No-Fault Case Law
FJL Med. Servs., P.C. v Nationwide Ins. (2022 NY Slip Op 51213(U))
December 9, 2022
The court considered the fact that the plaintiff had failed to appear for scheduled examinations under oath (EUOs) and the defendant's argument that the claim at issue was timely denied. The main issue was whether the defendant had established that it timely denied the claim at issue and whether the plaintiff demonstrated its prima facie entitlement to summary judgment. The holding was that the order was modified to provide that the defendant's motion for summary judgment dismissing the complaint is denied, as the defendant failed to establish that it timely denied the claim at issue. The plaintiff also failed to demonstrate its prima facie entitlement to summary judgment.
American Kinetics Lab, Inc. v Travelers Ins. Co. (2022 NY Slip Op 51212(U))
December 9, 2022
The case involved American Kinetics Lab, Inc. seeking to recover assigned first-party no-fault benefits from Travelers Insurance Company. Travelers moved for summary judgment to dismiss the complaint, arguing that American Kinetics Lab, Inc. had failed to provide requested verification. The Civil Court granted Travelers' motion and denied American Kinetics Lab's cross motion for summary judgment. The main issue was whether Travelers had properly requested additional verification from American Kinetics Lab, Inc., and the court held that Travelers had failed to establish that it properly requested any additional verification. Therefore, the court modified the order and denied Travelers' motion for summary judgment dismissing the complaint. Additionally, the court held that American Kinetics Lab's cross motion for summary judgment was properly denied as the proof submitted failed to establish that the claims had not been timely denied or that Travelers had issued timely denial of claim forms that were conclusory, vague, or without merit.
Ezra Supply, Inc. v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 22383)
December 9, 2022
The court considered the failure of the plaintiff's assignor to appear for scheduled examinations under oath (EUOs) and whether the defendant's denial of the claims was timely. The main issues that were decided were whether the defendant's motion to dismiss the complaint on the ground that the plaintiff's assignor had failed to appear for the scheduled EUOs could be granted, and whether the defendant had established that the denial of the claims was timely. The holding of the court was that the defendant had failed to establish that the denial of the claims was timely, and therefore its motion for summary judgment dismissing the complaint was properly denied. The order, insofar as appealed from, was affirmed.
Matter of Wesco Ins. Co. v Government Empls. Ins. Co. (2022 NY Slip Op 06936)
December 7, 2022
The main facts of the case involved a motor vehicle collision in which the injured party was seeking payment of no-fault benefits from the insurer of the loaner vehicle involved in the accident. The insurer, Wesco Insurance Company, was held liable for the benefits paid to the injured party in a compulsory arbitration proceeding. Wesco then sought to vacate the arbitration award, but the Supreme Court denied the petition, affirming the arbitrator's decision.
The main issue decided was whether Wesco Insurance Company was liable for the no-fault benefits paid to the injured party under the circumstances of the collision involving the loaner vehicle. The court held that Wesco was indeed liable for the benefits, affirming the decision of the arbitration award.
The holding of the case was that the Supreme Court properly denied the petition to vacate the arbitration award and dismissed the proceeding, upholding the decision that Wesco Insurance Company was liable for the benefits paid to the injured party.
Matter of Wesco Ins. Co. v GEICO Indem. Co. (2022 NY Slip Op 06935)
December 7, 2022
The court considered a proceeding to vacate an arbitration award dated September 26, 2019, where the appellant sought to recover benefits paid to a party injured in a motor vehicle collision. GEICO sought to recover the benefits paid from Wesco in a compulsory arbitration proceeding, and the arbitrators determined that Wesco was liable for the benefits paid. Wesco then commenced a proceeding seeking to vacate the arbitration award, which was denied by the Supreme Court. The main issue decided was whether the Supreme Court properly denied the petition and confirmed the arbitration award, and whether the petitioner presented evidence of actual bias or the appearance of bias on the part of one of the arbitrators. The holding was that the Supreme Court properly denied the petition and confirmed the arbitration award, and that the petitioner failed to present evidence of actual bias or the appearance of bias on the part of one of the arbitrators.
Matter of Wesco Ins. Co. v GEICO Indem. Co. (2022 NY Slip Op 06933)
December 7, 2022
The court considered the facts that in August 2017, Sarah Pierre was injured while operating a loaner vehicle owned by Bay Ridge Volvo and insured by Wesco Insurance Company. GEICO Indemnity Company paid basic no-fault benefits to Pierre from her GEICO policy and sought to recover these benefits from Wesco in a compulsory arbitration proceeding. The main issue the court decided was whether Wesco, as the insurer of the loaner vehicle, was liable for the benefits paid to Pierre according to the terms of the GEICO policy. The holding of the case was that the Supreme Court should have denied Wesco's petition to vacate the arbitration award and dismissed the proceeding, as the PIP endorsement in the GEICO policy did not provide coverage for the injuries Pierre sustained while operating the loaner vehicle.
Matter of GEICO Gen. Ins. Co. v Wesco Ins. Co. (2022 NY Slip Op 06927)
December 7, 2022
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.
Matter of GEICO Gen. Ins. Co. v Wesco Ins. Co. (2022 NY Slip Op 06926)
December 7, 2022
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.
Lancer Ins. Co. v Fishkin (2022 NY Slip Op 06921)
December 7, 2022
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.
Concord Direct, Inc. v Ameriprise Ins. Co. (2022 NY Slip Op 51272(U))
December 2, 2022
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.