No-Fault Case Law

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.

The court considered a case in which Professional Health Imaging, P.C. sought to recover first-party no-fault benefits as the assignee of Crystal Perez from State Farm Mutual Automobile Insurance Co. State Farm filed a motion for summary judgment to dismiss the complaint on the ground that Professional Health Imaging had failed to appear for scheduled examinations under oath. The Civil Court initially denied State Farm's motion, citing a disputed issue of fact regarding whether Professional Health Imaging had appeared for the examinations. However, State Farm's evidence showed that the scheduling letters for the examinations had been timely mailed and that Professional Health Imaging had failed to appear, thus failing to comply with a condition precedent to coverage. As a result, the Appellate Term reversed the denial of State Farm's motion and granted summary judgment in favor of State Farm, dismissing the complaint.

The main issue in the case of Kemper Independence Ins. Co. v Adelaida Physical Therapy, P.C. was whether the insurance company was obligated to provide no-fault benefits to the defendants who failed to appear for their scheduled examinations under oath (EUO) due to a motor vehicle accident. The lower court had granted the plaintiff's motion for summary judgment, declaring that the plaintiff was not obligated to provide benefits to the defendants. However, the Appellate Division reversed the judgment, stating that the plaintiff failed to supply sufficient evidence to determine if the notices served for the EUOs were subject to timeliness requirements and if the notices had been served in conformity with those requirements. The plaintiff failed to establish that the EUOs were not subject to the procedures and time frames set forth in the no-fault regulations and that they had properly noticed the EUOs in conformity with their terms. Thus, the motion was denied, and the judgment vacated.

The main issue in the case was whether the defendant, GEICO, timely and properly requested additional verification from the plaintiff, St. Barnabas Hospital, upon its receipt of proof of the claim which effectively tolls the 30-day time period within which GEICO must pay or deny the claim for services rendered in the amount of $43,212.59. The court held that the plaintiff's initial claim for payment was premature and was not complete until the defendant received additional verification of the claim as requested. The court also ruled that the hospital's response was vague and did not address the request for breakdown of charges up to where the patient was found to be stabilized. Ultimately, the court granted the defendant's cross motion for summary judgment and dismissed the complaint.