No-Fault Case Law

The court considered the fact that the plaintiff was seeking to recover no-fault benefits for medical services provided to its assignor after a motor vehicle accident on August 22, 2011. The plaintiff had already been awarded judgment in the amount of $3,723.72, which was later modified to $7,784.06 to include interest, costs, and attorney's fees. The main issue the court decided was whether the defendant's insurance policy had been exhausted, as the plaintiff claimed it had not and the defendant argued that it had. The court held that the defendant's motion to modify the judgment and seek a protective order should be denied in its entirety, as the defendant failed to raise and present evidence of the defense of policy exhaustion at trial, despite having had the opportunity to do so. Therefore, the court found in favor of the plaintiff.

The main issue in this appeal addressed the determination of the amount of an additional attorney's fee pursuant to Insurance Department Regulations (11 NYCRR) § 65-4.10 (j) (4). The appellant, AAAMG Leasing Corp., sought an attorney's fee in connection with the court proceedings on the petition to vacate a master arbitrator's award and the cross petition to confirm the award. The Supreme Court denied the appellant's requested relief without stating the basis for that determination, leading to the case being remitted to the Supreme Court, Nassau County, for a determination of the amount of the additional attorney's fee to which the appellant is entitled, stating the evidentiary basis for the award. The Appellate Division found that the Supreme Court erred in denying relief, and concluded that the court must consider the appellant's attorney's additional fee and indicate the evidentiary basis for the award.

The court considered whether the plaintiff, a chiropractic provider, had failed to appear at duly scheduled examinations under oath (EUOs), which is a condition precedent to an insurer's liability on a policy. The main issue decided was whether the defendant had proven the plaintiff's nonappearances at the EUOs. The court held that an appearance at an EUO is a condition precedent to an insurer's liability on a policy and defendant had submitted an affirmation from the attorney responsible for conducting the EUOs, which established that the plaintiff had failed to appear for the scheduled EUOs. Therefore, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the master arbitrator's award, which granted respondent no-fault insurance benefits, should be vacated. The court considered the fact that the petitioner's evidence established that the assignor failed to appear at three scheduled examinations under oath. The court held that the master arbitrator's award was arbitrary because it irrationally ignored the uncontroverted evidence presented by the petitioner. As a result, the court unanimously reversed the denial of the petition to vacate the award and directed the Clerk to enter judgment accordingly. This case demonstrates how courts may consider relevant evidence and the rationality of arbitrator's decisions when determining whether to vacate an award.

The court considered the fact that Advantage Radiology, P.C. was seeking to recover assigned first-party no-fault benefits from Nationwide Mutual Insurance Company. The main issue decided was whether plaintiff had failed to provide requested verification, which led to the defendant's motion for summary judgment dismissing the complaint. The holding of the case was that the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint, based on the grounds that the plaintiff had failed to provide the requested verification. The decision was made on February 15, 2017 by the Appellate Term, Second Department.

The court considered the plaintiff's request for first-party no-fault benefits and defendant's motion for summary judgment on the grounds that the plaintiff had failed to provide requested verification. The main issue decided was whether the defendant was required to send a delay letter to the plaintiff's attorney after sending a follow-up verification request. The court held that there was no requirement to send a delay letter, and that insurers are obligated to comply with the no-fault regulations, which require that both the initial and follow-up verification requests be sent to the party from whom the verification is sought. Therefore, the court affirmed the order of the District Court, granting defendant's motion for summary judgment.

The relevant facts considered in this case involve an automobile collision that occurred on September 11, 2011, resulting in personal injury to the claimants. The primary issue decided in this case is whether the plaintiff, Allstate Property & Casualty Insurance Company, is obligated to reimburse certain no-fault medical payments with respect to the motor vehicle collision, as well as whether the collision was an excluded act under the terms and conditions of an automobile liability insurance policy issued to the defendant Enis Sebastian. The holding of this case is that the plaintiff's motion for leave to enter a judgment against the defendants Sharine Carrier, Roland Sebastian-Hall, Enis Sebastian, Jennine Eastmond, Active Care Medical Supply Corp., Amy M. Kott, MT, Graham Wellness Medical, P.C., Heel to Toe Foot Center, LLC, Immediate Imaging, P.C., Jing Luo Acupuncture, P.C., Precision Medical Diagnostics of NY, P.C., and Ultra Ortho Products, Inc. is granted, establishing that the collision was an excluded act and all claims arising from it are excluded under the terms and conditions of the insurance policy, and that the plaintiff is not obligated to reimburse certain no-fault medical payments or provide coverage for any uninsured or underinsured motorist claims. The Supreme Court's denial of the plaintiff's unopposed motion pursuant to CPLR 3215 for leave to enter a judgment was reversed on this basis.

The court considered the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment dismissing the complaint in an action to recover assigned first-party no-fault benefits. The main issue decided was whether defendant's cross motion for summary judgment dismissing the complaint should be denied. The holding of the case was that the order was modified by providing that defendant's cross motion for summary judgment dismissing the complaint is denied, and the order was affirmed without costs.

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint by a provider to recover assigned first-party no-fault benefits, arguing that it had paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. The court considered whether defendant's motion was untimely, whether the defendant had properly applied the fee schedule, and whether the absence of a certificate of conformity in the defendant's moving papers was a fatal defect. The court held that the motion was not untimely, the absence of a certificate of conformity was not a fatal defect, and that defendant was entitled to deduct $200 from the sum it was required to pay plaintiff for the services. Therefore, the order granting defendant's motion for summary judgment dismissing the complaint was affirmed.

The main issues considered by the court in this case were the defendant's motion to dismiss the complaint for the plaintiff's failure to provide discovery and the plaintiff's failure to challenge the propriety of the demands within the time prescribed by CPLR 3122. The holding of the case was that the plaintiff is obligated to produce the information sought by the defendant, except as to matters that are palpably improper or privileged. The court found that the plaintiff failed to establish that the discovery demands sought information which is palpably improper or privileged. Therefore, the court affirmed the order directing the plaintiff to provide, within 60 days, responses to certain enumerated discovery demands. The decision was made on February 8, 2017.