No-Fault Case Law
Ave T MPC Corp. v Prudential Prop. & Cas. Ins. Co. (2016 NY Slip Op 51563(U))
October 21, 2016
The court considered the facts that in an action to recover assigned first-party no-fault benefits, the plaintiff entered into a stipulation with the defendant to provide legible copies of the claims at issue, and failed to do so. The defendant then moved to preclude the plaintiff from offering any evidence and to dismiss the complaint. The main issue decided was whether the plaintiff had failed to comply with the stipulation and the 60-day time requirement set forth in the order, and if so, whether the plaintiff should be precluded from using the claim forms at issue. The holding of the court was that the plaintiff did fail to comply with the stipulation and the 60-day time requirement, and therefore, the judgment to preclude the plaintiff and dismiss the complaint was affirmed.
J.K.M. Med. Care, P.C. v Interboro Ins. Co. (2016 NY Slip Op 26348)
October 21, 2016
This case involved an action by a medical provider to recover assigned first-party no-fault benefits. The defendant moved for summary judgment dismissing the complaint due to a judgment previously entered against the plaintiff in another action. The Civil Court previously denied this motion and granted the plaintiff's cross motion for summary judgment. After judgment was entered in the amount of $993.34, the defendant moved for summary judgment dismissing the complaint, as the amount due had been satisfied, or alternatively for an order granting a satisfaction of judgment. The Civil Court denied this second motion and all requested relief. The court modified the denial of the defendant's request for the entry of a satisfaction of judgment, remitting the matter to the Civil Court for further determination.
Decision: The order was modified by vacating the denial of the defendant's motion for the entry of a satisfaction of judgment and the matter was remitted to the Civil Court for a new determination.
Five Boro Med. Equip., Inc. v Praetorian Ins. Co. (2016 NY Slip Op 51481(U))
October 19, 2016
The court considered the defendant-insurer's motion for summary judgment dismissing the underlying first-party no-fault action. The main issue decided was whether the defendant had submitted competent proof of the assignor's nonappearance at scheduled independent medical examinations (IMEs). The court held that the defendant’s motion for summary judgment should have been denied, as the conclusory affidavits of the defendant's IME doctors lacked probative value and failed to adequately state the basis of their recollection that the assignor did not appear on the scheduled IME dates. Therefore, the court reversed the order and denied defendant's motion.
Bronx Acupuncture Therapy, P.C. v Hereford Ins. Co. (2016 NY Slip Op 51479(U))
October 19, 2016
The court considered the fact that the defendant claimed the assignor failed to appear for two scheduled independent medical examinations (IMEs), but failed to show that the scheduling of the IMEs complied with Insurance Department Regulations. The main issue decided was whether the action seeking recovery of assigned first-party no-fault benefits was ripe for summary dismissal based on the assignor's failure to appear for the IMEs. The holding of the case was that the action was not ripe for summary dismissal, as the defendant failed to show that the scheduling of the IMEs complied with the required procedures and time frames set forth in Insurance Department Regulations. Therefore, the defendant's motion for summary judgment was reversed and denied.
State Farm Mut. Auto. Ins. Co. v Pender (2016 NY Slip Op 26352)
October 17, 2016
The case involved a subrogation action by State Farm Mutual Automobile Insurance Company to recover additional personal injury protection benefits (APIP) it paid to its subrogor following an auto accident. The subrogor's employee had been awarded basic economic loss benefits as part of a workers' compensation hearing. The defendants moved to dismiss the complaint on the grounds that the workers' compensation benefits were the exclusive source of coverage and that the decision of the Workers' Compensation Board was res judicata. The issue at hand was whether APIP payments were synonymous with statutory basic economic loss benefits or a contractual benefit in addition to the statutory basic economic loss benefit. The court held that the workers' compensation award was not res judicata and plaintiff had the right to assert its subrogation rights for any amounts paid in addition to the statutory basic economic loss benefits paid by workers' compensation. Therefore, the defendants' motion to dismiss was denied. Additionally, the plaintiff's cross motion for sanctions against the defendants was also denied.
Tam Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51533(U))
October 13, 2016
The relevant facts the court considered in this case were that TAM Medical Supply Corp. was seeking to recover assigned first-party no-fault benefits and the Civil Court denied the plaintiff's motion for summary judgment while granting the defendant's cross motion for summary judgment dismissing the complaint. The main issues decided were whether the provider could recover assigned first-party no-fault benefits and whether the defendant's cross motion for summary judgment dismissing the complaint should be granted or denied. The holding of the case was that defendant's cross motion for summary judgment dismissing the complaint is denied, and the order is affirmed, without costs.
Tam Med. Supply Corp. v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51532(U))
October 13, 2016
The relevant facts considered by the court were that TAM Medical Supply Corp. was seeking to recover assigned first-party no-fault benefits from National Liability & Fire Insurance Company. The main issue decided was whether the defendant had demonstrated that it had not received the requested verification, and whether the plaintiff's action was premature. The court found that the affidavit by plaintiff's owner was sufficient to give rise to a presumption that the requested verification had been mailed to the defendant, creating a triable issue of fact as to whether the action was premature. The holding of the court was that defendant's cross motion for summary judgment dismissing the complaint was denied, and the order was affirmed with modification.
Renelique v Utica Mut. Ins. Co. (2016 NY Slip Op 51530(U))
October 13, 2016
The relevant facts for the court to consider in this case were whether the first scheduled examination under oath (EUO) letter sent to the plaintiff was timely, and whether the defendant had properly and timely denied the claim based on the plaintiff's failure to comply with the EUO requirement. The main issue decided by the court was whether the defendant had met the burden of proof in establishing that the first EUO scheduling letter sent to the plaintiff was timely and whether the denial of the claim based on the plaintiff's failure to appear for the EUO was valid. The holding of the case was that the defendant failed to demonstrate that it had properly and timely denied the claim based on the plaintiff's failure to comply with the condition of appearing for the EUO. As a result, the court reversed the order granting the defendant's motion for summary judgment and denied the motion.
Renelique v National Liab. & Fire Ins. Co. (2016 NY Slip Op 51528(U))
October 13, 2016
The court considered that the plaintiff, Pierre Jean Jacques Renelique, as the assignee of Rohan Streek, had moved for summary judgment to recover first-party no-fault benefits from the defendant, National Liability & Fire Insurance Company. However, the defendant had cross-moved for summary judgment to dismiss the complaint on the grounds that it had timely and properly denied the claim due to the assignor's failure to appear for scheduled independent medical examinations. The main issue decided was whether the defendant's denial of the claim based on the assignor's failure to appear for the examinations was valid. The court held that the denial was valid and affirmed the order, with costs. The decision was based on the same reasoning as another related case, Renelique v National Liab. & Fire Ins. Co., which was decided herewith.
New Way Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 51527(U))
October 13, 2016
The court considered an appeal from a judgment entered in a case involving a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment should have been granted, and if the plaintiff's cross motion for summary judgment should have been denied. The holding of the court was that the judgment was reversed, the order granting the plaintiff's cross motion was vacated, and the plaintiff's cross motion was denied. The defendant's motion was deemed properly denied, as they failed to establish that the plaintiff's assignor had failed to appear for independent medical examinations, but the plaintiff also failed to demonstrate their prima facie entitlement to summary judgment. Therefore, the judgment was reversed and the plaintiff's cross motion was denied.