No-Fault Case Law

The relevant facts of this case involved an action by medical providers to recover assigned first-party no-fault benefits, in which the defendant moved for summary judgment dismissing the complaint on the ground that there was no coverage for the accident which allegedly occurred on February 13, 2013. The defendant submitted the transcript of the examination under oath of the driver of the insured vehicle in support of its motion, and the driver testified that he had rented the insured vehicle, which he drove as a livery vehicle, that the assignors had been passengers in his vehicle on February 13, 2013, and that the vehicle had not been involved in an accident on that date. The main issue decided in this case was whether the alleged injuries arose out of an insured incident, and the court held that the defendant had established its entitlement to summary judgment dismissing the complaint by showing that the injuries did not arise out of an insured incident, and that the plaintiffs failed to raise a triable issue of fact in opposition. The court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the provider had failed to appear for duly scheduled examinations under oath. The holding was that the judgment was reversed, the order entered November 1, 2013 was vacated, the provider's motion for summary judgment was denied, and the insurer's cross motion for summary judgment dismissing the complaint was granted. The court found in favor of the insurer, reversing the lower court's decision and denying the provider's motion for summary judgment.

The main issue in this case was whether the automobile insurance policy in question was issued in Florida, and, if so, whether Florida law applied, pursuant to which there was a lack of coverage due to the rescission of the automobile insurance policy. The court found that the automobile was insured by the defendant under a Florida automobile insurance policy, and was being driven by the policyholder, the plaintiff's assignor. Despite the defendant's argument that the policy was validly rescinded pursuant to Florida law, the court ruled that the defendant failed to show that it had voided the policy ab initio pursuant to Florida law. As a result, the appellate court affirmed the order which denied the defendant's cross motion for summary judgment dismissing the complaint. In summary, the court considered the issue of whether the Florida automobile insurance policy was validly rescinded, and the holding was that the defendant failed to demonstrate that it had voided the policy ab initio pursuant to Florida law, thus the order denying the defendant's motion for summary judgment dismissing the complaint was affirmed.

The Court considered the fact that American Transit Insurance Company submitted proof that it served Innovative Medical Heights, P.C. with the summons and complaint. Innovative Medical did not deny receiving the summons and complaint, and also failed to set forth a reasonable excuse as to why it failed to timely answer the complaint. The main issue decided was whether plaintiff's motion for a default judgment pursuant to CPLR 3215 should be granted and whether the cross motion of defendant Innovative Medical Heights, P.C. for summary judgment dismissing the complaint as against it and for attorneys' fees should be denied. The holding of the case was that the Supreme Court properly granted plaintiff's motion for a default judgment and that Innovative Medical's cross motion was properly denied. Since Innovative Medical never properly filed an answer, it may not ask the court to reach the merits of the action.

The court considered the fact that Palisade Surgery Center LLC and Tutto Anesthesia were appealing a denial of their cross motion for summary judgment on the issue of medical necessity in a first-party no-fault action against Allstate Property & Casualty Insurance Company. The main issue decided was whether the doctrine of collateral estoppel barred the defendant-insurer from raising the medical necessity defense in this action, and whether there was a triable issue as to the medical necessity of the manipulation under anesthesia procedure. The holding of the court was that the doctrine of collateral estoppel did not bar the defendant-insurer from raising the medical necessity defense, and that the conflicting medical expert opinions raised a triable issue as to the medical necessity of the procedure. Note: The title of the case has been omitted as per the instruction.

The case involves an appeal of an order from the Supreme Court in Bronx County that denied a petition to vacate a master arbitration award in a dispute between an insurance company and a healthcare provider. The insurance company sought to challenge the arbitration award entitling the healthcare provider to no-fault insurance benefits. The main issue decided was whether the insurance company was able to demonstrate statutory grounds for vacating the arbitrator's award. The court held that the insurance company failed to demonstrate any statutory grounds for vacating the award and that the decision of the Master Arbitrator in affirming the arbitration award had evidentiary support and was not arbitrary and capricious. The court also determined that the original arbitrator had acted properly within her discretionary authority to refuse to entertain any late submissions from the insurance company.

The court considered the factual situation in which a medical provider was seeking to recover first-party no-fault benefits for MRIs of a patient's cervical and thoracic spines. The main issue decided was the medical necessity of the MRIs. The court found that the defendant's medical witness was not qualified as an expert and that his testimony was not credible. The judgment in favor of the plaintiff for the principal sum of $1,839.34 was affirmed. The court noted that the specialty of defendant's witness being different from the doctor who prescribed the MRIs only affected the weight given to the testimony, not the witness's competency.

The main issue in this case was whether the plaintiff's action to recover assigned first-party no-fault benefits was barred by the doctrine of res judicata due to a prior declaratory judgment action. The defendant had obtained a declaratory judgment in Supreme Court, New York County, which stated that the plaintiff's assignor was not eligible for no-fault benefits under the defendant's insurance policy and the defendant was not obligated to pay for the claims submitted by the plaintiff. The Appellate Term, Second Department held that the Civil Court should have considered the Supreme Court's declaratory judgment order, despite the lack of a notice of entry for it, because of its binding and conclusive effect. The Appellate Term ultimately reversed the order of the Civil Court and granted the defendant's motion for summary judgment dismissing the complaint, finding that the instant action was barred under the doctrine of res judicata by virtue of the Supreme Court order.

The court considered the fact that Clear Water Psychological Services PC sought to recover no-fault benefits assigned to it by Oshane Crooks and that defendant cross-moved for a 90-day stay of the action pending a determination by the Workers' Compensation Board as to whether the assignor was acting as an employee at the time of the automobile accident and whether he is entitled to workers' compensation benefits. The main issues were the admissibility of the signed but uncertified police accident report and the determination of the assignor's employment status and entitlement to benefits under the Workers' Compensation Law. The court held that the signed but uncertified police accident report did not qualify for admission as proof of the facts recorded therein, but that factual questions regarding the assignor's status as an employee of a taxi base must be resolved at a hearing before the Board, and as a result, the action was stayed for 90 days.

The court considered the novel issue of whether a no-fault insurer must request examinations under oath (EUOs) of all conceivable entities within 15 business days of receipt of a written notice of claim, or whether its 15 days in which to request an EUO starts anew after it completes one EUO and discovers the need for an additional EUO of another entity. Plaintiff Sure Way NY, Inc. sought to recover from defendant Travelers Insurance Co. no-fault benefits for services and medical equipment provided to its assignor Rachel Constantino for alleged injuries she sustained in a motor vehicle accident. The main issue decided was whether the defendant's denial of the plaintiff's claims was timely, and the court held that the defendant's motion for summary judgment was granted, and the plaintiff's cross motion for summary judgment was denied.