No-Fault Case Law
Rehabxpress, PT, P.C. v Auto One Ins. Co. (2017 NY Slip Op 27246)
July 14, 2017
The relevant facts the court considered include the defendant's failure to timely answer or appear in the action, as well as their commencement of another action seeking a declaration that the plaintiff was not entitled to recover no-fault benefits for a motor vehicle accident. The main issue decided was whether the judgment obtained against the defendant should be vacated and the plaintiff be compelled to accept the defendant's late answer. The holding of the case was that the default judgment against the defendant should not be vacated and that the Civil Court's determination not to set off the judgments was not an improvident exercise of discretion.
Lenox Hill Radiology v Global Liberty Ins. Co. of N.Y. (2017 NY Slip Op 50978(U))
July 6, 2017
The relevant facts considered by the court were that Lenox Hill Radiology was seeking first-party no-fault benefits in the sum of $6,651.66 for medical services rendered to a patient involved in an automobile accident. The main issue was whether the time to pay or deny the claims commenced, considering the defendant's contention that the verification requests were not responded to by the plaintiff. The holding of the case was that the defendant's motion for summary judgment to dismiss the complaint was denied, as the court found that the defendant failed to establish a prima facie showing of entitlement to summary judgment. The court found that the defendant's no-fault claims adjuster failed to sufficiently demonstrate the standard office practice or procedure used to ensure that the verification requests were properly addressed and mailed, in addition to failing to establish an objective, reasonable basis for the contents of the verification demands.
Charles Deng Acupuncture, P.C. v Country Wide Ins. Co. (2017 NY Slip Op 50864(U))
June 23, 2017
The main facts of the case involve Charles Deng Acupuncture, P.C. appealing from an order of the Civil Court of the City of New York, Queens County, which denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint. The main issue decided in the case was whether the provider, as an assignee of Tanis, Leonel, was entitled to recover first-party no-fault benefits from Country Wide Insurance Company. The holding of the case was that defendant's cross motion for summary judgment dismissing the complaint was denied and the order was affirmed. This decision was based on the reasoning provided in the case Island Life Chiropractic Pain Care, PLLC v Country Wide Ins. Co. (53 Misc 3d 131[A], 2016 NY Slip Op 51378[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]) which supported the denial of the cross motion for summary judgment.
Island Life Chiropractic, P.C. v Commerce Ins. Co. (2017 NY Slip Op 50856(U))
June 23, 2017
The court considered the motion for summary judgment filed by the defendant, Commerce Ins. Co., in a case brought by Island Life Chiropractic, P.C. to recover first-party no-fault benefits. The main issue decided was whether the insurance policy provided by Commerce Ins. Co. had been exhausted, as the defendant contended that the $50,000 in personal injury protection benefits had been paid out in claims and that the coverage limits had been reached. However, the court held that the defendant had failed to establish, as a matter of law, that the policy had been exhausted at the time the claim at issue was complete. As a result, the court reversed the order granting the defendant's motion for summary judgment and denied the motion, finding that the defendant did not establish their entitlement to summary judgment dismissing the complaint.
Sharp View Diagnostic Imaging, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 50855(U))
June 23, 2017
The relevant facts of the case involved an action by a provider to recover assigned first-party no-fault benefits. The court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had demonstrated that the limits of the applicable insurance policy had been exhausted. The court held that the defendant's cross motion for summary judgment dismissing the complaint should have been denied. Additionally, the court found that the plaintiff had failed to establish its prima facie entitlement to summary judgment. Therefore, the order was modified to provide that the defendant's cross motion for summary judgment dismissing the complaint was denied.
