No-Fault Case Law

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.

The court considered the fact that the plaintiff, First Spine Chiropractic of NY, P.C., was seeking to recover assigned first-party no-fault benefits from the defendant, Nationwide Affinity Insurance Company of America. The defendant had filed a motion for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for scheduled examinations under oath, and the plaintiff's cross motion for summary judgment was denied. The main issue decided was whether the defendant's motion for summary judgment should be granted, and the court held that the affidavits of the defendant's claim specialist and mailing manager were sufficient to establish, prima facie, that the defendant had timely denied the plaintiff's claims. In addition, the court found that the plaintiff had failed to raise a triable issue of fact in opposition to the defendant's motion. Therefore, the court affirmed the order of the Civil Court.

The court considered the history of a declaratory judgment action where Harleysville Worcester Insurance Company sought a judgment that it had no duty to pay no-fault benefits to Healthwise Medical Associates, P.C. and its assignor, Reynaldo Rosa, due to Rosa not being an eligible injured person under the insurance policy. Healthwise Medical Associates, P.C. then commenced an action against Nationwide Insurance to recover no-fault benefits for medical services provided to Reynaldo Rosa. Harleysville Worcester Insurance Company appeared in the action, agreeing that the allegations in the complaint were properly asserted against it. The main issue decided was whether the order in the declaratory judgment action had res judicata effect on the action brought by Healthwise Medical Associates, P.C., thereby warranting the dismissal of the complaint. The court held that the declaratory judgment order had res judicata effect on the action, as Harleysville proffered sufficient evidence to support its contention that it was the proper insurer. Therefore, the court affirmed the order, granted Harleysville's motion for summary judgment, and dismissed the complaint.

The main issue in this case was whether the Civil Court properly granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment as untimely. The court considered that the plaintiff did not argue that the defendant's motion was insufficient to make a prima facie showing of entitlement to summary judgment, and did not assert that its cross motion raised any triable issues of fact. The court held that the plaintiff failed to establish a reasonable excuse for its failure to cross-move during the seven months it had to do so, and therefore found no basis to disturb the Civil Court's refusal to review the plaintiff's papers. The appellate court affirmed the order of the Civil Court.

The relevant facts of this case involve a medical provider, Metro Medical Diagnostics, P.C., seeking to recover assigned first-party no-fault benefits from Country-Wide Insurance Company. The case was settled in 2010, and a judgment was entered in January 2017, awarding the plaintiff statutory no-fault interest from the date of the settlement. In 2017, the plaintiff moved to recalculate the interest rate, arguing that it should be compounded rather than simple. The Civil Court granted the motion and entered a judgment in October 2021. The main issue decided by the court was whether the plaintiff was entitled to the interest from the date of the settlement without having to make a demand for the money. The court held that the plaintiff was not required to make a demand for the agreed-upon amount and that the defendant did not demonstrate that the plaintiff had prevented them in any way from paying the settlement amount. Therefore, the court reversed the judgment and remitted the matter to the Civil Court for the entry of a new judgment in accordance with this decision and order.