No-Fault Case Law

The court considered the facts that the defendant insurer moved for summary judgment dismissing the complaint on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). The plaintiff opposed the motion and cross-moved for summary judgment, and the Civil Court denied the defendant's motion and granted the plaintiff's cross motion. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based upon plaintiff's nonappearance at duly scheduled EUOs. The holding of the case was that the defendant failed to establish that it had timely and properly denied the claims, and therefore, the order denying the defendant's motion for summary judgment dismissing the complaint and granting plaintiff's cross motion for summary judgment was affirmed.

The main issue in this case was whether the action brought by the plaintiff was barred by the doctrine of res judicata. The plaintiff had brought an action to recover assigned first-party no-fault benefits for medical services for injuries sustained in a motor vehicle accident. The defendant opposed the motion on the ground that the action was barred by res judicata, citing a previous declaratory judgment action in which the Supreme Court declared that the insurer was not required to pay any claims for no-fault benefits under the policy. The appellate court held that the causes of action in the present matter arose out of the same transaction as the previous action and involved the same parties, and therefore, the action was barred by the doctrine of res judicata. As a result, the court affirmed the lower court's decision to deny the plaintiff's motion and grant the defendant's cross motion.

The relevant facts considered by the court were that the plaintiff, J.K.M. Medical Care, P.C., had commenced an action to recover first-party no-fault benefits for medical services provided to Tevin Jackson as a result of a motor vehicle accident. The injured party signed an assignment of benefits to the plaintiff. The defendant, Ameriprise Auto & Home Insurance Company, scheduled examinations under oath (EUOs) for the assignor, but the assignor allegedly did not appear for the scheduled EUOs. The main issue decided by the court was whether the defendant was obligated to pay assigned first-party no-fault benefits to the plaintiff, and whether the assignor's failure to appear for the scheduled EUOs was sufficient grounds for the defendant to deny payment. The holding of the case was that the court reversed the order granting the defendant's motion for summary judgment dismissing the complaint, and denied the defendant's motion for summary judgment. The court held that the defendant was obligated to pay assigned first-party no-fault benefits to the plaintiff, and the assignor's failure to appear for the scheduled EUOs was not sufficient grounds for the defendant to deny payment.

The case involved J.K.M. Medical Care, P.C. filing a lawsuit on May 6, 2013 to recover assigned first-party no-fault benefits for medical services provided as the result of a motor vehicle accident that occurred on May 5, 2011. Defendant, Ameriprise Insurance Company, moved for summary judgment dismissing the complaint on the grounds that it was not obligated to pay assigned first-party no-fault benefits to plaintiff due to a previous Supreme Court order and the assignor's failure to appear for scheduled EUOs. Plaintiff argued that it was not bound by the declaratory judgment rendered in the Supreme Court proceeding and that defendant failed to establish that it had timely and properly scheduled EUOs. Defendant failed to establish that it had timely and properly mailed its EUO scheduling letters and the scheduling letters failed to advise the assignor, in accordance with 11 NYCRR 65-3.5, that she would be reimbursed for any loss of earnings and reasonable transportation costs incurred in complying with the request for an EUO. Therefore, defendant failed to demonstrate entitlement to summary judgment. The Appellate Court reversed the order and denied defendant's motion for summary judgment dismissing the complaint.

The relevant facts that the court considered in this case include that Golden Needle Acupuncture P.C. was seeking to recover assigned first-party no-fault benefits from MAPFRE Ins. Co. Plaintiff claimed to have mailed three claims for benefits to the defendant's Arizona location. The first claim was for $1,114.84, the second for $1,087.39, and the third for $384.23. Plaintiff argued that none of the claims were paid within 30 days of defendant's receipt, as required by law. MAPFRE Ins. Co. argued that the denials of the claims were based on the plaintiff's failure to appear for an examination under oath. The main issue decided in this case was whether defendant's requests for a recorded statement and verification requests effectively tolled the time by which it had to pay or deny the claims. The court found that a request for a recorded statement did not toll the time, as it was not specified in the relevant regulations and case law. Additionally, the court found that the verification requests sent by the defendant did not toll the time to deny the claims as they did not specifically request a particular form of verification and the person from whom the verification was sought. The holding of the court was that the plaintiff's motion for summary judgment was granted as to claims 1 and 3, as defendant's denials of these claims were untimely. Plaintiff was awarded $1,499.07 plus statutory costs, attorney's fees, disbursements, and interest for these claims. However, as to claim 2, it was not established whether it was timely mailed, so the case was to proceed to trial to determine the timeliness of claim 2.

