No-Fault Case Law

The court considered the circumstances surrounding a motor vehicle collision in which a nonparty was injured while operating a loaner vehicle insured by Wesco Insurance Company. GEICO Indemnity Company paid no-fault benefits to the injured party and sought to recover the benefits from Wesco in a compulsory arbitration. An arbitrator determined that Wesco was liable for the benefits paid. Wesco subsequently sought to vacate the arbitration award, but the Supreme Court denied the petition and confirmed the arbitration award. The main issue decided was whether the Supreme Court properly denied Wesco's petition to vacate the arbitration award and confirmed the award. The holding of the case was that the Supreme Court properly denied Wesco's petition to vacate the arbitration award and confirmed the arbitration award.

The case revolved around a proceeding pursuant to CPLR article 75 to vacate an arbitration award issued on May 30, 2019. The appellant, GEICO General Insurance Company, appealed an order of the Supreme Court in Queens County that denied the petition and dismissed the proceeding. This case involved a dispute over insurance coverage resulting from injuries sustained by Biru Saha after being involved in a motor vehicle collision while operating a loaner vehicle from New Country Motor Car Group, Inc. GEICO sought to recover no-fault benefits paid to Saha from Wesco Insurance Company. The Supreme Court denied GEICO's request to vacate the arbitration award, but the Appellate Division reversed the order, vacated the arbitration award, and remitted the matter to the Supreme Court in Queens County. The court held that the arbitrator's determination that GEICO was liable for the benefits paid to Saha was arbitrary and capricious and not supported by the evidence. Therefore, the Supreme Court should have vacated the arbitration award.

The relevant facts in Lancer Insurance Company v. Zair Fishkin include the plaintiff, a no-fault insurance carrier, denying claims for reimbursement for medical treatment submitted by the defendant, a medical provider, and the subsequent arbitration award in favor of the defendant. The plaintiff initiated an action pursuant to Insurance Law § 5106 (c) for a de novo determination of claims for no-fault insurance benefits in Nassau County. The plaintiff moved for leave to enter a default judgment against the defendant, who had failed to oppose the motion. The defendant also moved to change the venue of the action to Monroe County based upon the convenience of material witnesses. The main issues were whether to grant the plaintiff's motion for leave to enter a default judgment and whether to change the venue of the action. The court held that the plaintiff's motion should have been granted, as the defendant failed to oppose the motion and establish a reasonable excuse for the default. The cross-appeal was rendered academic in light of this determination.

The court considered whether a misrepresentation by the insured in obtaining an insurance policy was material, and if the insurer would not have issued the policy if the correct information had been disclosed. The issue was whether the defendant insurance company was entitled to summary judgment dismissing the complaint on the grounds that the insured made material misrepresentations about the garaging of a vehicle and the address of a driver covered under the policy. The court held that the defendant failed to establish as a matter of law that it would not have issued the policy in question, as neither the examination under oath testimony of the assignor nor the declaration page of the insurance policy established that the assignor made a misrepresentation on her application for insurance. The court affirmed the order denying the defendant's motion for summary judgment.

The relevant facts the court considered in this case were that NGM Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from Nationwide Insurance Company. The main issue decided by the court was whether Nationwide Insurance Company was justified in denying the first, fifth, and seventh causes of action on the ground that NGM Acupuncture, P.C. had failed to appear for duly scheduled examinations under oath (EUOs). The holding of the case was that the court affirmed the order granting the branches of defendant's motion seeking summary judgment dismissing the first, fifth, and seventh causes of action. The court found that the claims underlying the fifth and seventh causes of action were timely denied, and that the initial EUO had been scheduled before defendant received the claim underlying the first cause of action, therefore defendant's time to pay or deny this claim was tolled.

The Appellate Term, Second Department, considered an appeal from an order of the Civil Court of the City of New York, Kings County, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issue in the case was whether the action by a provider to recover assigned first-party no-fault benefits was premature, as the plaintiff allegedly failed to respond to the defendant's timely requests for additional verification. The court held that the defendant's cross motion for summary judgment dismissing the complaint should have been denied, as the defendant did not establish its entitlement to summary judgment dismissing a specific cause of action, and also failed to properly request additional verification in other instances. Additionally, the court determined that the plaintiff's motion for summary judgment was properly denied, as the proof submitted by the plaintiff failed to establish that the claims at issue had not been timely denied, or that the defendant had issued timely denial of claim forms that were conclusory, vague, or without merit as a matter of law. Therefore, the order was modified by providing that defendant's cross motion for summary judgment dismissing the complaint is denied.

The court considered the facts that the vehicle in which the plaintiff's assignor was a passenger at the time of the accident was owned and self-insured by U-Haul, Inc. The defendant did not insure the vehicle, and was a third-party claims handler processing claims on behalf of U-Haul, Inc. The main issue decided was whether there was an issue of fact as to whether the three-year limitation period of CPLR 214 (2) was applicable. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was granted, as it was demonstrated that there was no coverage for no-fault benefits from the defendant, and the three-year statute of limitations set forth in CPLR 214 (2) would apply.

The relevant facts considered by the court were that plaintiff, Spring Rehab PT, P.C., brought an action to recover first-party no-fault benefits on behalf of its assignor against defendant Nationwide Affinity Insurance Company. Defendant had denied the claims on the grounds that plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). Defendant submitted evidence showing that the EUO scheduling letters and denial of claim forms were timely mailed, as well as affidavits and certified transcripts demonstrating the assignor's failure to appear for the EUOs. The main issue decided was whether defendant was entitled to summary judgment dismissing the complaint, and the holding of the court was that defendant's cross motion for summary judgment should have been granted. Therefore, the court reversed the order, denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint.

The court considered the fact that the defendant had timely mailed its initial and follow-up verification requests and that they had not received the requested verification. The main issue decided was whether the plaintiff had raised a triable issue of fact in opposition to the defendant's cross motion for summary judgment. The court held that the action was premature, and the complaint must be dismissed without prejudice. The order denying defendant's cross motion for summary judgment was reversed, and defendant's cross motion for summary judgment dismissing the complaint was granted without prejudice.

The court considered the issue of whether the instant action was barred by res judicata based on a prior declaratory judgment action by the defendant, Nationwide Ins. Co. The main issue decided was whether res judicata was invoked when a party seeks to relitigate a disposition on the merits of claims arising out of the same transaction or series of transactions which were raised or could have been raised in a prior proceeding between the same parties. The holding of the court was that res judicata was indeed invoked, as the plaintiff, Medical Supply of NY Corp., sought to recover for medical supplies furnished to its assignor as a result of injuries allegedly sustained in an August 22, 2018 accident, which was the subject of the prior declaratory judgment action, and therefore the defendant's motion for summary judgment dismissing the complaint was granted.