No-Fault Case Law
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.
Tam Med. Supply Corp. v American Ind. Ins. Co. (2022 NY Slip Op 50913(U))
September 9, 2022
The court considered the facts of a provider seeking to recover assigned first-party no-fault benefits, where the affidavit of service alleged that the summons and complaint were served by mail pursuant to CPLR 312-a, but did not contain an acknowledgment of service. American Independent Ins. Co. moved to dismiss the complaint on the grounds of lack of personal jurisdiction, while American Independent Insurance Companies, Inc. and Good2Go Auto Insurance also sought to dismiss the complaint on the same grounds. The main issue decided was whether the plaintiff had obtained personal jurisdiction over the defendants. The court held that for the reasons stated in Longevity Med. Supply, Inc. v American Ind. Ins. Co. (69 Misc 3d 127[A], 2020 NY Slip Op 51118[U]), the motion by American Independent Ins. Co. to dismiss the complaint was granted, as well as the branches of the motion seeking to dismiss the complaint against American Independent Insurance Companies, Inc. and Good2Go Auto Insurance.
MK Healthcare Med. PC v Travelers Ins. Co. (2022 NY Slip Op 50824(U))
August 25, 2022
The court considered the evidence presented by both parties, including medical records, expert witness testimony, and the Referral Guidelines for Electrodiagnostic Medicine Consultations. The main issue was whether the defendant's denial of the claim on the ground of medical necessity was proper under Insurance Law § 5102[a][1]. The court held that the defendant sufficiently demonstrated that there was no medical necessity for the procedures based on the findings of the expert witness, Dr. Hadhoud. The court found Dr. Hadhoud's testimony to be medically sound and credible, and that he relied upon his examination and review of the Assignor's medical records to reach his opinion. The court further found that the plaintiff failed to demonstrate its entitlement to judgment or rebut the defendant's showing, and as a result, judgment was rendered in favor of the defendant and the matter was dismissed with prejudice.
State Farm Mut. Auto. Ins. Co. v Emote Med. Servs., P.C. (2022 NY Slip Op 50818(U))
August 24, 2022
The relevant facts in this case include that State Farm Mutual Automobile Insurance Company and State Farm Fire and Casualty Company brought a declaratory judgment action against Emote Medical Services, P.C. regarding no-fault insurance coverage. The insurance company alleged that Emote Medical Services, P.C. systematically failed or refused to appear for examinations under oath (EUOs) which were requested by plaintiffs compelling the denials of claims. The court denied the default judgment motion made by the plaintiffs since the verified complaint failed to provide adequate proof of timely and properly requested EUOs. Additionally, the court expressed concern that plaintiffs were seeking to circumvent the procedures governing disputes between insurers and health services providers by bringing one action against Emote Medical Services, P.C. based on repeated EUO non-appearances rather than addressing the provider's eligibility directly.
Shafai Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50907(U))
August 19, 2022
The main issue in this case was whether the plaintiff, Shafai Acupuncture, P.C., had effectively served the defendant, State Farm Mutual Automobile Ins. Co., within the time frame directed by a previous order of the Civil Court. The court found that the 30-day period for service specified in the November 14, 2019 order had not expired due to a stay contained in the plaintiff's November 26, 2019 order, and therefore overturned the dismissal of the complaint with prejudice. It was also disputed whether an attempted service on April 3, 2018, which occurred after the expiration of the 120-day time period allotted by CPLR 306-b, could be considered effective. The court ultimately ruled in favor of the plaintiff, deeming the April 3, 2018 service as satisfying the service that plaintiff had been directed to effectuate. As a result, the defendant's cross motion to dismiss the complaint based on res judicata was granted, and the order was reversed.
Laga v Unitrin Auto & Home Ins. Co. (2022 NY Slip Op 50906(U))
August 19, 2022
The relevant facts of the case are that Adelaida M. Laga, P.T. (Laga) brought an action against Unitrin Auto and Home Insurance Company to recover first-party no-fault benefits for medical services provided to its assignor, Belle Au Monde Corriolant, due to injuries sustained in an automobile accident. A declaratory judgment had been entered in a separate Supreme Court action, stating that Laga and other providers were not entitled to no-fault insurance coverage for the accident that occurred. Unitrin Auto and Home Insurance Company moved to dismiss the complaint on the basis of collateral estoppel, claiming that the issue was identical to the one decided in the declaratory judgment action. The court ultimately held that Unitrin Auto and Home Insurance Company was entitled to dismissal of the complaint on the ground of collateral estoppel, reversing the judgment and vacating the prior order in favor of the plaintiff, and remitting the matter to the Civil Court for entry of a judgment in favor of the defendant.
Island Life Chiropractic Pain Care, PLLC v American Ind. Ins. Co. (2022 NY Slip Op 50903(U))
August 19, 2022
The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which denied the branches of the defendants' joint motion seeking to dismiss part of the complaint against American Independent Ins. Co., American Independent Insurance Companies, Inc., and Good2Go Auto Insurance. The main issue decided was whether the branches of the motion to dismiss part of the complaint against these defendants should be granted. The court held that the branches of the motion seeking to dismiss so much of the complaint as was asserted against American Independent Ins. Co. and American Independent Insurance Companies, Inc., respectively, should be granted, and the order was affirmed with modifications. Therefore, the appeal was partly dismissed, and the decision from the lower court was modified to grant the dismissal of part of the complaint against the specified defendants.