No-Fault Case Law
Remedy Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50935(U))
September 23, 2022
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.
Wellness Plaza Acupuncture, P.C. v Nationwide Ins. (2022 NY Slip Op 50934(U))
September 23, 2022
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.
Columbus Imaging Ctr., LLC v Erie Ins. Co. of N.Y. (2022 NY Slip Op 50929(U))
September 23, 2022
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.
Arguelles M.D., P.C. v American Ind. Ins. Co. (2022 NY Slip Op 50926(U))
September 23, 2022
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.
Parisien v Tri State Consumers Ins. Co. (2022 NY Slip Op 50920(U))
September 16, 2022
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.
Fine Needle Acupuncture P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50873(U))
September 16, 2022
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.
Top Choice Pharm. Corp. v Merchants Mut. Ins. Co. (2022 NY Slip Op 50867(U))
September 14, 2022
The relevant facts considered by the court were that Plaintiff, as the assignee of Viera, had commenced an action against Defendant insurance company to recover $1,359.40 in unpaid first-party No-Fault benefits for medicine prescribed to Viera on September 24, 2020. Defendant moved for summary judgment dismissing the complaint on the grounds of lack of standing and lack of medical necessity, and Plaintiff cross-moved for summary judgment on its claim against Defendant. The main issue decided by the court was whether Plaintiff had standing to bring the action and whether the prescribed medication was medically necessary. The holding of the court was that Defendant's motion for summary judgment was denied, and Plaintiff's cross-motion for summary judgment was granted, with the court ordering the entry of judgment in Plaintiff's favor against Defendant in the amount of $1,359.40, along with statutory interest and attorneys' fees.
Herman v Country-Wide Ins. Co. (2022 NY Slip Op 50916(U))
September 9, 2022
The court considered the facts of the case, where plaintiff moved for an order compelling the clerk to enter judgment based upon an inquest held in 1997 for first-party no-fault benefits. Defendant cross-moved to dismiss the action, arguing that plaintiff had failed to submit a proposed judgment within 60 days. The main issue was whether all no-fault statutory interest should be tolled due to plaintiff's delay in seeking to enter judgment, and whether interest should be awarded from April 21, 1995 until June 27, 1997. The court ultimately held that no-fault statutory interest is tolled from June 27, 1997 until April 5, 2018, but declined to award interest from April 21, 1995 until June 27, 1997. The decision was made by the Appellate Term, Second Department on September 9, 2022.
Forest Park Acupuncture, P.C. v Nationwide Prop. & Cas. Ins. Co. (2022 NY Slip Op 50915(U))
September 9, 2022
The relevant facts considered by the court were that Forest Park Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from Nationwide Property & Casualty Insurance Co. The main issue decided was whether plaintiff's assignor failed to appear for scheduled examinations under oath (EUOs). The holding of the case was that defendant's motion for summary judgment dismissing the complaint was granted, as the court found that plaintiff's assignor did indeed fail to appear for the scheduled EUO and that plaintiff failed to raise a triable issue of fact in opposition to defendant's motion. Therefore, the defendant was entitled to summary judgment dismissing the complaint.
Forest Park Acupuncture, P.C. v Nationwide Prop. & Cas. Ins. Co. (2022 NY Slip Op 50914(U))
September 9, 2022
The court considered that the defendant had sought summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor failed to appear for duly scheduled examinations under oath (EUOs). The Civil Court found that the plaintiff had established the timely mailing of the bills and the defendant established the timely mailing of its denials, and limited the issue for trial to defendant's "EUO no show defense as to the March 27, 2017 date." The main issue decided was whether the plaintiff's assignor's failure to appear for scheduled EUOs was grounds for summary judgment to dismiss the complaint. The holding of the court was that the order denying the defendant's motion for summary judgment was reversed, and the defendant's motion for summary judgment dismissing the complaint was granted.