No-Fault Case Law
State Farm Fire & Cas. Co. v Jewsbury (2019 NY Slip Op 01247)
February 20, 2019
The insurer's declaratory judgment action survived dismissal because resolving coverage for all providers served judicial economy. A provider had brought two Civil Court actions for unpaid no-fault benefits before the insurer sued in Supreme Court, alleging material misrepresentations about vehicle garaging to obtain a lower premium. The Appellate Division, Second Department, reversed the order granting the provider dismissal under CPLR 3211 (a) (4) and denied that branch of the motion. Although dismissal for another pending action is discretionary when parties and relief substantially coincide, the declaratory action included other providers absent from the Civil Court suits and sought relief Civil Court could not issue. The ruling preserved the coverage action without deciding the alleged misrepresentations.
Country-Wide Ins. Co. v Yao Jian Ping (2019 NY Slip Op 50160(U))
February 13, 2019
A de novo no-fault action following a master arbitration award exceeding $5,000 may be brought in Civil Court if the dispute does not exceed $25,000. The insurer sought de novo adjudication under Insurance Law § 5106 (c), and the party seeking benefits moved to dismiss the action and for related relief. Applying CCA 212-a, the Appellate Term, First Department, concluded that the action was properly commenced in Civil Court because the amount in dispute fell within that court's monetary jurisdiction. It affirmed the denial of the motion; the remaining appellate argument was rendered academic.
Atlantic Chiropractic, P.C. v Utica Mut. Ins. Co. (2019 NY Slip Op 50173(U))
February 8, 2019
The insurer did not waive res judicata by answering before entry of the declaratory judgment on which that defense depended. A default declaratory judgment relieved the insurer of paying benefits to the provider and assignor because the alleged accident was staged and outside coverage. The provider showed no prejudice or surprise from amendment, and the insurer established that the defense had merit. Under CPLR 3025 (b), leave to amend should therefore have been granted. The unvacated default judgment barred recovery that would impair the rights it established. The Appellate Term, Second Department, reversed, granted leave to add res judicata, deemed the amended answer timely served nunc pro tunc, and granted the insurer summary judgment dismissing the complaint.
Dynamic Balance Acupuncture, P.C. v State Farm Ins. (2019 NY Slip Op 50171(U))
February 8, 2019
The provider's challenge to the EUO demands failed because it offered no proof of mailing its objection letter. The Civil Court found under CPLR 3212 (g) that the insurer established timely and proper mailing of scheduling letters and denials and the provider's EUO nonappearances, but reserved issues concerning letter generation and the reasonableness of the requests for trial. The provider did not dispute the insurer's prima facie showing and instead relied on an unanswered demand for good-faith reasons. That argument lacked a mailing foundation; moreover, the insurer was not required to disclose its reasons in response to an objection. The Appellate Term, Second Department, reversed the order, insofar as appealed from, and granted the insurer summary judgment dismissing the complaint.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50099(U))
January 18, 2019
The provider's judgment was reversed because no testimony was taken in its action at the consolidated nonjury trial. The action for assigned no-fault benefits was consolidated for trial with five other actions. After receiving testimony only in the first action, the Civil Court found for the provider in this action and entered judgment. The Appellate Term, Second Department, agreed with the insurer that the absence of testimony concerning this action required reversal. It remitted the matter to the Civil Court for a new trial.
Healthy Way Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50098(U))
January 18, 2019
The provider's judgment was reversed because no testimony was taken in its action at the consolidated nonjury trial. The action for assigned no-fault benefits was consolidated for trial with five other actions. After receiving testimony only in the first action, the Civil Court found for the provider in this action and entered judgment. The Appellate Term, Second Department, agreed with the insurer that the absence of testimony concerning this action required reversal. It remitted the matter to the Civil Court for a new trial.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50097(U))
January 18, 2019
The provider's judgment was reversed because no testimony was taken in its action at the consolidated nonjury trial. The action for assigned no-fault benefits was consolidated for trial with five other actions. After receiving testimony only in the first action, the Civil Court found for the provider in this action and entered judgment. The Appellate Term, Second Department, agreed with the insurer that the absence of testimony concerning this action required reversal. It remitted the matter to the Civil Court for a new trial.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50096(U))
January 18, 2019
The provider's judgment was reversed because no testimony was taken in its action at the consolidated nonjury trial. The action for assigned no-fault benefits was consolidated for trial with five other actions. After receiving testimony only in the first action, the Civil Court found for the provider in this action and entered judgment. The Appellate Term, Second Department, agreed with the insurer that the absence of testimony concerning this action required reversal. It remitted the matter to the Civil Court for a new trial.
Lotus Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50095(U))
January 18, 2019
The provider's judgment was reversed because no testimony was taken in its action at the consolidated nonjury trial. The action for assigned no-fault benefits was consolidated for trial with five other actions. After receiving testimony only in the first action, the Civil Court found for the provider in this action and entered judgment. The Appellate Term, Second Department, agreed with the insurer that the absence of testimony concerning this action required reversal. It remitted the matter to the Civil Court for a new trial.
Healthy Way Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 50094(U))
January 18, 2019
The insurer proved an IME nonappearance defense to three of seven claims, reducing the provider's recovery after trial. The provider established its prima facie case on all seven claims by showing that the insurer received the bills and had not paid them. For three claims, however, the insurer's trial proof established timely mailing of the IME scheduling letters and denials and the assignor's failure to appear. Under Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., those nonappearances violated a condition precedent to coverage and defeated recovery on those bills. The Appellate Term, Second Department, modified the judgment to exclude the three claims, otherwise affirmed, and remitted for recalculation of statutory interest and entry of an amended judgment.