No-Fault Case Law

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.

The facts of this case involve an automobile accident in which the defendant, Balgobin Manoo, filed a claim for no-fault benefits. Plaintiff, Mapfre Insurance Company, requested an examination under oath (EUO) to investigate the claim, but Manoo failed to appear on three separate occasions. The court initially granted plaintiff's motion for summary judgment, ruling in favor of the insurance company, but upon reargument, the court reversed that decision, stating that the insurance company did not establish that its initial request for an EUO was made within the time frame set forth in the no-fault regulations. The main issue decided by the court was whether the insurance company complied with the regulations in requesting the EUO, and the holding of the case was that the insurance company's motion for summary judgment should be granted.

The court considered the fact that the defendant denied the no-fault claims based on the plaintiff's failure to appear for two examinations under oath (EUOs) on April 10, 2014, and May 1, 2014. The main issue decided was whether the defendant insurer provided the requisite "specific objective justification supporting the use of such examination" in response to the plaintiff's timely demand for same, as required by the applicable no-fault regulation. The court concluded that the defendant insurer failed to provide the necessary justification and, as a result, the initial and subsequent EUO requests were noncompliant with the regulations. Therefore, the defendant's motion for summary judgment was denied, and the plaintiff's cross-motion for summary judgment in its favor against the defendant was granted.

The relevant facts that the court considered were the timeline of events surrounding the notice of intention to arbitrate and the submission of a petition to permanently stay arbitration. The main issue decided by the court was whether the petition to permanently stay arbitration was time-barred according to CPLR 7503 (c), which requires the application to be made within 20 days after service of a notice of intention to arbitrate. The holding of the case was that the court reversed the order granting the petition to permanently stay arbitration, as it was not made within 20 days after service of the notice of intention to arbitrate and was therefore time-barred. The court determined that the notices of intention to arbitrate complied with the requirements of CPLR 7503 (c) and that the petitioner failed to establish that they were deceptive and intended to prevent it from timely commencing the proceeding. Therefore, the court denied the petition and dismissed the proceeding as time-barred.