No-Fault Case Law

The court considered the fact that the plaintiff, MSB Physical Therapy, P.C., was seeking to recover assigned first-party no-fault benefits from the defendant, Nationwide Ins. The main issue was whether the plaintiff failed to appear at duly scheduled examinations under oath (EUOs), and if so, if the EUOs were scheduled at reasonably convenient dates. The court held that the plaintiff repeatedly sent letters to the defendant seeking to reschedule the EUOs for unspecified dates two months beyond the initial scheduled date, and the defendant complied with these requests. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint, as the plaintiff failed to demonstrate the existence of an issue of fact as to whether the EUOs were scheduled at reasonably convenient dates.

The court considered an appeal from an order denying the defendants' joint motion to dismiss the complaint asserted against American Independent Ins. Co., American Independent Insurance Companies, Inc., and Good2Go Auto Insurance. The defendants argued that they were not subject to New York's jurisdiction based on their lack of business operations and real property in New York. The plaintiff claimed that the defendants transacted business in New York and were subject to jurisdiction. The court held that defendant American Independent Ins. Co. did not have sufficient contacts with the state of New York to establish jurisdiction. The court also found that American Independent Insurance Companies, Inc. and Good2Go Auto Insurance failed to show a basis to dismiss the complaint, and therefore ordered that the branches of the motion seeking to dismiss the complaint asserted against American Independent Ins. Co. and American Independent Insurance Companies, Inc. to be granted, and affirmed the order in that respect.

The case involved a no-fault insurance coverage action where Liberty Mutual Insurance Company and American States Insurance Company (Liberty Mutual) moved for default judgment against defendant Edwine Brutus and several medical-provider assignees. The court granted Liberty Mutual's motion for default-judgment and also granted in part and denied in part a cross-motion by defendant NYC Axis Chiropractic PC for summary judgment. Liberty Mutual provided evidence of their claim, including that Brutus failed to fully respond to post-examination under oath document requests, and that he lived at a different address from the one he had used on his insurance application. The court found that these facts established a prima facie case that Brutus committed a material misrepresentation on his insurance application. The court also denied the branch of NYC Axis's cross-motion seeking sanctions.

The court considered the issue of no-fault insurance coverage in this case, as plaintiff American Transit Insurance Company moved without opposition for default judgment against the alleged injured person, defendant Nadine Ferguson, and a number of Ferguson's medical-provider assignees who have not appeared in the action. The main issue decided was whether the information provided in American Transit's motion papers satisfied the timeliness requirements of the applicable no-fault regulations, as required to obtain default or summary judgment. The court held that American Transit did not establish that it satisfied the timeliness requirements of the applicable no-fault regulations and therefore denied their motion for default judgment. The court also ordered that if American Transit does not file a renewed motion for default judgment against the defaulting defendants within 30 days of the entry of the order, the action will be dismissed as against those defendants.

The relevant facts the court considered in this case were that the plaintiff, Hands on Physical Therapy Care, was seeking to recover assigned first-party no-fault benefits from Nationwide Ins. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint on the ground that the plaintiff failed to appear for duly scheduled examinations under oath (EUOs) should be granted, and whether the plaintiff's cross motion for summary judgment should be denied. The holding of the court was that the branches of defendant's motion seeking summary judgment dismissing the first through third causes of action were denied, and the order was modified accordingly. The court determined that the defendant failed to establish that it timely denied the claims underlying the first through third causes of action within 30 days of the second EUO nonappearance. Additionally, the court found that the proof submitted in support of the plaintiff's cross motion failed to establish that the claims had not been timely denied, or that the defendant had issued timely denial of claim forms. The court also determined that the proof submitted by the defendant was sufficient to give rise to a presumption that the EUO scheduling letters and denial of claim forms had been properly mailed. Therefore, the order was modified to deny the branches of the defendant's motion seeking summary judgment dismissing the first through third causes of action.

The court considered the facts that the plaintiff was seeking to recover assigned first-party no-fault benefits and that the defendant had motioned for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for examinations under oath (EUOs). The main issue decided was whether the insurer had demonstrated, as a matter of law, that it had twice duly demanded an EUO from the assignor, that the assigner had twice failed to appear, and that the denial of the claims was timely. The court held that the insurer had sufficiently established that the EUO scheduling letters had been timely mailed in accordance with the insurer's standard office practices and procedures, and affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment.

The court considered the fact that the plaintiff, a medical services provider, was seeking to recover first-party no-fault benefits that had been assigned to them. The main issue decided was whether the defendant's motion for summary judgment to dismiss the complaint on the grounds that the plaintiff had failed to appear for duly scheduled examinations under oath should be granted. The holding of the case was that the order denying the defendant's motion for summary judgment and granting the plaintiff's cross motion for summary judgment was affirmed. The court's decision was based on reasons stated in a previous case, and it was affirmed by all judges.

The court considered a case in which a medical services provider, RA Medical Services, P.C., sought to recover first-party no-fault benefits from Lancer Insurance Co. The main issue in the case was whether Lancer Insurance Co. was entitled to summary judgment dismissing the complaint on the grounds that RA Medical Services had failed to appear for duly scheduled examinations under oath (EUOs). The court held that Lancer Insurance Co. failed to demonstrate that it was entitled to summary judgment dismissing the complaint based on RA Medical Services' failure to appear for EUOs. The court pointed out that the initial EUO request to RA Medical Services had been sent more than 30 days after Lancer Insurance Co. had received the claims at issue, making the requests nullities as to those claims. Therefore, the court affirmed the denial of Lancer Insurance Co.'s motion for summary judgment and granted RA Medical Services' cross motion for summary judgment.

The court considered the fact that the defendant failed to appear or answer the complaint, resulting in a default judgment being entered against them. The defendant claimed that it had not forwarded the complaint to its attorneys, informed the plaintiff that it was not the insurance carrier for the plaintiff's assignor, and promptly referred the matter to its counsel. The main issue decided was whether the defendant demonstrated a reasonable excuse for its default and a meritorious defense to the action. The holding of the case was that the Civil Court affirmed an order granting the defendant's motion to vacate the default judgment, finding that the defendant had demonstrated a reasonable excuse for its default and a potentially meritorious defense to the action. However, there was a dissenting opinion stating that the defendant failed to establish a reasonable excuse for its default, and the motion should have been denied.

The court considered a case in which a provider sought to recover assigned first-party no-fault benefits from MVAIC Insurance Company. MVAIC had denied the claims due to the provider's untimely submissions, but informed the provider that it could excuse the delay if reasonable justification was provided. The main issue decided was whether the provider had provided a reasonable justification for its untimely submission of the claim forms to MVAIC. The court held that the provider did not establish a reasonable justification for its untimely submission, and therefore reversed the lower court's decision, granting MVAIC's motion for summary judgment dismissing the complaint and denying the provider's cross motion for summary judgment.