No-Fault Case Law
Ultimate Health Prods., Inc. v Hereford Ins. Co. (2016 NY Slip Op 50367(U))
March 16, 2016
The relevant facts considered by the court in the case of Ultimate Health Prods., Inc. v Hereford Ins. Co. were that the plaintiff was seeking to recover first-party no-fault benefits as the assignee of an individual named Paul Luckner. The main issue decided in the case was whether the defendant, Hereford Insurance Co., had issued an automobile insurance policy covering the underlying accident. The court held that the defendant had established that there was no coverage for no-fault benefits because the policy being sued upon was a workers' compensation insurance policy which did not cover the plaintiff's claim for reimbursement of assigned first-party no-fault benefits. Therefore, the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint was affirmed.
Performance Plus Med., P.C. v Nationwide Ins. (2016 NY Slip Op 50366(U))
March 16, 2016
The court considered the appeal of Performance Plus Medical, P.C. from an order of the Civil Court of the City of New York, Kings County that granted defendant's motion for summary judgment dismissing the complaint. The main issues decided were whether the insurer's time to pay or deny a claim is tolled when a timely verification request has been provided, and whether the defendant had properly denied the claims for the services at issue. The holding of the court was that the insurer's time to pay or deny the entire claim is tolled if the provider has failed to respond to a request for verification, and that the defendant had established prima facie entitlement to summary judgment dismissing the second through tenth causes of action, as well as dismissing the first cause of action pursuant to the workers' compensation fee schedule. Therefore, the court affirmed the order of the Civil Court.
Matter of Singh v Allstate Ins. Co. (2016 NY Slip Op 01855)
March 16, 2016
The court considered a petition to vacate master arbitration awards that had denied the petitioner's no-fault claims for lost wages following an automobile accident. The petitioner appealed after the master arbitration awards were confirmed by a lower court. The main issue was whether there were sufficient grounds to vacate the master arbitration awards. The court held that the public policy in favor of arbitration meant that the grounds specified in CPLR 7511 for vacating or modifying a no-fault arbitration award were few and narrowly applied. In this case, the petitioner failed to demonstrate any ground for vacating the master arbitration awards, and the determinations of the master arbitrator were found to have evidentiary support and a rational basis. Therefore, the court affirmed the lower court's decision to deny the petition and confirm the master arbitration awards.
Ultimate Health Prods., Inc. v American Tr. Ins. Co. (2016 NY Slip Op 50330(U))
March 15, 2016
The main issue in this case was whether the insurance company had properly denied a claim for first-party no-fault benefits based on the plaintiff's assignor's failure to appear for examinations under oath (EUOs). The court held that the insurance company had timely mailed the EUO scheduling letters and that the plaintiff's assignor had failed to comply with the scheduled EUOs. Since the insurance company had timely denied the claim on the ground of the assignor's failure to appear for the EUOs, they had demonstrated that the assignor failed to comply with a condition precedent to coverage. The court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. Therefore, the order was affirmed.
GBI Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50329(U))
March 15, 2016
The main issue in this case was whether State Farm Mutual Automobile Insurance Co. had properly used the workers' compensation fee schedule applicable to chiropractors who render the same services as acupuncturists to reimburse GBI Acupuncture, P.C. for the acupuncture services it had rendered. The court considered the argument from GBI Acupuncture, P.C. that State Farm failed to establish that its fee schedule reductions were proper. However, the court disagreed with GBI Acupuncture, P.C. and found that State Farm had demonstrated that it had fully paid GBI Acupuncture, P.C. for the services at issue in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. As a result, the court affirmed the order granting State Farm's motion for summary judgment dismissing the complaint.
Atlantic Radiology Imaging, P.C. v Metropolitan Prop. & Cas. Ins. Co. (2016 NY Slip Op 50321(U))
March 11, 2016
The relevant facts the court considered were that the plaintiff failed to file written opposition to the defendant's motion for summary judgment in a timely manner, resulting in the motion being granted on default. The main issue decided was whether the plaintiff had a reasonable excuse for the default and a potentially meritorious opposition to the defendant's motion. The holding of the case was that the plaintiff's excuse for the default was not reasonable, as it was attributed to law office failure, and the plaintiff failed to demonstrate a potentially meritorious opposition to the defendant's motion for summary judgment. As a result, the court affirmed the denial of plaintiff's motion to vacate the prior order granting summary judgment to the defendant.
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2016 NY Slip Op 50319(U))
March 11, 2016
The court considered the fact that the defendant had timely and properly mailed letters scheduling examinations under oath (EUOs) and denial of claim forms due to the plaintiff's failure to appear at the EUOs. The main issue was whether the defendant's EUO scheduling letters were defective and if the plaintiff's objections regarding the letters would be heard. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint should have been granted, as the plaintiff did not claim to have responded in any way to the EUO requests, and therefore the objections regarding the scheduling letters would not be heard. Therefore, the order was reversed, the plaintiff's motion for summary judgment was denied, and the defendant's cross motion for summary judgment dismissing the complaint was granted.
Atlantic Radiology Imaging, P.C. v Esurance Ins. Co. (2016 NY Slip Op 50315(U))
March 11, 2016
The court considered the case of Atlantic Radiology Imaging, P.C. as Assignee of Kareem Hoyte v. Esurance Ins. Co. The main issue decided was whether the plaintiff's assignor had failed to appear for duly scheduled examinations under oath (EUOs), and if so, whether the defendant's motion for summary judgment dismissing the complaint should be granted. The court held that the defendant's employee affidavit was sufficient to establish the mailing of the EUO scheduling letters, and that the affirmation by the managing partner of defendant's law firm did not establish that the assignor had failed to appear for the EUOs. Therefore, as the plaintiff failed to demonstrate any basis to disturb the Civil Court's order, the order granting the defendant's motion for summary judgment to dismiss the complaint was affirmed.
EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50314(U))
March 11, 2016
The court considered that the plaintiff, EMC Health Products, Inc., was seeking to recover no-fault benefits from Allstate Insurance Company, as the assignee of Peter Esquilin. The main issue decided was whether Allstate Insurance Company provided insurance coverage for the vehicle on the date of the accident. The holding of the case was that the court affirmed the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint. The court found that the defendant's affidavit was sufficient to demonstrate that the plaintiff's claim did not arise out of a covered incident, and as the plaintiff failed to raise a triable issue of fact, the civil court properly granted the defendant's cross motion for summary judgment.
EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50313(U))
March 11, 2016
The relevant facts considered in this case were that a provider was seeking to recover first party no-fault benefits that had been assigned to them. The main issue decided was whether the provider had made a prima facie showing of entitlement to summary judgment, and whether the denial of claim forms pertaining to the claims in question had been timely mailed. The holding of the case was that the court granted the provider's motion for summary judgment, but only in part. The branches of the provider's motion seeking summary judgment upon the third and fourth causes of action were denied, as the denial of claim forms had been timely mailed, raising triable issues of fact. Therefore, the order was modified to provide that the branches of the motion seeking summary judgment upon the third and fourth causes of action were denied.