No-Fault Case Law
Thomas Dow, D.C., P.C. v New York Cent. Mut. Fire Ins. Co. (2017 NY Slip Op 50495(U))
April 13, 2017
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.
Brooklyn Chiropractic & Sports Therapy, P.C. v Unitrin Direct Auto Ins. Co. (2017 NY Slip Op 50494(U))
April 13, 2017
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.
Excel Surgery Ctr., L.L.C. v Travelers Prop. Cas. Ins. Co. (2017 NY Slip Op 50493(U))
April 13, 2017
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.
Gentle Care Med. Servs., P.C. v Country Wide Ins. Co. (2017 NY Slip Op 50488(U))
April 12, 2017
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.
Gentle Care Med. Servs., P.C. v Country Wide Ins. Co. (2017 NY Slip Op 50487(U))
April 12, 2017
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.
Country-Wide Ins. Co. v GEICO Gen. Ins. Co. (2017 NY Slip Op 50460(U))
April 12, 2017
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.
Matter of Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co. (2017 NY Slip Op 02785)
April 12, 2017
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.
Maximum Chiropractic, P.C. v Allstate Ins. Co. (2017 NY Slip Op 50552(U))
April 11, 2017
The main issue in this case was whether the trial court properly denied the plaintiff's motion for a default judgment and granted the defendant's cross motion to compel the plaintiff to accept an untimely answer. The court considered the defendant's argument that they had a reasonable excuse for the untimely answer and a potentially meritorious defense, as they had not received the summons and complaint and may have a viable defense based on a lack of medical necessity. The court ultimately held that the branch of the defendant's cross motion seeking to compel the plaintiff to accept the untimely answer was properly granted, as the defendant demonstrated both a reasonable excuse and a potentially meritorious defense. As a result, the order was affirmed.
S & R Med., P.C. v Allstate Prop. & Cas. Ins. Co. (2017 NY Slip Op 50551(U))
April 11, 2017
The relevant facts that the court considered in this case were that the defendant failed to timely answer in an action by a provider to recover assigned first-party no-fault benefits. Plaintiff moved for leave to enter a default judgment, and the defendant cross-moved to compel the plaintiff to accept an untimely answer. The main issues decided were whether the defendant's untimely answer should be accepted and whether the plaintiff was entitled to a default judgment. The holding of the case was that the branch of defendant's cross motion seeking to compel plaintiff to accept the untimely answer was denied, as defendant failed to provide a reasonable excuse for the default and demonstrate a meritorious defense. Additionally, the plaintiff's motion for leave to enter a default judgment was properly denied as they failed to establish valid service. Therefore, the defendant's cross motion was denied, and the order was affirmed without costs.
NY Spine Physical Therapy, P.C. v Geico Gen. Ins. Co. (2017 NY Slip Op 50434(U))
April 7, 2017
The relevant facts considered by the court in this case were that NY Spine Physical Therapy, P.C. was seeking to recover assigned first-party no-fault benefits from GEICO General Insurance Co. after a nonjury trial that resulted in a judgment awarding the plaintiff the principal sum of $289.29. The main issue decided by the court was whether the Civil Court improvidently exercised its discretion in denying the defendant's application to adjourn the trial to secure the attendance of expert witnesses. The holding of the court was that the judgment was affirmed, with the court finding that the defendant's sole contention on appeal was without merit and aligning with the decision in another similar case. Therefore, the judgment awarding the plaintiff the no-fault benefits was upheld.