In a proceeding pursuant to CPLR 7511 to vacate an arbitration award dated March 24, 2014, in which Global Liberty Insurance Co. of N.Y. cross-petitioned to confirm the award, the petitioner, Liberty Mutual Fire Insurance Company, sought to recover payments of $11,398.38 from Global. They did so after their insured's vehicle was in a collision with a livery vehicle insured by Global, and the insured had received medical treatment. The arbitrator awarded Liberty Mutual $5,699.19 instead of the full amount, even though they had found the livery vehicle insured by Global to be 100% at fault and that they didn't manage the medical claims properly. Despite judicial review of arbitration awards being limited to specific grounds, the Supreme Court granted Liberty Mutual's petition and denied Global's cross petition, determining that there was no evidence to support the arbitrator's findings. The appellate court upheld the Supreme Court's decision, finding the arbitrator's award to be arbitrary and capricious.

The court considered the fact that plaintiff commenced an action to recover assigned first-party no-fault benefits in 2009, to which the defendant did not appear or answer, resulting in a default judgment entered in December 2009. The defendant moved to vacate the default judgment and the marshal's notice in September 2013. The main issues decided were whether the defendant's motion to vacate was untimely, and whether the defendant demonstrated a reasonable excuse for the default and a meritorious defense to the action. The holding of the case was that the defendant's September 2013 motion to vacate was not made within one year after the service of the default judgment, and the vacatur of the default judgment was not warranted. Therefore, the court reversed the order and denied the defendant's motion.

The relevant facts considered by the court in this case were that Neptune Medical Care, P.C. was seeking to recover assigned first-party no-fault benefits in the amount of $2,279.17. The main issue decided was whether the defendant, Dairyland Ins. Co., had paid the claim at issue in a timely manner. The holding of the court was that an issue of fact existed as to whether the defendant had timely paid the claim, and therefore, neither party was entitled to summary judgment. The court ordered that the defendant's cross motion for summary judgment dismissing the complaint be denied. Therefore, the order denying the plaintiff's motion for summary judgment and granting the defendant's cross-motion for summary judgment was affirmed in part and modified in part, with the defendant's cross-motion being denied.

The court considered the case of a chiropractic and acupuncture office that had submitted a no-fault benefits claim to an insurance company after the claim had been denied due to the assignor's failure to appear at scheduled independent medical examinations. The main issue decided was whether the master arbitrator exceeded his power by vacating the arbitration award in favor of the provider, upon a determination that the award was not supported by sufficient evidence and was incorrect as a matter of law. The holding of the court was that the master arbitrator did not exceed the scope of his authority, as he did not weigh or independently evaluate issues of credibility or engage in any factual analysis. The court ultimately reversed the lower court's decision and denied the petition to vacate the master arbitrator's award, while granting the cross petition to confirm the master arbitrator's award.

The court considered an action brought by a provider to recover assigned first-party no-fault benefits. The automobile insurance policy in question had been issued in Florida, and the defendant moved for summary judgment dismissing the complaint on the ground that, based upon a conflict-of-law analysis, Florida law applied, pursuant to which there was a lack of coverage due to the valid rescission of the policy. Defendant contended that it made a prima facie showing of its defense of rescission of the underlying insurance policy in accordance with Florida law and that its motion for summary judgment dismissing the complaint should have been granted. The court held that based on evidence provided by the defendant, it properly voided the motor vehicle insurance policy ab initio, in accordance with Florida law, and granted the defendant's motion for summary judgment dismissing the complaint.