No-Fault Case Law
Masigla v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 51239(U))
November 18, 2022
The main issue in this case was whether the insurance company was entitled to summary judgment dismissing the complaint brought by a provider to recover assigned first-party no-fault benefits, based on the provider's failure to appear for duly scheduled examinations under oath (EUOs). The court considered the fact that the insurer had twice duly demanded an EUO from the provider, that the provider twice failed to appear, and that the insurer issued a timely denial of the claim(s) on that ground. The court held that the insurer had established its prima facie entitlement to summary judgment dismissing the complaint. The court also rejected the provider's contention that the insurer could not deny the claims based on the failure to appear for EUOs that occurred prior to the submission of the claims at issue, and that the insurer needed to schedule additional EUOs after the submission of the claims. Therefore, the court reversed the denial of the insurer's motion for summary judgment and granted the motion to dismiss the complaint.
Longevity Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51235(U))
November 18, 2022
The court considered the fact that Longevity Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether defendant State Farm Mutual Automobile Insurance Company had previously paid another provider for the same piece of medical equipment that was the basis for the claim at issue in this case. The holding was that the affidavit executed by defendant's claims specialist, along with the relevant supporting documents, demonstrated that defendant had indeed previously paid another provider for the same medical equipment, establishing its prima facie entitlement to summary judgment dismissing the complaint. As a result, plaintiff failed to raise a triable issue of fact, and the order granting defendant's motion for summary judgment and denying plaintiff's cross motion for summary judgment was affirmed.
Tyorkin v New Jersey Mfrs. Ins. Group (2022 NY Slip Op 51234(U))
November 18, 2022
The court considered the motion for summary judgment and cross motion for summary judgment in an action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether to grant leave to renew the plaintiff's prior motion and opposition to the defendant's cross motion. The holding of the court was that the plaintiff failed to demonstrate any basis upon which to grant him leave to renew, as the affidavits he submitted in support of his motion asserted no new facts, and he failed to provide a reasonable justification for failing to submit the affidavits in support of his original motion for summary judgment and in opposition to defendant's cross motion for summary judgment. Therefore, the order, insofar as appealed from, was affirmed.
Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51232(U))
November 18, 2022
The court considered the issue of whether a medical supply company, as assignee of a customer injured in a car accident, had fully responded to the insurance company's verification requests for first-party no-fault benefits. The court also considered whether verification was still outstanding before the insurance company issued a denial of the claim. After a nonjury trial, the Civil Court dismissed the complaint, finding that the insurance company had proven that the medical supply company had not fully responded to the verification requests and that verification was still outstanding before the denial was issued. The Appellate Term, Second Department affirmed the judgment, determining that the trial court's assessment of the evidence supported their findings regarding the medical supply company's responses and the timing of the denial of the claim. Therefore, the judgment was affirmed.
National Gen. Ins. Online, Inc. v Blasco (2022 NY Slip Op 06252)
November 9, 2022
The court considered an action in which the plaintiffs sought a judgment declaring that they are not obligated to pay certain no-fault claims. The medical provider defendants appealed from a judgment of the Supreme Court that declared that the plaintiffs have no duty to provide coverage for the subject no-fault claims. The collisions for which the claims were made were determined to be intentional and staged, which means they were not covered by the policy of insurance. The plaintiffs established their prima facie entitlement to judgment by demonstrating through admissible evidence that the subject collisions were intentionally caused or staged. The medical provider defendants failed to raise a triable issue of fact as to whether the collisions were intentionally caused or staged, and therefore the judgment in favor of the plaintiffs was affirmed.
New Capital 1 Inc. v Kemper Independence Ins. Co. (2022 NY Slip Op 51033(U))
October 24, 2022
The main issue in this case was whether the defendant-insurer had a duty to pay the plaintiff's no-fault claims for medical services rendered to Carol Smart, who was injured in a motor vehicle accident. The court considered a separate action in which the Supreme Court, New York County, had declared that the defendant had no duty to pay the plaintiff's claims arising from the same accident. Based on the doctrine of res judicata, the court held that the underlying action to recover first-party no-fault benefits was barred. The court determined that the judgment in the separate action was a conclusive final determination, and therefore the defendant's motion for summary judgment dismissing the instant action should have been granted. Ultimately, the court reversed the order of the Civil Court, and granted the defendant's motion for summary judgment, dismissing the complaint.
Health Value Med., P.C. v Country Wide Ins. (2022 NY Slip Op 51137(U))
October 21, 2022
The court considered the settlement of a claim by a medical provider for first-party no-fault benefits, which was not paid by the insurance company leading to a judgment being entered with a simple interest rate. The main issue decided was whether the interest on the judgment should be recalculated from a simple rate to a compound rate, as per the pre-2002 regulations that were in effect at the time of the accident. The court held that the interest should be recalculated to a compound rate, as the accident occurred before the effective date of the current regulations, which now provide for a simple rate of interest. The court also clarified that postjudgment interest in a no-fault action is governed by Insurance Law § 5106 and its implementing regulations, not the CPLR.
Good Samaritan Hosp. v MVAIC Ins. Co. (2022 NY Slip Op 51100(U))
October 14, 2022
The relevant facts of the case were that Good Samaritan Hospital sought to recover assigned first-party no-fault benefits from MVAIC Insurance Company. The main issue decided was whether MVAIC timely denied plaintiff's claim and whether plaintiff provided reasonable justification for the delay in submitting the claim. The court ultimately held that defendant's motion for summary judgment dismissing the complaint was granted, and plaintiff's cross motion for summary judgment was denied. The court found that defendant demonstrated its entitlement to summary judgment by proving that it timely denied plaintiff's claim for no-fault benefits due to untimeliness. Plaintiff failed to provide a reasonable justification for the delay and also failed to establish that the claim was submitted to MVAIC in a timely manner. Therefore, defendant's motion for summary judgment was granted, and plaintiff's motion was denied.
Sloan v Nationwide Mut. Ins. Co. (2022 NY Slip Op 50997(U))
October 13, 2022
The court considered the fact that the plaintiff, a medical professional, sued the defendant insurance company to recover unpaid first-party No-Fault benefits for medical services provided to the plaintiff's assignor. The defendant moved for summary judgment dismissing the complaint on the grounds that the plaintiff failed to attend scheduled Examinations Under Oath (EUO). The main issue decided was whether the defendant's request for an EUO was timely and whether the defendant was required to pay or deny the claims after the plaintiff failed to attend the EUO. The court held that the defendant's request for an EUO was untimely, and the failure to attend two scheduled EUOs was a sufficient basis for the defendant to deny the No-Fault claim. Therefore, the court denied the defendant's motion for summary judgment and granted the plaintiff's cross-motion for summary judgment, awarding the plaintiff $385.63 plus statutory interest and attorneys' fees.
Dos Manos Chiropractic, P.C. v State Farm Ins. Co. (2022 NY Slip Op 50995(U))
October 12, 2022
The court considered the fact that the plaintiff sued the defendant insurance company to recover unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor, who was injured in an automobile accident. Additionally, the defendant had commenced a declaratory judgment action in Supreme Court against the plaintiff and others who filed No-Fault benefit claims, and had been granted a default judgment holding that the defendant owed no duty to pay No-Fault claims arising from the accident. The main issue decided by the court was whether the plaintiff's action was barred by res judicata and collateral estoppel, and the court held that res judicata barred the plaintiff's action. The court granted the defendant's motion for summary judgment and dismissed the plaintiff's complaint, without addressing whether collateral estoppel also barred the action.