No-Fault Case Law

Maiga Prods. Corp. v Unitrin Auto & Home Ins. Co. (2017 NY Slip Op 50113(U))

The main issue in this case was whether the defendant insurance company had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law, which is a requirement under Insurance Law. The court found that the plaintiff had failed to establish a prima facie case in this regard, and that the defendant's papers did not establish that the plaintiff's assignor had failed to appear for two duly scheduled examinations under oath (EUOs). As a result, the Civil Court correctly found that the defendant had failed to establish its entitlement to summary judgment dismissing the complaint. The holding of the court was that the judgment in favor of the plaintiff was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion was denied.
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Flatbush Chiropractic, P.C. v American Tr. Ins. Co. (2017 NY Slip Op 50106(U))

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, which granted the defendant's motion to dismiss the complaint and denied the plaintiff's cross motion for leave to renew its prior motion for summary judgment. The main issue decided in the case was whether the provider could recover assigned first-party no-fault benefits. The court affirmed the order, stating that for the reasons stated in a similar case, the order is affirmed. The holding of the case was that the order granting the defendant's motion to dismiss the complaint and denying the plaintiff's cross motion for leave to renew its prior motion for summary judgment was affirmed.
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Flatbush Chiropractic, P.C. v American Tr. Ins. Co. (2017 NY Slip Op 50105(U))

The court considered that the plaintiff, Flatbush Chiropractic, P.C., had moved for summary judgment to recover first-party no-fault benefits, but the defendant, American Transit Ins. Co., argued that there was a question as to whether the assignor had been injured during the course of his employment, which should be submitted to the Workers' Compensation Board. The Civil Court initially denied plaintiff's motion for summary judgment and granted defendant's cross motion, finding that resolution from the Board was required. The court further stated that the action may be dismissed if the matter was not filed with the Board within 90 days. Defendant later moved to dismiss the complaint based on plaintiff's failure to comply with the Civil Court's order, and plaintiff cross-moved for leave to renew its motion for summary judgment based on new evidence. The court found that plaintiff did not demonstrate that the assignor had made a proper application for workers' compensation benefits and denied plaintiff's cross motion for leave to renew and granted defendant's motion to dismiss the complaint. Therefore, the court affirmed the order.
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Integral Assist Med., P.C. v Tri-State Consumer Ins. Co. (2017 NY Slip Op 50103(U))

The court considered the appeal from an order of the District Court of Suffolk County, which granted defendant's motion for summary judgment dismissing the complaint in a case brought by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had taken an adversarial position during claims processing in violation of 11 NYCRR 65-3.2 (b). The court held that there was no merit to the plaintiff's argument on appeal that the defendant had clearly taken an adversarial position during claims processing and affirmed the order of the District Court.
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Bronx Acupuncture Therapy, P.C. v Hereford Ins. Co. (2017 NY Slip Op 50101(U))

The court considered the case of Bronx Acupuncture Therapy, P.C. v Hereford Ins. Co. in which the appellant sought to recover assigned first-party no-fault benefits. The main issue decided by the court was whether the defendant was entitled to summary judgment dismissing the complaint based on the argument that it had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedules. The court held that the defendant was not entitled to summary judgment because the workers' compensation fee schedules did not assign a relative value to the services at issue, and the defendant did not request additional verification from the plaintiff as required in order to review the claims for those services. Therefore, the branches of defendant's motion seeking summary judgment dismissing the complaint as it related to these services were denied.
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City Care Acupuncture, P.C. v Hereford Ins. Co. (2017 NY Slip Op 50037(U))

The relevant facts of this case involved an action by medical providers to recover assigned first-party no-fault benefits, in which the defendant moved for summary judgment dismissing the complaint on the ground that there was no coverage for the accident which allegedly occurred on February 13, 2013. The defendant submitted the transcript of the examination under oath of the driver of the insured vehicle in support of its motion, and the driver testified that he had rented the insured vehicle, which he drove as a livery vehicle, that the assignors had been passengers in his vehicle on February 13, 2013, and that the vehicle had not been involved in an accident on that date. The main issue decided in this case was whether the alleged injuries arose out of an insured incident, and the court held that the defendant had established its entitlement to summary judgment dismissing the complaint by showing that the injuries did not arise out of an insured incident, and that the plaintiffs failed to raise a triable issue of fact in opposition. The court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.
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Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2017 NY Slip Op 50031(U))

The court considered an action by a provider to recover assigned first-party no-fault benefits. The main issue was whether the provider had failed to appear for duly scheduled examinations under oath. The holding was that the judgment was reversed, the order entered November 1, 2013 was vacated, the provider's motion for summary judgment was denied, and the insurer's cross motion for summary judgment dismissing the complaint was granted. The court found in favor of the insurer, reversing the lower court's decision and denying the provider's motion for summary judgment.
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Daily Med. Equip. Distrib. Ctr., Inc. v Allstate Ins. Co. (2017 NY Slip Op 50029(U))

The main issue in this case was whether the automobile insurance policy in question was issued in Florida, and, if so, whether Florida law applied, pursuant to which there was a lack of coverage due to the rescission of the automobile insurance policy. The court found that the automobile was insured by the defendant under a Florida automobile insurance policy, and was being driven by the policyholder, the plaintiff's assignor. Despite the defendant's argument that the policy was validly rescinded pursuant to Florida law, the court ruled that the defendant failed to show that it had voided the policy ab initio pursuant to Florida law. As a result, the appellate court affirmed the order which denied the defendant's cross motion for summary judgment dismissing the complaint. In summary, the court considered the issue of whether the Florida automobile insurance policy was validly rescinded, and the holding was that the defendant failed to demonstrate that it had voided the policy ab initio pursuant to Florida law, thus the order denying the defendant's motion for summary judgment dismissing the complaint was affirmed.
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American Tr. Ins. Co. v Baucage (2017 NY Slip Op 00015)

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.
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Palisade Surgery Ctr. LLC v Allstate Prop. & Cas. Ins. Co. (2016 NY Slip Op 51824(U))

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.
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