No-Fault Case Law

The court considered the failure of the plaintiff's assignor to appear for scheduled examinations under oath (EUOs) and whether the defendant's denial of the claims was timely. The main issues that were decided were whether the defendant's motion to dismiss the complaint on the ground that the plaintiff's assignor had failed to appear for the scheduled EUOs could be granted, and whether the defendant had established that the denial of the claims was timely. The holding of the court was that the defendant had failed to establish that the denial of the claims was timely, and therefore its motion for summary judgment dismissing the complaint was properly denied. The order, insofar as appealed from, was affirmed.

The main facts of the case involved a motor vehicle collision in which the injured party was seeking payment of no-fault benefits from the insurer of the loaner vehicle involved in the accident. The insurer, Wesco Insurance Company, was held liable for the benefits paid to the injured party in a compulsory arbitration proceeding. Wesco then sought to vacate the arbitration award, but the Supreme Court denied the petition, affirming the arbitrator's decision. The main issue decided was whether Wesco Insurance Company was liable for the no-fault benefits paid to the injured party under the circumstances of the collision involving the loaner vehicle. The court held that Wesco was indeed liable for the benefits, affirming the decision of the arbitration award. The holding of the case was that the Supreme Court properly denied the petition to vacate the arbitration award and dismissed the proceeding, upholding the decision that Wesco Insurance Company was liable for the benefits paid to the injured party.

The court considered a proceeding to vacate an arbitration award dated September 26, 2019, where the appellant sought to recover benefits paid to a party injured in a motor vehicle collision. GEICO sought to recover the benefits paid from Wesco in a compulsory arbitration proceeding, and the arbitrators determined that Wesco was liable for the benefits paid. Wesco then commenced a proceeding seeking to vacate the arbitration award, which was denied by the Supreme Court. The main issue decided was whether the Supreme Court properly denied the petition and confirmed the arbitration award, and whether the petitioner presented evidence of actual bias or the appearance of bias on the part of one of the arbitrators. The holding was that the Supreme Court properly denied the petition and confirmed the arbitration award, and that the petitioner failed to present evidence of actual bias or the appearance of bias on the part of one of the arbitrators.

The court considered the facts that in August 2017, Sarah Pierre was injured while operating a loaner vehicle owned by Bay Ridge Volvo and insured by Wesco Insurance Company. GEICO Indemnity Company paid basic no-fault benefits to Pierre from her GEICO policy and sought to recover these benefits from Wesco in a compulsory arbitration proceeding. The main issue the court decided was whether Wesco, as the insurer of the loaner vehicle, was liable for the benefits paid to Pierre according to the terms of the GEICO policy. The holding of the case was that the Supreme Court should have denied Wesco's petition to vacate the arbitration award and dismissed the proceeding, as the PIP endorsement in the GEICO policy did not provide coverage for the injuries Pierre sustained while operating the loaner vehicle.

The court considered the circumstances surrounding a motor vehicle collision in which a nonparty was injured while operating a loaner vehicle insured by Wesco Insurance Company. GEICO Indemnity Company paid no-fault benefits to the injured party and sought to recover the benefits from Wesco in a compulsory arbitration. An arbitrator determined that Wesco was liable for the benefits paid. Wesco subsequently sought to vacate the arbitration award, but the Supreme Court denied the petition and confirmed the arbitration award. The main issue decided was whether the Supreme Court properly denied Wesco's petition to vacate the arbitration award and confirmed the award. The holding of the case was that the Supreme Court properly denied Wesco's petition to vacate the arbitration award and confirmed the arbitration award.

The case revolved around a proceeding pursuant to CPLR article 75 to vacate an arbitration award issued on May 30, 2019. The appellant, GEICO General Insurance Company, appealed an order of the Supreme Court in Queens County that denied the petition and dismissed the proceeding. This case involved a dispute over insurance coverage resulting from injuries sustained by Biru Saha after being involved in a motor vehicle collision while operating a loaner vehicle from New Country Motor Car Group, Inc. GEICO sought to recover no-fault benefits paid to Saha from Wesco Insurance Company. The Supreme Court denied GEICO's request to vacate the arbitration award, but the Appellate Division reversed the order, vacated the arbitration award, and remitted the matter to the Supreme Court in Queens County. The court held that the arbitrator's determination that GEICO was liable for the benefits paid to Saha was arbitrary and capricious and not supported by the evidence. Therefore, the Supreme Court should have vacated the arbitration award.

The relevant facts in Lancer Insurance Company v. Zair Fishkin include the plaintiff, a no-fault insurance carrier, denying claims for reimbursement for medical treatment submitted by the defendant, a medical provider, and the subsequent arbitration award in favor of the defendant. The plaintiff initiated an action pursuant to Insurance Law § 5106 (c) for a de novo determination of claims for no-fault insurance benefits in Nassau County. The plaintiff moved for leave to enter a default judgment against the defendant, who had failed to oppose the motion. The defendant also moved to change the venue of the action to Monroe County based upon the convenience of material witnesses. The main issues were whether to grant the plaintiff's motion for leave to enter a default judgment and whether to change the venue of the action. The court held that the plaintiff's motion should have been granted, as the defendant failed to oppose the motion and establish a reasonable excuse for the default. The cross-appeal was rendered academic in light of this determination.

The court considered whether a misrepresentation by the insured in obtaining an insurance policy was material, and if the insurer would not have issued the policy if the correct information had been disclosed. The issue was whether the defendant insurance company was entitled to summary judgment dismissing the complaint on the grounds that the insured made material misrepresentations about the garaging of a vehicle and the address of a driver covered under the policy. The court held that the defendant failed to establish as a matter of law that it would not have issued the policy in question, as neither the examination under oath testimony of the assignor nor the declaration page of the insurance policy established that the assignor made a misrepresentation on her application for insurance. The court affirmed the order denying the defendant's motion for summary judgment.

The relevant facts the court considered in this case were that NGM Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from Nationwide Insurance Company. The main issue decided by the court was whether Nationwide Insurance Company was justified in denying the first, fifth, and seventh causes of action on the ground that NGM Acupuncture, P.C. had failed to appear for duly scheduled examinations under oath (EUOs). The holding of the case was that the court affirmed the order granting the branches of defendant's motion seeking summary judgment dismissing the first, fifth, and seventh causes of action. The court found that the claims underlying the fifth and seventh causes of action were timely denied, and that the initial EUO had been scheduled before defendant received the claim underlying the first cause of action, therefore defendant's time to pay or deny this claim was tolled.

The Appellate Term, Second Department, considered an appeal from an order of the Civil Court of the City of New York, Kings County, which denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The main issue in the case was whether the action by a provider to recover assigned first-party no-fault benefits was premature, as the plaintiff allegedly failed to respond to the defendant's timely requests for additional verification. The court held that the defendant's cross motion for summary judgment dismissing the complaint should have been denied, as the defendant did not establish its entitlement to summary judgment dismissing a specific cause of action, and also failed to properly request additional verification in other instances. Additionally, the court determined that the plaintiff's motion for summary judgment was properly denied, as the proof submitted by the plaintiff failed to establish that the claims at issue had not been timely denied, or that the defendant had issued timely denial of claim forms that were conclusory, vague, or without merit as a matter of law. Therefore, the order was modified by providing that defendant's cross motion for summary judgment dismissing the complaint is denied.