's proof sufficiently established the proper mailing of the EUO scheduling letters and that the plaintiff had indeed failed to appear for the scheduled EUOs, thus leading to the affirmation of the order.
Staten Is. Advanced Surgical Supply v GEICO Ins. Co. (2017 NY Slip Op 51899(U))
December 22, 2017
The relevant facts considered by the court were that the plaintiff, Staten Island Advanced Surgical Supply, was seeking to recover assigned first-party no-fault benefits for medical supplies provided to its assignor. The main issue decided was whether the judgment of the Civil Court, which awarded the plaintiff the principal sum of $1,277.26, should be reversed. The holding of the court was that the judgment was indeed reversed, with the matter remitted to the Civil Court for a new trial. This decision was made for the same reasons stated in a related case, Staten Is. Advanced Surgical Supply, as Assignee of Gu Zhang v GEICO Ins. Co, which was decided at the same time. The Justices Pesce, Aliotta and Solomon all concurred with this decision.
Staten Is. Advanced Surgical Supply v GEICO Ins. Co. (2017 NY Slip Op 51898(U))
December 22, 2017
The court considered the appeal of a judgment from the Civil Court of New York, Queens County, in a case where Staten Island Advanced Surgical Supply sought to recover first-party no-fault benefits for medical supplies provided to its assignor. The judgment awarded the plaintiff $1,670.30 after a nonjury trial.
The main issue decided was whether the plaintiff was entitled to recover no-fault benefits for the medical supplies provided. The court reversed the judgment and remitted the matter to the Civil Court for a new trial. The decision to reverse the judgment was based on the reasons stated in a similar case, Staten Is. Advanced Surgical Supply, as Assignee of Gu Zhang v GEICO Ins. Co., decided in the same time period. The decision was made by Justices Pesce, Aliotta, and Solomon.
The holding of the case was that the judgment of the Civil Court was reversed and remitted for a new trial.
Alur Med. Supply, Inc. v GEICO Ins. Co. (2017 NY Slip Op 51897(U))
December 22, 2017
The court considered a judgment from the Civil Court of the City of New York, Queens County, in which the plaintiff, Alur Medical Supply, Inc., as Assignee of Daniels, Donald, was awarded $740.25 in a nonjury trial against GEICO Ins. Co. The main issue was whether Alur Medical Supply, Inc. was entitled to recover assigned first-party no-fault benefits for medical supplies it had provided to its assignor. The court reversed the judgment and remitted the matter to the Civil Court for a new trial, citing similar reasoning from a related case. The holding of the court was that a new trial was warranted in this case, and the judgment was reversed.
Alur Med. Supply, Inc. v GEICO Ins. Co. (2017 NY Slip Op 51896(U))
December 22, 2017
The court considered the appeal of a judgment in a case where a medical supply provider was seeking to recover first-party no-fault benefits for medical supplies provided to its assignor. The main issue was whether the provider was entitled to the principal sum of $1,937. The court held that the judgment was reversed, with $30 costs, and the matter was remitted to the Civil Court for a new trial. The court referenced a similar case and stated that for the reasons stated in that case, the judgment was reversed and a new trial was ordered. The decision was made on December 22, 2017.