Fresh Acupuncture, P.C. v Interboro Ins. Co. (2017 NY Slip Op 27214)
June 23, 2017
The main issue in Fresh Acupuncture, P.C. v Interboro Ins. Co. was whether the Civil Court had subject matter jurisdiction to entertain a declaratory judgment action involving the obligation of an insurer to indemnify or defend a defendant in an action seeking to recover damages not exceeding $25,000. The Civil Court, New York County did not have the jurisdiction to hear the declaratory judgment action because it was an action by an insurer against a provider and did not meet the requirements for the court's jurisdiction as defined in section 3001 of the CPLR. The holding of the case was that the order, insofar as appealed from, was reversed, and so much of the order as, in effect, sua sponte searched the record and granted defendant partial summary judgment dismissing so much of the complaint as was asserted by plaintiff Fresh Acupuncture, P.C., was vacated. Therefore, the Civil Court, New York County, did not have jurisdiction to entertain the declaratory judgment action.
Global Liberty Ins. Co. v Jonathan Lewin, M.D., P.C. (2017 NY Slip Op 50897(U))
June 22, 2017
The relevant facts considered by the court in this case were that the defendant moved for an order dismissing the complaint on the grounds that the matter had already been adjudicated in arbitration and that the pleading failed to state a cause of action. The court also considered the defendant's request to consolidate the matter with another action in Bronx County. In response, the plaintiff opposed the motion and cross-moved for an order granting summary judgment adjudging and declaring that the defendant was not entitled to no-fault coverage for a motor vehicle accident. The main issue decided by the court was whether the matter had already been adjudicated in arbitration, and if the pleading failed to state a cause of action. The court held that the arbitration award in another matter submitted by the defendant did not apply to this action, and that the plaintiff was entitled to summary judgment as the defendant failed to respond to the request for verification of MRI films, and the plaintiff established prima facie entitlement to summary judgment.
Santorello v State Farm Ins. Co. (2017 NY Slip Op 50829(U))
June 21, 2017
The relevant facts the court considered in this case were that the plaintiff was injured in a car accident and received chiropractic treatment, and she executed an Assignment of Benefits to the treating doctor. The defendant moved for summary judgment based on the assignment, arguing that the plaintiff lacked standing to maintain the action. The main issue decided was whether the plaintiff's assignment of benefits to the doctor deprived her of standing to seek reimbursement from the defendant. The holding of the court was that the plaintiff's assignment of benefits to the doctor transferred her rights for reimbursement of medical expenses, and as a result, the plaintiff lacked standing to maintain the action. The court granted the defendant's motion for summary judgment and dismissed the action.
Zwanger & Pesiri Radiology Group, LLP v Mapfre Ins. Co. (2017 NY Slip Op 50981(U))
June 14, 2017
The relevant facts the court considered included the failure of the plaintiff to fully comply with the defendant's requests for additional verification of certain medical services. The main issues decided were whether the defendant was entitled to summary judgment for dismissal of the plaintiff's complaint seeking first-party no-fault benefits for medical services rendered, and whether the verification requests made by the defendant were timely and proper. The holding of the case was that the court denied the motion by the defendant for summary judgment dismissing the plaintiff's action, as the defendant failed to make a prima facie showing of entitlement to judgment as a matter of law with proof in admissible form, and failed to create a presumption of timely and proper mailing of verification requests.
Ortho Passive Motion, Inc. v Allstate Ins. Co. (2017 NY Slip Op 50771(U))
June 2, 2017
The main issue in this case was whether the defendant, Allstate Insurance Co., was entitled to modify a judgment in favor of the plaintiff, Ortho Passive Motion, Inc., after the coverage limits of the insurance policy had been exhausted. Following a nonjury trial, the Civil Court awarded the plaintiff a judgment for first-party no-fault benefits. Eight months later, the defendant sought to modify the judgment, arguing that the coverage limits of the insurance policy had been exhausted, and therefore, there were no funds available to pay the judgment. The Appellate Term found that the defendant's motion papers failed to establish an exhaustion of the coverage limits of the insurance policy at the time the claims at issue were deemed complete. Additionally, the defendant failed to demonstrate that there was a technical defect or ministerial mistake in the judgment. Therefore, the court held that the defendant had not established a basis to disturb the judgment and affirmed the lower court's decision.