No-Fault Case Law

The main issue in the case was whether the defendant, Auto One Ins. Co., had a reasonable excuse for its default in a prior order and a meritorious defense to the action in a case where a provider was seeking to recover assigned first-party no-fault benefits. The court considered the fact that the initial order granting the plaintiff's motion for summary judgment was entered without opposition from the defendant and that both sides had agreed to the terms. The defendant subsequently moved to vacate the judgment and the order, arguing for a reasonable excuse for its default and a meritorious defense to the action. However, the court found that the defendant had not provided a reasonable excuse for its default and upheld the initial order on different grounds. The holding of the case was that the order denying the defendant's motion to vacate the judgment and order was affirmed, without costs, as the defendant failed to establish grounds sufficient to set aside the stipulation that was entered on consent. The court ruled in favor of the plaintiff, Healthworx Medical, P.C., as the defendant, Auto One Ins. Co., failed to make a sufficient showing to vacate the prior order.

The relevant facts considered by the court were that Utopia Equipment Inc. appealed a decision from the Civil Court of New York County which granted Chubb Indemnity Insurance Company's motion for summary judgment dismissing the complaint. The main issue decided by the court was whether Chubb had established its entitlement to summary judgment based on Utopia's alleged untimely submission of the no-fault claims beyond the 45-day time limit. The holding of the court was to reverse the order of the Civil Court, deny Chubb's motion for summary judgment, and reinstate the complaint. The court found that Chubb had failed to establish its entitlement to summary judgment because its claims adjuster's affidavit was inadequate to demonstrate that Utopia's bills were not timely received within the 45-day period. Therefore, denial of Chubb's motion was required regardless of the sufficiency of Utopia's opposition papers.

The relevant facts the court considered were that Exultant Medical Diagnostics, P.C. was seeking to recover first-party no-fault benefits as the assignee of two individuals, Devon Crawford and Shatara Griffin. American Commerce Insurance Company had denied the claim on the ground of lack of medical necessity, but failed to establish that the denial of claim forms had been properly and timely mailed. The main issues decided in this case were whether the denial of claim forms had been properly and timely mailed, and whether the defendant had established its prima facie entitlement to summary judgment. The holding of the court was that the order denying the defendant's motion for summary judgment was affirmed, as the defendant had failed to establish its entitlement to summary judgment.

The main issue in the case was whether the defendant had established that it had timely denied the claims of the plaintiff. The court considered whether the amount sought to be recovered by the plaintiff was in excess of the amount permitted by the workers' compensation fee schedule. The holding of the court was that the defendant had in fact timely mailed its denial of claim forms and had made a prima facie showing that the amount sought by the plaintiff was in excess of the permitted amount. The court found that the plaintiff had failed to proffer evidence in admissible form to raise a triable issue of fact with respect to the defendant's fee schedule defense, and therefore the branch of defendant's motion seeking summary judgment was granted.

The main issue in this case was whether the District Court erred in refusing to grant an adjournment to the defendant to call its sole witness, a medical expert, to testify as to the medical necessity of the services rendered. The court considered the fact that the defendant's expert testimony was critical to the sole contested liability issue in the case, and that there was no evidence in the record that the defendant was merely seeking to delay the trial. The judgment awarded to the plaintiff was reversed and the matter was remitted to the District Court for a new trial. The Appellate Term, Second Department found that the District Court had improvidently exercised its discretion in refusing to grant defendant an adjournment, and that the trial should have been rescheduled for a day other than a Monday, or to a Monday more than eight weeks later.

The relevant facts considered by the court in Excel Surgery Ctr., L.L.C. v Travelers Prop. Cas. Ins. Co. were that Excel Surgery Center, L.L.C., as assignee of Leslie Monroy, appealed an order by the District Court of Suffolk County granting Travelers Property Casualty Ins. Co.'s motion for summary judgment, which dismissed the complaint. The main issue decided was whether the action by the provider to recover assigned first-party no-fault benefits was premature due to the plaintiff's failure to provide all requested verification. The holding of the case was that the order was affirmed without costs, as the sole argument raised by the plaintiff on appeal was found to be unpreserved for appellate review, since it was not raised in the District Court. Therefore, the order granting defendant's motion for summary judgment dismissing the complaint was upheld.

The main issues in this case were whether it was appropriate to vacate an order that had previously been granted for summary judgment in favor of the plaintiff and against the defendant, and whether the defendant should be allowed alternative relief. The relevant facts considered by the court included the lack of timeliness in the submission of the defendant's cross motion and the release of pending no-fault claims made by the plaintiff's sole officer and shareholder. The holding of the case was that the court reversed the order denying the defendant's motion to vacate the previous order granting summary judgment and denying the defendant's cross motion, and instead vacated the previous order and granted the defendant's cross motion for summary judgment dismissing the complaint. The court found that there was sufficient reason and in the interest of substantial justice to vacate the previous order and grant the defendant's cross motion, based on their release of the pending claims.

The court considered the facts surrounding a claim for first-party no-fault benefits assigned to the plaintiff, as well as a general release documented by the defendant's counsel. The main issue was whether the general release, that was executed by the plaintiff's sole officer and shareholder, was valid and applicable to release the no-fault claims underlying the action. The court held that the motion to renew was granted, as the release submitted by the defendant's counsel constituted a complete bar to the instant action, and the plaintiff's counsel did not challenge the validity, authenticity, or applicability of the release. Therefore, the plaintiff's motion for summary judgment was denied, and the defendant's cross-motion for summary judgment dismissing the complaint was granted.

The court considered a petition to confirm an arbitration award dated November 17, 2015 and a cross-petition to confirm an arbitration award dated January 29, 2016. The main issue decided was whether respondent GEICO General Insurance Company was entitled to recoup no-fault benefits paid through "loss transfer" reimbursement. The court held that the arbitrator's determination that GEICO was entitled to recoup the benefits was supported by evidence and was not arbitrary and capricious. The court also rejected the appellant's contention that the arbitrator improperly considered new evidence, stating that any mistake made by the arbitrator did not establish fraud or misconduct and did not provide a sufficient basis for vacatur.

The court considered the arbitration, master arbitration, and the Supreme Court's previous decisions. The main issue decided was whether an error had occurred when the arbitrator invalidated an award for acupuncture treatment. The main decision was that the arbitrator had indeed made an error when they invalidated the award and that the award of the master arbitrator was rational, and as such, the petition to invalidate the award of the master arbitrator was denied, and the award was upheld.