No-Fault Case Law

The relevant facts the court considered included a prior declaratory judgment action in which the Supreme Court determined that the plaintiff's assignor was not eligible for no-fault benefits under the defendant's policy. The main issue decided in the case was whether the instant action to recover first-party no-fault benefits was barred under the doctrines of res judicata and collateral estoppel due to the prior Supreme Court order. The court held that the instant action was indeed barred under the doctrine of res judicata. The Supreme Court's order from the declaratory judgment action was a conclusive final determination, and res judicata applies to an order or judgment taken by default which has not been vacated. Therefore, the order denying the motion for summary judgment and granting the cross motion to dismiss the complaint was affirmed.

The court considered a case where Compas Medical, P.C. sought to recover first-party no-fault benefits as the assignee of Nelson Josner. Compas moved for summary judgment, but Praetorian Ins. Co. cross-moved for summary judgment, arguing that it had timely denied the claims due to Josner's fraudulent procurement of the insurance policy. The fraudulent misrepresentation involved Josner providing a false address to obtain a lower insurance premium. The main issue was whether Praetorian had valid grounds to deny the claims based on Josner's misrepresentation. The court held that Praetorian's cross motion for summary judgment dismissing the complaint was denied, providing a victory for Compas Medical, P.C. and allowing the case to proceed.

The relevant facts the court considered in the case were that Compas Medical, P.C. was seeking to recover first-party no-fault benefits as an assignee of the policyholder. The main issue decided in the case was whether the insurance company had timely denied the claims and whether the remaining claims were premature due to outstanding verification requests. The holding of the case was that the insurance company's cross motion for summary judgment dismissing the complaint was denied, as they failed to timely mail letters scheduling the policyholder's examination under oath, and failed to establish that the misrepresentation by the policyholder as to his place of residence was material. Additionally, a triable issue of fact existed as to whether the remaining causes of action were premature.

The court considered the fact that the defendant had moved for summary judgment dismissing the complaint on grounds that the plaintiff had failed to appear for duly scheduled EUOs. The main issue decided in the case was whether the plaintiff had timely responded in any way to the EUO requests and whether they had failed to appear for the scheduled EUOs. The court held that the defendant had sufficiently established the plaintiff's failure to appear for the scheduled EUOs and that the plaintiff had failed to timely object to the EUO requests in claims processing, leading to the denial of the cross motion seeking summary judgment and compelling the defendant to respond to discovery demands. Therefore, the court affirmed the order in favor of the defendant.

The main issue in this legal case was whether a preliminary injunction should be granted against Raia Medical Health, P.C. The plaintiffs had alleged that the defendant, RMH, had fraudulently billed them for medical services and filed a motion for a preliminary injunction. To obtain the injunction, the plaintiffs had to demonstrate a likelihood of success on the merits, irreparable injury if the injunction was not granted, and a balance of equities in their favor. The Supreme Court found that the plaintiffs had demonstrated a likelihood of success on the merits, irreparable injury in the form of over 100 pending actions and open arbitrations commenced against them by RMH, and that the balance of equities was in their favor. As a result, the court granted the preliminary injunction.

The relevant facts of the case are that ALFA Medical Supplies, Inc., acting as an assignee of Juan Vargas, filed a complaint against Allstate Ins. Co. to recover first-party no-fault benefits. Allstate Ins. Co. failed to respond to the complaint, resulting in a default judgment being entered against them. Allstate Ins. Co. then moved to vacate the default judgment, claiming a clerical error in their office caused them to overlook the summons and complaint. The main issue decided by the court was whether Allstate Ins. Co. provided a reasonable excuse for their two-year delay in answering the complaint. The holding of the court was that the affidavit provided by the claim representative of Allstate Ins. Co. was insufficient to show that the failure to timely appear and answer was due to a clerical error, and therefore the motion to vacate the default judgment was denied and the default judgment was reinstated.

The relevant facts considered by the court were that Brand Medical Supply, Inc. brought a lawsuit to recover no-fault benefits, but the defendant moved for summary judgment based on lack of medical necessity, and the court granted the motion on default. The plaintiff then tried to vacate the default order. The main issue decided by the court was whether the default order should be vacated. The court held that the plaintiff failed to demonstrate a reasonable excuse for the default and a potentially meritorious opposition to the motion for summary judgment, and therefore affirmed the order denying the plaintiff's motion to vacate the default order.

The court considered the defendant-insurer's motion for summary judgment dismissing the action for first-party no-fault benefits. The defendant-insurer established that it timely and properly mailed notices for independent medical examinations (IMEs) to the plaintiff's assignor and the assignor's attorney, and that the assignor failed to appear. The defendant submitted sworn affidavits of the scheduled examining chiropractor/acupuncturist and an employee of the defendant's third-party IME scheduler, demonstrating the assignor's repeated failures to appear for the IMEs. In response, the plaintiff did not specifically deny the assignor's nonappearance or raise a triable issue, and the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant-insurer was entitled to summary judgment dismissing the action for first-party no-fault benefits based on the assignor's failure to appear for scheduled IMEs. The court held that the defendant made a prima facie showing of entitlement to summary judgment by establishing the timely and proper mailing of IME notices and the assignor's nonappearance. The court determined that the plaintiff did not raise a triable issue in opposition to the defendant's motion, and therefore affirmed the order granting summary judgment in favor of the defendant.

The main issue in this case was whether the defendant-insurer was entitled to summary judgment dismissing the action for first-party no-fault benefits based on the plaintiff's assignor's failure to appear at scheduled examinations under oath (EUOs). The court considered evidence submitted by the defendant of the assignor's repeated failures to appear for the EUOs, including the affirmation of the defendant's attorney and the affidavit of the defendant's employee responsible for scheduling the EUOs. The court found that the defendant made a prima facie showing of entitlement to summary judgment by establishing that the notices for EUOs were timely and properly mailed and that the assignor failed to appear. In opposition to defendant's showing, the plaintiff did not specifically deny the assignor's nonappearance or raise a triable issue with respect to the mailing or reasonableness of the notices. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered the relevant facts of Aetna Health Plans v. Hanover Insurance Company, including that Luz Herrera was in an accident and had private health insurance through Aetna Health Plans. Herrera's medical bills for the accident-related injuries were initially submitted to Aetna, who paid them. Aetna then sought reimbursement from Hanover Insurance Company, the no-fault insurer, since Hanover had not responded to its earlier demands for payment. Aetna also filed a lien for reimbursement in the personal injury action Herrera brought against the person who caused her injuries. The main issue was whether a health insurer could maintain a reimbursement claim against a no-fault insurer under New York's Comprehensive Motor Vehicle Insurance Reparations Act (No-Fault Law). The court held that Aetna, as a health insurer, cannot maintain such a reimbursement claim against a no-fault insurer because the No-Fault Law and its regulatory scheme do not contemplate such reimbursement. The Appellate Division unanimously affirmed the lower court's decision. Ultimately, the court found that Aetna could not seek reimbursement from Hanover and that Herrera's health providers were the ones who should have submitted the bills to Hanover for payment.