No-Fault Case Law

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.

The court considered a case in which Remedy Chiropractic, P.C. appealed an order from the Civil Court of the City of New York, Kings County, which granted Nationwide Ins.'s motion for summary judgment and denied Remedy Chiropractic's cross motion for summary judgment. The issue decided was whether Nationwide Ins. had timely mailed initial and follow-up requests for verification, and whether Remedy Chiropractic had provided all of the requested verification. The court held that Nationwide Ins. had demonstrated, prima facie, that it had timely mailed the requests for verification and had not received all of the requested verification. In contrast, Remedy Chiropractic failed to establish a triable issue of fact by demonstrating that it had provided the requested verification or had set forth a reasonable justification for the failure to comply with Nationwide Ins.'s verification requests. Therefore, the court affirmed the order granting Nationwide Ins.'s motion for summary judgment and dismissing Remedy Chiropractic's complaint.

The court considered the issue of whether a provider could recover assigned first-party no-fault benefits when the assignor had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the proof submitted by the defendant in support of its motion was sufficient to give rise to a presumption that the EUO scheduling letters and denial of claim forms had been timely mailed. The court held that the proof submitted by the defendant was indeed sufficient, and that the plaintiff failed to raise a triable issue of fact with respect to the timeliness of the mailings. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint and denying the plaintiff's cross motion for summary judgment.

The court considered the fact that the defendant scheduled independent medical examinations (IMEs) for the plaintiff's assignor, but the assignor failed to appear for the IMEs. The defendant timely denied the claim based on the assignor's failure to appear for the IMEs, and argued that the assignor's appearance at an IME was a condition precedent to the insurer's liability on the policy. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint on the ground that the assignor failed to appear for the scheduled IMEs. The holding of the case was that the defendant demonstrated that it properly scheduled IMEs, and the assignor's failure to appear at the IMEs relieved the defendant of liability on the policy. Therefore, the defendant's motion for summary judgment dismissing the complaint was granted.

The relevant facts in this case involved a provider seeking to recover assigned first-party no-fault benefits. The defendants appealed from an order of the Civil Court, which denied their motion for summary judgment dismissing the complaint. The main issue decided by the court was whether the action was barred by the statute of limitations. The court held that the provider did not commence the action until 2018, after the six-year statute of limitations for contract actions had expired, and thus the defendants' motion to dismiss based on the statute of limitations should have been granted. Therefore, the court reversed the order and granted the defendants' motion for summary judgment dismissing the complaint.

The court considered an appeal from an order denying a motion for summary judgment and granting a cross motion for summary judgment dismissing the complaint. The appellant was seeking to recover assigned first-party no-fault benefits from the respondent insurance company. The main issues decided were whether the insurance company was entitled to summary judgment dismissing the various causes of action and whether the appellant was entitled to summary judgment on the first cause of action. The holding of the court was that the insurance company was not entitled to summary judgment dismissing the first and third through tenth causes of action, and the appellant was entitled to summary judgment on the first cause of action, therefore modifying the original order to reflect these decisions.

The court considered the background of the case, which involved the defendant insurance company seeking a judgment declaring that they did not owe the plaintiff, a medical service provider, any No-Fault claims due to the plaintiff's failure to appear for scheduled examinations under oath. The plaintiff sued the defendant to recover unpaid No-Fault benefits for medical services provided to an assignor who was injured in an automobile accident, but the defendant moved for summary judgment based on the doctrine of res judicata, arguing that the action was barred. The main issue decided was whether the action was barred by res judicata, and the court held that while the doctrine of res judicata did not apply, the related concept of collateral estoppel did apply, preventing the plaintiff from raising the issue of non-attendance of the examinations under oath. As a result, the defendant's motion for summary judgment was granted without opposition, and the plaintiff's complaint was dismissed.