No-Fault Case Law

The court considered an appeal from an order of the District Court which denied the defendant's motion for summary judgment in a case where a medical care provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The main issue decided by the court was whether the insurance policy had been effectively terminated, as the defendant claimed, and whether this termination was effective with respect to the plaintiff's assignor. The court held that the defendant failed to sufficiently demonstrate that it had filed a copy of the notice of termination of the insurance policy with the Department of Motor Vehicles within 30 days of the effective date of the termination, as required by Vehicle and Traffic Law, and therefore the termination was not effective with respect to the plaintiff's assignor. Consequently, the defendant's motion for summary judgment dismissing the complaint was properly denied and the order was affirmed.

The main issues in the case were whether the defendant, 21st Century Insurance, acted negligently in denying the plaintiff, Michael Bertucci's, claim for no-fault benefits and whether punitive damages were warranted. The court considered the plaintiff's claim that his medical treatment was delayed due to the defendant's non-payment of his medical bills, resulting in the aggravation and exacerbation of his injuries. The court also considered the defendant's argument that it had no legal duty to refrain from communicating with the plaintiff's health care providers regarding its intentions to not pay submitted bills. The holding of the case was that the defendant's motion to dismiss the plaintiff's first cause of action was granted, as the plaintiff failed to specify or identify the duty that the defendant allegedly breached. Additionally, the claim for punitive damages in the plaintiff's second cause of action was dismissed, as the defendant's conduct did not constitute a tort independent of the insurance contract itself.

The relevant facts of the case were that plaintiff brought an action to recover no-fault benefits for services rendered to its assignor, who allegedly sustained injuries in a motor vehicle accident. Defendant had also commenced a declaratory judgment action against the plaintiff's assignor and other providers, seeking a declaration that they were not entitled to no-fault benefits due to the assignor's failure to comply with the terms of the insurance policy. Plaintiff and the assignor did not appear or serve an answer in the declaratory judgment action. Defendant then moved for summary judgment dismissing the complaint in this action, based on the assignor's failure to appear at scheduled examinations under oath (EUOs). The court held that the action was barred under the doctrine of res judicata, as a decision in favor of the defendant had been made in the declaratory judgment action, and affirmed the order granting defendant's cross-motion for summary judgment dismissing the complaint.

The court considered a motion to dismiss the complaint pursuant to CPLR 3211 (a) (5), which claimed that the plaintiff's cause of action was barred by virtue of an order entered in a Supreme Court declaratory judgment action. The order, entered on default, declared that the plaintiff and its assignor had no right to be reimbursed for services rendered to the assignor and that the defendant had no obligation to provide coverage for no-fault claims with respect to the accident in question. The court held that the present action is barred under the doctrine of res judicata, as any judgment in favor of the plaintiff in this action would destroy or impair rights or interests established by the Supreme Court order. The holding of the case is that the order dismissing the complaint is affirmed. The plaintiff's remaining contentions were not properly before the court, as they were raised for the first time on appeal.

The court considered the denial of the defendant-insurer's motion for summary judgment, which sought to dismiss the complaint. The main issue decided was whether the underlying no-fault claim was precluded by a provision in the insurance policy limiting coverage upon the death of the insured to the "legal representative of the deceased." The holding of the court was to affirm the denial of the defendant's motion for summary judgment, as the defendant failed to provide evidentiary proof in admissible form that the policy contained such a provision. The court did not address whether such a policy provision would, as a matter of law, preclude the underlying no-fault claim, as this issue was not fully briefed by the parties.

The relevant facts that the court considered in this case included the defendant-insurer's timely and proper mailing of notices for independent medical examinations (IMEs) to the plaintiff's assignor, who failed to appear for the IMEs. The main issue decided by the court was whether the defendant was entitled to request the IMEs prior to its receipt of the plaintiff's claim forms, and whether the defendant had the right to deny all claims retroactively to the date of loss when the assignor failed to appear for the requested acupuncture IMEs. The holding of the case was that the defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the plaintiff-provider's claim for first-party no-fault benefits, and the defendant's motion for summary judgment dismissing the complaint was granted. The court found that the defendant had the right to deny all claims retroactively to the date of loss when the assignor failed to appear for the IMEs.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The plaintiff moved for summary judgment and the defendant cross-moved for summary judgment dismissing the complaint. The main issue was whether the plaintiff was entitled to summary judgment upon the first and third through seventh causes of action, and whether the defendant was entitled to summary judgment dismissing the first and third through sixth causes of action. The holding of the court was that the defendant's cross motion seeking summary judgment dismissing the first and third through sixth causes of action was denied, and there was a triable issue of fact as to whether the causes of action were premature. The order was modified to deny the defendant's motion seeking summary judgment dismissing the first and third through sixth causes of action.

The relevant facts considered by the court were that the plaintiff was seeking to recover assigned first-party no-fault benefits for medical supplies provided to an individual who had been injured in a motor vehicle accident. The defendant had previously obtained a declaratory judgment in a separate action, determining that the medical providers, including the plaintiff, and the injured individual were not entitled to recover benefits related to the accident. The main issue decided by the court was whether the current action was barred by the previous declaratory judgment under the doctrine of res judicata. The holding of the court was that the instant action was indeed barred by the previous declaratory judgment, and therefore the order denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment was affirmed.

The court considered the appeal of a case involving Excel Imaging, P.C. as an assignee of Kenneth Owens against Allstate Insurance Company. Allstate Insurance Company denied the claim due to the assignor's alleged failure to appear at examinations under oath (EUOs). Defendant moved for summary judgment dismissing the complaint, arguing that the assignor had failed to comply with a condition precedent to coverage. However, the court found that there was an issue of fact as to whether the assignor failed to comply with the condition precedent. The court stated that there were details missing from the record, preventing them from determining the reasonableness and timeliness of each party's conduct. Ultimately, the court affirmed the order, ruling in favor of Excel Imaging, P.C. as the plaintiff.

The court considered the fact that the defendant-insurer timely and properly denied the plaintiff's no-fault claims on the ground that the fees charged for the acupuncture services exceeded the amount permitted by the applicable worker's compensation fee schedule. The main issue decided was whether the defendant was entitled to summary judgment dismissing the claims, and the court held that the defendant made a prima facie showing of entitlement to judgment as a matter of law. The court also held that the plaintiff failed to raise a triable issue in opposition, and that the defendant established its entitlement to summary judgment dismissing the claims.