No-Fault Case Law

The main issue in this case was whether the lower court erred in denying the plaintiff's cross motion for summary judgment and granting the defendant's motion to dismiss the complaint. The court considered the defendant's motion to dismiss the complaint pursuant to CPLR 3126 or, in the alternative, to compel the plaintiff to respond to the defendant's notice for discovery and inspection, and its "demand for verified written interrogatories." The court held that the order of the Civil Court was affirmed, with the plaintiff being compelled to provide the defendant with verified responses to specific discovery demands and to produce the plaintiff's owner for an examination before trial. The court considered the reasons stated in a similar case and affirmed the decision of the lower court.

The main issues in this case were whether the appellant was obligated to produce information sought by the appellee, and whether the appellant was entitled to summary judgment. The court held that since the appellant failed to timely challenge the propriety of the appellee's notice for discovery and inspection, it was obligated to produce the information sought except as to matters which are privileged or palpably improper. The court also found that the discovery at issue was not palpably improper, and the appellee was entitled to an examination before trial of the appellant's owner. Therefore, the court affirmed the order, insofar as appealed from, and held that the appellant's contention that it was entitled to summary judgment was premature.

The relevant facts the court considered were that the plaintiff, Vladimir Shur, was seeking to recover assigned first-party no-fault benefits from the defendant, Unitrin Advantage Insurance Company. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should have been granted, and if the plaintiff's cross motion for summary judgment should have been granted. The holding of the case was that the defendant's motion for summary judgment dismissing the complaint was denied, as the court found that the defendant had failed to make a prima facie showing of lack of causation regarding the injuries. The court also found that the plaintiff's cross motion for summary judgment should not have been granted, as the plaintiff had failed to establish its prima facie entitlement to judgment.

The main issue in this case was whether the plaintiff was obligated to pay certain no-fault insurance benefits for medical services rendered to the defendant's assignor, which the plaintiff claimed were not medically necessary. The plaintiff appealed from an order denying its unopposed motion for a default judgment after the defendant failed to appear or answer the complaint. The court considered the requirements for proper service of the summons and complaint, the defendant's default, and the facts constituting the claim. The court held that the plaintiff failed to demonstrate strict compliance with the service requirements under Limited Liability Company Law, particularly in regards to the filing of an "affidavit of compliance." As a result, the plaintiff was not entitled to a default judgment. The order denying the plaintiff's motion for a default judgment was affirmed.

The court considered the facts of the case where Promed Orthocare Supply, Inc. was seeking to recover assigned first-party no-fault benefits for various medical supplies provided to its assignor. In a nonjury trial, the court found that the cervical traction unit for which recovery was sought was not medically necessary, based on the testimony of defendant's expert witness. However, the Civil Court erred in refusing to consider expert testimony from the witness who did not prepare the peer review report, and indicating that testimony from the author of the peer review report was required. The court held that testimony of an expert witness who did not prepare the peer review report can be used to prove a lack of medical necessity and that a new trial was required on the second cause of action. The judgment was reversed, and the matter remitted to the Civil Court for the entry of a judgment in favor of plaintiff in the principal sum of $549.18 on the first cause of action, with a new trial on the second cause of action.

The relevant facts considered in the case were that the plaintiff insurance company sought a judgment declaring that it was not obligated to pay certain no-fault insurance benefits because the defendant failed to appear for examinations under oath. The defendant filed an answer about 3 1/2 months past the statutory time to file an answer. The issue decided was whether the plaintiff should be compelled to accept the untimely answer as timely or to extend the time for the defendant to answer. The holding of the case was that the defendant did not provide a reasonable excuse for the delay and failed to demonstrate a potentially meritorious defense to the action, so the Supreme Court was correct in denying the defendant's motion.

The court considered the fact that in a no-fault benefits case, Plaintiff timely submitted the bills at issue to Defendant, and that the burden shifted to the Defendant to show that its Examination Under Oath (EUO) requests were timely mailed and that the assignor failed to appear for the EUOs. Defendant produced a witness who testified regarding their office procedures when scheduling EUOs and when an assignor failed to appear for an EUO. The court found that the witness did not have personal knowledge of the assignor's failures to appear based solely on her review of the file, and therefore, judgment was awarded in favor of Plaintiff for $785.12 plus interest, attorneys' fees, and statutory costs and disbursements. The main issue decided was whether the Defendant was able to prove that its EUO requests were timely mailed and that the assignor failed to appear for the EUOs. The holding of the case was that the court did not find that the Defendant's witness had personal knowledge of the assignor's failures to appear based solely on her review of the file, and therefore, judgment was awarded in favor of Plaintiff.

The court considered the insurance policy application submitted by the plaintiff’s assignor-insured, Tammy Murphy, and two motor vehicle accident reports from the New York State Department of Motor Vehicles. The main issue was whether Murphy misrepresented her address on the insurance application, which would determine if the defendant insurance company had the right to deny the claim for medical services. The holding of the court was that the defendant insurance company failed to meet its burden of proof that Murphy provided a false and fraudulent residential address on her insurance application and, therefore, the plaintiff was entitled to a money judgment in the amount of $1,979.30, plus costs and disbursements and statutory interest.

The court considered the motion by the defendant for an order of dismissal due to the plaintiff's non-compliance with interrogatories and combined discovery demands, as well as the defendant's alternative motion to compel the plaintiff's owner to appear for an examination before trial. The main issues decided were whether the plaintiff had complied with the defendant's discovery demands and whether the defendant's requests for discovery concerning the plaintiff's incorporation and eligibility to recover no-fault benefits were material and necessary to the defense. The holding of the court was to deny the motion to strike the plaintiff's Notice of Trial and dismiss the complaint, conditional upon the plaintiff providing specific and meaningful responses to the defendant's discovery demands, and to grant the defendant's alternative motion to compel the plaintiff's owner to appear for an examination before trial. The court also denied the plaintiff's cross-motion for a protective order and their request to compel the defendant to produce their SIU Investigator and claims representative for deposition.

The court considered the fact that the defendant had scheduled an initial and follow-up independent medical examination (IME) for the plaintiff's assignor, which the assignor failed to appear for. The main issue decided was whether the failure to appear for the scheduled IMEs constituted a failure to comply with a condition precedent to coverage, and whether the defendant had timely denied the claims on that ground. The holding of the case was that the defendant was entitled to summary judgment dismissing the complaint, as the plaintiff had failed to comply with a condition precedent to coverage, and the defendant had timely denied the claims on that ground. Therefore, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.