No-Fault Case Law

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.

The relevant facts of the case include a dispute over a settlement dating back to 2008, where NCT Diagnostics, Inc. sought to recover no-fault benefits that had been assigned to them. The plaintiff received a judgment for the principal amount of $992.20, but also sought statutory no-fault interest from the date of the settlement in 2008. The main issue at hand was whether the defendant was obligated to pay the settlement amount to the plaintiff without the need for a demand, and whether there was any evidence to show that the plaintiff had prevented the defendant from making the payment. The holding of the case was that the Civil Court had erred in tolling the accrual of interest, and the matter was remitted for the entry of a new judgment in accordance with the decision and order. The judgment, insofar as appealed from, was reversed and the matter was remitted to the Civil Court for the entry of a new judgment.

The court considered the fact that the plaintiff, Heal-Rite, P.T., P.C., as Assigned of Mark Lee, had failed to appear for scheduled examinations under oath (EUOs), which resulted in the denial of the claims by defendant, State Farm Mutual Auto. Ins. Co. The main issue decided was whether plaintiff's failure to appear for the EUOs warranted summary judgment in favor of the defendant. The court held that defendant had established its prima facie entitlement to summary judgment by providing evidence that the EUO scheduling letters and denial of claim forms had been timely mailed and that the plaintiff had failed to appear as affirmed by the defendant's attorney. Since plaintiff failed to raise a triable issue of fact in opposition to defendant's motion, the Civil Court properly granted defendant's motion for summary judgment dismissing the complaint. Therefore, the order granting defendant's motion for summary judgment dismissing the complaint was affirmed.

The court considered the evidence provided by Country-Wide Insurance Company, including the policy declaration page, an affidavit by its no-fault claim supervisor, and a payment ledger showing $50,000 was paid to Elmhurst Hospital Center. The main issue decided was whether Country-Wide Insurance Company owed further duty to pay any no-fault claims with respect to a specified motor vehicle accident. The holding of the court was that Country-Wide was under no further obligation to pay defendants once the policy limits were exhausted, and that the affidavit by the no-fault claim supervisor was sufficient to lay a foundation for admission of the documents as business records under CPLR 4518 (a). Additionally, the court held that defendants failed to submit any evidence to establish the existence of material issues of fact requiring a trial, and rejected their suggestion that Country-Wide was required to show compliance with 11 NYCRR 65-3.15's priority of payment rule to make its prima facie case.

The court considered the medical necessity of the treatment received by Joshua Lessy, as well as the expert qualifications of licensed Chiropractor Dr. Todd Aordkian and the documents he reviewed. The main issue decided was whether the treatment provided by the Plaintiff, Longevity Medical Supply Inc, was medically necessary. The holding was that the Defendant, Travelers Insurance Company, met its burden of establishing that the services were not medically necessary, and the Plaintiff failed to present any evidence to rebut the showing of lack of medical necessity. As a result, the court dismissed the complaint. The court found that the Defendant provided sufficient proof that the procedures were not medically necessary, and the Plaintiff failed to demonstrate its entitlement to judgment or otherwise rebut Defendant's showing.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The defendant moved for summary judgment dismissing the complaint on the grounds that the plaintiff had failed to provide requested verification, and the plaintiff opposed the motion and cross-moved for summary judgment. The Civil Court granted the defendant's motion and denied the plaintiff's cross-motion. The main issue decided in this case was whether the plaintiff had provided the requested verification for the first-party no-fault benefits, and the court affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross-motion. The holding of the case was that the order of the Civil Court was affirmed, and the defendant's motion for summary judgment was granted.

The court considered the fact that Jules Francois Parisien, M.D. had commenced an action against Kemper Insurance Company to recover first-party no-fault benefits for services provided to his assignor, Joshua David, who had been injured in an accident. Unitrin Direct Insurance Company appeared in the action and brought a declaratory judgment action against Parisien and David, pertaining to the same accident, and moved for summary judgment against Parisien. Unitrin's attorney alleged that plaintiff sued a non-existent entity and that the complaint should be dismissed on that basis alone. The main issue decided was whether the May 11, 2020 Supreme Court order should have res judicata effect on the action, warranting the dismissal of the complaint. The court held that Unitrin was the proper defendant and that any judgment in favor of the plaintiff in this action would impair rights or interests established by the order in the declaratory judgment action. Therefore, the court affirmed the order granting Unitrin's motion to dismiss the complaint and denied the plaintiff's cross motion for summary judgment.