No-Fault Case Law

The court considered an action in which the plaintiffs sought a judgment declaring that they are not obligated to pay certain no-fault claims. The medical provider defendants appealed from a judgment of the Supreme Court that declared that the plaintiffs have no duty to provide coverage for the subject no-fault claims. The collisions for which the claims were made were determined to be intentional and staged, which means they were not covered by the policy of insurance. The plaintiffs established their prima facie entitlement to judgment by demonstrating through admissible evidence that the subject collisions were intentionally caused or staged. The medical provider defendants failed to raise a triable issue of fact as to whether the collisions were intentionally caused or staged, and therefore the judgment in favor of the plaintiffs was affirmed.

The main issue in this case was whether the defendant-insurer had a duty to pay the plaintiff's no-fault claims for medical services rendered to Carol Smart, who was injured in a motor vehicle accident. The court considered a separate action in which the Supreme Court, New York County, had declared that the defendant had no duty to pay the plaintiff's claims arising from the same accident. Based on the doctrine of res judicata, the court held that the underlying action to recover first-party no-fault benefits was barred. The court determined that the judgment in the separate action was a conclusive final determination, and therefore the defendant's motion for summary judgment dismissing the instant action should have been granted. Ultimately, the court reversed the order of the Civil Court, and granted the defendant's motion for summary judgment, dismissing the complaint.

The court considered the settlement of a claim by a medical provider for first-party no-fault benefits, which was not paid by the insurance company leading to a judgment being entered with a simple interest rate. The main issue decided was whether the interest on the judgment should be recalculated from a simple rate to a compound rate, as per the pre-2002 regulations that were in effect at the time of the accident. The court held that the interest should be recalculated to a compound rate, as the accident occurred before the effective date of the current regulations, which now provide for a simple rate of interest. The court also clarified that postjudgment interest in a no-fault action is governed by Insurance Law § 5106 and its implementing regulations, not the CPLR.

The relevant facts of the case were that Good Samaritan Hospital sought to recover assigned first-party no-fault benefits from MVAIC Insurance Company. The main issue decided was whether MVAIC timely denied plaintiff's claim and whether plaintiff provided reasonable justification for the delay in submitting the claim. The court ultimately held that defendant's motion for summary judgment dismissing the complaint was granted, and plaintiff's cross motion for summary judgment was denied. The court found that defendant demonstrated its entitlement to summary judgment by proving that it timely denied plaintiff's claim for no-fault benefits due to untimeliness. Plaintiff failed to provide a reasonable justification for the delay and also failed to establish that the claim was submitted to MVAIC in a timely manner. Therefore, defendant's motion for summary judgment was granted, and plaintiff's motion was denied.

The court considered the fact that the plaintiff, a medical professional, sued the defendant insurance company to recover unpaid first-party No-Fault benefits for medical services provided to the plaintiff's assignor. The defendant moved for summary judgment dismissing the complaint on the grounds that the plaintiff failed to attend scheduled Examinations Under Oath (EUO). The main issue decided was whether the defendant's request for an EUO was timely and whether the defendant was required to pay or deny the claims after the plaintiff failed to attend the EUO. The court held that the defendant's request for an EUO was untimely, and the failure to attend two scheduled EUOs was a sufficient basis for the defendant to deny the No-Fault claim. Therefore, the court denied the defendant's motion for summary judgment and granted the plaintiff's cross-motion for summary judgment, awarding the plaintiff $385.63 plus statutory interest and attorneys' fees.

The court considered the fact that the plaintiff sued the defendant insurance company to recover unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor, who was injured in an automobile accident. Additionally, the defendant had commenced a declaratory judgment action in Supreme Court against the plaintiff and others who filed No-Fault benefit claims, and had been granted a default judgment holding that the defendant owed no duty to pay No-Fault claims arising from the accident. The main issue decided by the court was whether the plaintiff's action was barred by res judicata and collateral estoppel, and the court held that res judicata barred the plaintiff's action. The court granted the defendant's motion for summary judgment and dismissed the plaintiff's complaint, without addressing whether collateral estoppel also barred the action.

The relevant facts the court considered were that the plaintiff had sued the defendant insurance company in 2002 to recover unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor. The action was marked "inactive" as of June 2, 2007. The defendant moved to dismiss the plaintiff's complaint as abandoned or barred by laches and to stay interest, which the plaintiff opposed. The main issue decided was whether the plaintiff's complaint should be dismissed as abandoned and if interest should be stayed. The Court held that the plaintiff's complaint should not be dismissed as abandoned because the applicable statute did not apply to actions in New York City Civil Court, where the case was being heard. Additionally, the court granted the defendant's motion to fix the accrual of interest and ruled that in the event the plaintiff prevails on its claims, interest shall accrue from the filing date of the notice of trial. The holding of the case was that the defendant's motion to dismiss the plaintiff's complaint was denied, and the defendant's motion to fix accrual of interest was granted. If the plaintiff prevails on its claims, interest shall accrue from the filing date of the notice of trial.

The court considered the fact that the defendant in this case had moved for summary judgment to dismiss the complaint on the grounds that the action was premature as the plaintiff had failed to respond to the defendant's timely requests for additional verification. The main issue decided was whether the requested verification had been mailed to and received by the defendant, thus making the action premature. The holding of the case was that while the defendant demonstrated that they had timely mailed initial and follow-up requests for verification, the affidavit submitted by the plaintiff in opposition raised an issue of fact as to whether the requested verification had been received by the defendant. As a result, the court found that there was an issue of fact as to whether the plaintiff's action was premature, and denied the plaintiff's cross motion for summary judgment.

The court considered the letters sent by Progressive and Farmers Insurance regarding coverage of the vehicle involved in the accident, as well as the denial of medical benefits to the assignor by Farmers. The main issue decided was whether the assignee of the injured person was entitled to reimbursement under Farmers Insurance's policy, given that the vehicle was being used for Uber ride sharing at the time of the accident, which was not covered under the policy. The court held that the assignee was not entitled to reimbursement under Farmers Insurance's policy due to the lack of coverage for the accident, and that there was no dispute or controversy between insurers that would require mandatory arbitration. The court granted defendant Farmers Insurance's motion for summary judgment and dismissed the case, denying plaintiff's cross motion for summary judgment.

The main issue in the case was whether defendant medical providers are entitled to any no-fault benefits under the claimant's automobile insurance policy. The court considered the fact that the claimant was injured in a collision involving a vehicle that she insured under her automobile insurance policy. The insurers alleged that the claimant had intentionally and materially misrepresented her home address in procuring the policy. The insurers submitted evidence of the misrepresentation based on the claimant's testimony at an examination under oath. However, the court held that the insurers failed to establish, as a matter of law, that the alleged misrepresentation of the correct address was material. Therefore, the court reversed the decision of the Supreme Court, denied the insurers' motion for summary judgment, vacated the declaration, and remanded the matter for further discovery concerning the insurers' claim and underwriting practices and guidelines.