No-Fault Case Law

Facts: Allstate Insurance Company appealed the denial of their petition to vacate a master arbitration award in favor of Longevity Medical Supply, Inc., which awarded Longevity unpaid no-fault benefits in the amount of $1,080.00 and attorney's fees. The arbitration award was based on Longevity's response to verification demands sent by Allstate. Issues: The main issue was whether Allstate had demonstrated sufficient grounds to vacate the master arbitrator's award, and if the master arbitrator's legal analysis of the arbitrator's determination was within the scope of her authority. Holding: The appellate court affirmed the order and judgment, stating that Allstate had failed to demonstrate a ground pursuant to CPLR 7511 to vacate the master arbitrator's award. The court found that there was a rational basis for the master arbitrator's finding that Longevity had sufficiently responded to the verification demands, and that Allstate was required but failed to rebut the presumption of receipt of the verification or show that it timely acted upon receipt. The court held that the master arbitrator's legal analysis was well within her authority and that applying the law to a given set of facts is within the province of a master arbitrator, even if the conclusion differs from that of the arbitrator.

The court considered whether plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs) and whether plaintiff had made a prima facie showing of entitlement to summary judgment. The main issue decided was whether plaintiff's motion for summary judgment should be granted, and if defendant's cross motion for summary judgment dismissing the complaint should be denied. The court held that plaintiff had failed to establish that its claims had not been timely denied, and that defendant is not entitled to summary judgment dismissing the complaint based on plaintiff's assignor's failure to appear for IMEs. Therefore, the court modified the order by providing that plaintiff's motion for summary judgment is denied, and affirmed the order without costs.

The relevant facts that the court considered in this case were a dispute between Motionpro Physical Therapy and Hereford Insurance Co. regarding first-party no-fault benefits. The main issues decided related to whether plaintiff Motionpro had made a prima facie showing of its entitlement to summary judgment, and whether defendant Hereford had issued timely denial of claim forms. The holding of the case was that the defendant had demonstrated that plaintiff's assignor had failed to appear for duly scheduled independent medical examinations, and that defendant had timely denied the claim underlying the second cause of action on that ground. As a result, the motion for summary judgment by plaintiff was denied and the branch of the defendant's cross-motion seeking summary judgment dismissing the second cause of action was granted.

The court considered the fact that the plaintiff, Active Chiropractic, P.C., filed a lawsuit to recover first-party no-fault benefits, and the defendant, Allstate Insurance, argued that the action was barred by a previous declaratory judgment order. The previous order declared that the defendant was not obligated to provide coverage for the claims arising from the accident in question, and that the plaintiff and its assignor were not entitled to reimbursement for services rendered. The main issue decided was whether the defendant's failure to raise the defense of res judicata in its answer was grounds for dismissing the plaintiff's motion for summary judgment. The holding of the case was that the order granting the plaintiff's motion was reversed, the defendant's answer was deemed amended to assert the affirmative defense of res judicata, and the plaintiff's motion for summary judgment was denied while the defendant's cross motion, in effect, for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court in this case were that plaintiff Active Chiropractic, P.C. sought to recover first-party no-fault benefits from Allstate Insurance. Defendant Allstate Insurance argued that the action was barred by a prior Supreme Court declaratory judgment order, which declared that Allstate was not obligated to provide coverage for the accident in question, and that the plaintiff and its assignor were not entitled to reimbursement for services rendered. The main issue decided by the court was whether the defense of res judicata could be raised by the defendant, as it had not been initially asserted in their answer. The holding of the case was that the order granting the plaintiff's motion for summary judgment was reversed, defendant's answer was deemed amended to assert the affirmative defense of res judicata, and plaintiff's motion for summary judgment was denied while defendant's cross motion for summary judgment dismissing the complaint was granted.

The court considered the fact that the plaintiff had commenced an action to recover first-party no-fault benefits and the defendant had served an answer, but the plaintiff then moved for summary judgment and the defendant cross-moved to dismiss the complaint. The defendant contended that the plaintiff's action was barred by an order entered in a Supreme Court action declaring that the defendant was not obligated to provide coverage for the claims in question. The main issue was whether the defendant's answer should be deemed amended to assert the affirmative defense of res judicata, even though it had not been explicitly raised in the answer. The holding of the court was that the defendant's answer was deemed amended to assert the affirmative defense of res judicata, the plaintiff's motion for summary judgment was denied, and the defendant's cross motion to dismiss the complaint was granted.

The main issue in this case was whether the defendant’s motion for summary judgment dismissing the complaint should be granted based on the doctrines of res judicata and collateral estoppel. The court considered the fact that the defendant had previously brought a declaratory judgment action against the plaintiff and its assignor, in which the Supreme Court had granted a motion for the entry of a default judgment against the plaintiff and assignor. However, the Supreme Court’s order did not make a statement declaring the rights of the parties involved, and therefore, could not have a preclusive effect in the action at bar. The court held that the Supreme Court order cannot be considered a conclusive final determination and affirmed the lower court’s order granting the plaintiff’s motion for summary judgment and denying the defendant’s cross motion for summary judgment.

The relevant facts considered by the court in this case were that the provider, Choice Health Chiropractic, P.C., was attempting to recover assigned first-party no-fault benefits from American Transit Insurance Company. The insurance company had timely scheduled independent medical examinations (IME) for the plaintiff's assignor, who failed to appear for these examinations. The insurance company denied the plaintiff's claim based on the assignor's failure to appear for the scheduled IMEs which were scheduled on January 9, 2014 and February 6, 2014. The main issue decided by the court was whether the insurance company's denial of the plaintiff's claim for $1,310.94 was timely, considering the pending verification requests. The holding of the case was that the branch of defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the $1,310.94 claim was denied. Therefore, the order was affirmed in part and modified in part.

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.