No-Fault Case Law
Right Aid Med. Supply, Corp. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 27181)
May 30, 2017
The relevant facts considered by the court were in relation to an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was the burden of proof for establishing whether verification requests remain outstanding. The court held that the burden of proving that verification remains outstanding is on the defendant, as it is an affirmative defense. The court found that the defendant failed to meet its burden of establishing its affirmative defense of outstanding verification and therefore directed the Clerk to enter judgment in favor of the plaintiff in the amount of $2,389.76 with applicable statutory attorney's fees, interest, costs, and disbursements.
Z.M.S. & Y. Acupuncture, P.C. v Geico Gen. Ins. Co. (2017 NY Slip Op 27189)
May 26, 2017
The relevant facts of the case Z.M.S. & Y. Acupuncture, P.C. v Geico Gen. Ins. Co. include a dispute over unpaid no-fault bills, with the plaintiff arguing that the denials issued in the case were untimely due to late EUO scheduling letters. The main issue at hand was whether the EUO scheduling letters sent by the defendant were timely and whether the plaintiff was justified in not appearing for the scheduled EUOs. The court held that the insurer's one-day tardiness in issuing its follow-up request for the EUO scheduled for June 16, 2015 was a technical defect excusable under 11 NYCRR 65-3.5 (p), and that the plaintiff's obligation to appear for an EUO was not negated based on the one-day tardiness. The court ultimately granted the defendant's cross motion for summary judgment and dismissed the plaintiff's complaint.
Fatiha v Autoone Ins. Co. (2017 NY Slip Op 50723(U))
May 23, 2017
The court considered the fact that the defendant failed to answer or appear in the action, resulting in a default judgment being entered against them. The main issue being decided was whether the defendant had a reasonable excuse for their default and whether they had a potentially meritorious defense to the action. The holding of the court was that the defendant failed to establish a reasonable excuse for their default, as the claims examiner's explanation for the default was not deemed sufficient. Therefore, it was unnecessary for the court to determine whether the defendant had a potentially meritorious defense to the action, and the order denying the defendant's motion to vacate the default judgment was affirmed.
Gentle Acupuncture, P.C. v Tri-State Consumer Ins. Co. (2017 NY Slip Op 50706(U))
May 23, 2017
The court considered whether a provider could recover first-party no-fault benefits, and the main issues decided were whether the amounts sought were in accordance with the workers' compensation fee schedule and whether the services provided were medically necessary. The court reversed the order granting the defendant's motion for summary judgment dismissing the complaint. It was held that the defendant did not establish its entitlement to summary judgment for the fee schedule issue, as it failed to provide an expert's affidavit to explain its interpretation of the fee schedule. Additionally, the court found that the plaintiff's opposition to the motion, including an affirmation by the treating acupuncturist, was sufficient to rebut the defendant's argument regarding the medical necessity of the services, despite the acupuncturist being ineligible to submit an affirmation under CPLR 2106. Therefore, the defendant's motion for summary judgment was denied.
Country-Wide Ins. Co. v Valdan Acupuncture, P.C. (2017 NY Slip Op 04068)
May 23, 2017
The case involved an appeal by Country-Wide Ins. Co. from a judgment in favor of Valdan Acupuncture, P.C. The court affirmed the judgment, finding that there were no grounds for vacating an arbitration award. The insurer attempted to show that Valdan Acupuncture was involved in fraudulent incorporation, but the court found that the evidence did not support this claim. Additionally, the court ruled that there was no default in the case, and any delay in opposing the petition to vacate the arbitration award was deemed to be "good cause" for the delay. As a result of the appeal, Valdan Acupuncture was entitled to attorneys' fees calculated as 20% of the no-fault benefits awarded.
Hu-Nam-Nam v Allstate Ins. Co. (2017 NY Slip Op 50685(U))
May 19, 2017
The court considered the fact that the plaintiff had filed a complaint to recover first-party no-fault benefits as a result of an accident that occurred on June 20, 2010, but the defendant did not answer the complaint. Instead, the defendant commenced a declaratory judgment action in the Supreme Court, New York County, which resulted in an order declaring that the defendant was not obligated to provide coverage for the claims by the plaintiff related to an accident on June 21, 2010. The main issue was whether the defendant had a reasonable excuse for its default and the existence of a potentially meritorious defense. The holding of the case was that the defendant failed to demonstrate a potentially meritorious defense due to the discrepancy in the dates of the accident and, therefore, the order denying the defendant's motion to vacate the default judgment was affirmed.
State Farm Mut. Auto. Ins. Co. v RLC Med., P.C. (2017 NY Slip Op 03979)
May 17, 2017
The relevant facts in this case involve an insurance company suing the Estate of Ronald L.L. Collins, seeking a declaration that they are not obligated to pay no-fault claims for medical services purportedly rendered by Collins. The main issue decided by the court was whether the Supreme Court was correct in directing the administrator of Collins's estate to appear for a deposition. The holding of the court was that the Supreme Court improperly directed the administrator to appear for a deposition, as the plaintiff failed to demonstrate that conducting the deposition would result in the disclosure of relevant evidence or lead to the discovery of information bearing on the claims. Therefore, the order was reversed, and the plaintiff's insurance company's argument was upheld.
Fiduciary Ins. Co. of Am. v Medical Diagnostic Servs., P.C. (2017 NY Slip Op 03888)
May 16, 2017
The relevant facts considered by the court were that the defendant, Star of N.Y. Chiropractic Diagnostic, P.C., sought attorneys' fees against the plaintiff, Fiduciary Insurance Company of America. The main issue decided by the court was whether a prevailing party may recover attorneys' fees from the losing party in the absence of a statute, agreement, or court rule explicitly authorizing such recovery. The decision of the court was that the plaintiff owed no duty to defend the defendant as the defendant was merely seeking reimbursement for services rendered in a no-fault action, and therefore the defendant was not entitled to attorneys' fees in this case. The court did not find the defendant's remaining arguments to be valid.
Active Care Med. Supply Corp. v Delos Ins. Co. (2017 NY Slip Op 50652(U))
May 12, 2017
The court considered a case in which plaintiff sought to recover first-party no-fault benefits for medical supplies provided to its assignor, who was injured in a motor vehicle accident. Defendant moved for summary judgment, claiming that the action was barred by the doctrines of res judicata and collateral estoppel due to a previous order obtained in a declaratory judgment action involving the same accident. The main issue decided by the court was whether the action was indeed barred by res judicata and collateral estoppel. The court held that, for the reasons stated in another case decided in conjunction with this one, the appeal was dismissed.
Active Care Med. Supply Corp. v Delos Ins. Co. (2017 NY Slip Op 50651(U))
May 12, 2017
The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, in which the defendant was awarded "$250 in fees" in a case involving a first-party no-fault benefits claim for medical supplies provided to the plaintiff's assignor who was injured in a motor vehicle accident. The main issue in the case was whether the action was barred by the doctrines of res judicata and collateral estoppel due to a previous order obtained by the defendant in a Supreme Court declaratory judgment action involving the same motor vehicle accident. The court ultimately dismissed the appeal, affirming the Civil Court's order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion, as well as the award of defense counsel fees.