No-Fault Case Law

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.

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.

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.

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.

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.

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.

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.