No-Fault Case Law
Utopia Equip., Inc. v Infinity Ins. Co. (2017 NY Slip Op 50332(U))
March 20, 2017
The court considered whether an automobile insurance policy had been properly rescinded ab initio according to Florida law, and whether there was coverage available to the plaintiff's assignor. The main issue decided was whether the defendant-insurer's motion for summary judgment should have been granted in the first-party no-fault action. The holding of the case was that the defendant's motion for summary judgment should have been granted, and the complaint was dismissed. The court found that the defendant established, prima facie, that the Florida automobile insurance policy had been properly rescinded according to Florida law, and there was no coverage available to the plaintiff's assignor. Additionally, the court found that the plaintiff failed to raise a triable issue of fact in opposition to the defendant's showing.
Utica Acupuncture P.C. v Amica Mut. Ins. Co. (2017 NY Slip Op 50331(U))
March 20, 2017
The relevant facts considered by the court in this case included the motion for summary judgment filed by the defendant-insurer in a first-party no-fault action. The main issue decided by the court was whether the defendant's motion for summary judgment should have been granted, and if the defendant had submitted competent proof of the assignor's nonappearance at scheduled independent medical examinations (IMEs). The holding of the court was that the defendant's motion for summary judgment should have been denied because it failed to submit competent proof of the assignor's nonappearance at the scheduled IMEs. The court found that the conclusory affirmation of the defendant's IME doctor lacked probative value, as she failed to adequately state the basis of her recollection that the assignor did not appear on the scheduled IME dates. Therefore, the court reversed the order granting the defendant's motion for summary judgment and denied the motion.
Matter of Global Liberty Ins. Co. v Therapeutic Physical Therapy, P.C. (2017 NY Slip Op 01833)
March 15, 2017
This case involves an insurance company's petition to vacate an arbitration award in favor of a physical therapy provider for no-fault compensation. The insurance company had refused to pay for certain physical therapy services on the grounds that it had already reimbursed a different provider for services on the same dates. The arbitration resulted in an award in favor of the physical therapy provider, but the insurance company appealed, arguing that the physical therapy provider did not adequately preserve their defense. The master arbitrator wrongly found that the lower arbitrator had considered the fee schedule defense and determined that the physical therapy provider failed to provide evidence as to the other provider, leading to the reversal of the lower court's decision. The Appellate Division reversed the lower court's decision and remanded the matter to a different arbitrator for arbitration of the fee schedule defense on the merits. Therefore, the holding of the case was in favor of the insurance company, vacating the arbitration award and remanding the case for further arbitration.
High Definition MRI, P.C. v Mapfre Ins. Co. of N.Y. (2017 NY Slip Op 01800)
March 15, 2017
The court in this case considered the motion for reargument of the defendant's motion to sever the breach of contract cause of action, or, in the alternative, for a stay of the severance order pending appeal. The main issue was whether the breach of contract cause of action, which contained 198 unrelated no-fault claims, raised common issues of fact or law that justified severing the claims. The court held that the breach of contract cause of action should be severed, as the claims raised no common issues of fact or law. The court also held that the defense of fraudulent incorporation did not present common factual and legal issues, as the defendant had indicated that it did not intend to pursue that defense. Finally, the court held that adjudication of the separate breach of contract claims in Civil Court was not dependent on a determination of the declaratory judgment cause of action.
Ortho Passive Motion Inc. v Allstate Ins. Co. (2017 NY Slip Op 27057)
March 1, 2017
The court considered the fact that the plaintiff was seeking to recover no-fault benefits for medical services provided to its assignor after a motor vehicle accident on August 22, 2011. The plaintiff had already been awarded judgment in the amount of $3,723.72, which was later modified to $7,784.06 to include interest, costs, and attorney's fees. The main issue the court decided was whether the defendant's insurance policy had been exhausted, as the plaintiff claimed it had not and the defendant argued that it had. The court held that the defendant's motion to modify the judgment and seek a protective order should be denied in its entirety, as the defendant failed to raise and present evidence of the defense of policy exhaustion at trial, despite having had the opportunity to do so. Therefore, the court found in favor of the plaintiff.
Matter of GEICO Ins. Co. v AAAMG Leasing Corp. (2017 NY Slip Op 01552)
March 1, 2017
The main issue in this appeal addressed the determination of the amount of an additional attorney's fee pursuant to Insurance Department Regulations (11 NYCRR) § 65-4.10 (j) (4). The appellant, AAAMG Leasing Corp., sought an attorney's fee in connection with the court proceedings on the petition to vacate a master arbitrator's award and the cross petition to confirm the award. The Supreme Court denied the appellant's requested relief without stating the basis for that determination, leading to the case being remitted to the Supreme Court, Nassau County, for a determination of the amount of the additional attorney's fee to which the appellant is entitled, stating the evidentiary basis for the award. The Appellate Division found that the Supreme Court erred in denying relief, and concluded that the court must consider the appellant's attorney's additional fee and indicate the evidentiary basis for the award.
A.O.T. Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 50288(U))
February 27, 2017
The court considered whether the plaintiff, a chiropractic provider, had failed to appear at duly scheduled examinations under oath (EUOs), which is a condition precedent to an insurer's liability on a policy. The main issue decided was whether the defendant had proven the plaintiff's nonappearances at the EUOs. The court held that an appearance at an EUO is a condition precedent to an insurer's liability on a policy and defendant had submitted an affirmation from the attorney responsible for conducting the EUOs, which established that the plaintiff had failed to appear for the scheduled EUOs. Therefore, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.
Country-Wide Ins. Co. v Radiology of Westchester, P.C. (2017 NY Slip Op 01461)
February 23, 2017
The main issue in this case was whether the master arbitrator's award, which granted respondent no-fault insurance benefits, should be vacated. The court considered the fact that the petitioner's evidence established that the assignor failed to appear at three scheduled examinations under oath. The court held that the master arbitrator's award was arbitrary because it irrationally ignored the uncontroverted evidence presented by the petitioner. As a result, the court unanimously reversed the denial of the petition to vacate the award and directed the Clerk to enter judgment accordingly. This case demonstrates how courts may consider relevant evidence and the rationality of arbitrator's decisions when determining whether to vacate an award.
Advantage Radiology, P.C. v Nationwide Mut. Ins. Co. (2017 NY Slip Op 50268(U))
February 15, 2017
The court considered the fact that Advantage Radiology, P.C. was seeking to recover assigned first-party no-fault benefits from Nationwide Mutual Insurance Company. The main issue decided was whether plaintiff had failed to provide requested verification, which led to the defendant's motion for summary judgment dismissing the complaint. The holding of the case was that the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint, based on the grounds that the plaintiff had failed to provide the requested verification. The decision was made on February 15, 2017 by the Appellate Term, Second Department.
Advantage Radiology, P.C. v Nationwide Mut. Ins. Co. (2017 NY Slip Op 27061)
February 15, 2017
The court considered the plaintiff's request for first-party no-fault benefits and defendant's motion for summary judgment on the grounds that the plaintiff had failed to provide requested verification. The main issue decided was whether the defendant was required to send a delay letter to the plaintiff's attorney after sending a follow-up verification request. The court held that there was no requirement to send a delay letter, and that insurers are obligated to comply with the no-fault regulations, which require that both the initial and follow-up verification requests be sent to the party from whom the verification is sought. Therefore, the court affirmed the order of the District Court, granting defendant's motion for summary judgment.