No-Fault Case Law
American Tr. Ins. Co. v Baucage (2017 NY Slip Op 00015)
January 3, 2017
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.
Palisade Surgery Ctr. LLC v Allstate Prop. & Cas. Ins. Co. (2016 NY Slip Op 51824(U))
December 29, 2016
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.
Matter of Global Liberty Ins. Co. v Coastal Anesthesia Servs., LLC (2016 NY Slip Op 08964)
December 29, 2016
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.
Metropolitan Diagnostic Med. Care, P.C. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51815(U))
December 16, 2016
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.
Active Care Med. Supply Corp. v American Commerce Ins. Co. (2016 NY Slip Op 51813(U))
December 15, 2016
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.
Clear Water Psychological Servs. PC v American Tr. Ins. Co. (2016 NY Slip Op 26420)
December 8, 2016
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.
Sure Way NY, Inc. v Travelers Ins. Co. (2016 NY Slip Op 26413)
December 8, 2016
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.
City Care Acupuncture, P.C. v Allstate Prop. & Cas. Ins. Co. (2016 NY Slip Op 51793(U))
December 7, 2016
The court considered whether the City Court erred in failing to award plaintiffs statutory attorney's fees. The main issue was the entitlement to attorney's fees under statutory law and regulations in a no-fault benefits case. The holding of the case was that the plaintiffs were entitled to the maximum statutory attorney's fees of $850, as the City Court had awarded a default judgment in their favor for first-party no-fault benefits in the principal sum of $4,491.47. The judgment was found to be inconsistent with the decision and was reversed, remitting the matter to the City Court for the entry of a new judgment in favor of plaintiffs and against Allstate only, in the principal sum of $4,491.47, with a calculation of statutory interest and an assessment of attorney's fees in the amount of $850 due pursuant to Insurance Law § 5106 (a) and the regulations promulgated thereunder.
Matter of Global Liberty Ins. Co. v Lenox Hill Radiology & Med. Imaging Assoc. P.C. (2016 NY Slip Op 51792(U))
December 7, 2016
The main issue in the case was whether the determination of the master arbitrator, upholding the award of an arbitrator granting the provider's claim for reimbursement of assigned first-party no-fault benefits in the sum of $78.29, had a rational basis and was not arbitrary, capricious, or contrary to settled law. The court considered the petition to vacate the master arbitrator's award, which was denied by the District Court. Upon review of the record, the court found that the determination of the master arbitrator had a rational basis and was not arbitrary, capricious, or contrary to settled law. As a result, the petition to vacate the master arbitrator's award was properly denied, and the master arbitrator's award was properly confirmed. The holding of the case was that the petition to vacate the master arbitrator's award was properly denied and the master arbitrator's award was properly confirmed.
EMC Health Prods., Inc. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51788(U))
December 7, 2016
The relevant facts considered by the court were that the defendant, Erie Insurance Company of New York, had failed to appear for oral argument in a case filed by EMC Health Products, Inc. to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant should be granted vacatur of a prior order that granted summary judgment to the plaintiff and denied the defendant's cross motion for summary judgment. The holding of the case was that the branch of the defendant's motion seeking to vacate the prior order was granted, and the matter was remitted to the Civil Court for argument and determination of plaintiff's motion for summary judgment and defendant's cross motion for summary judgment dismissing the complaint. The court found that the defendant had established a reasonable excuse for its default, a potentially meritorious defense to the plaintiff's motion, and the potential merits of the cross motion, and therefore vacatur of the prior order was warranted.