No-Fault Case Law

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.

The court considered the facts of the case, where a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company had moved for summary judgment, claiming that the action was premature because the provider had failed to provide requested verification. The main issue decided was whether the insurance company's motion for summary judgment should be granted or denied. The court held that the insurance company's motion for summary judgment dismissing the complaint was denied, reversing the previous order, and stating that the action was not premature.

The court considered the timely and proper denial of claims by the defendant on the basis that the plaintiff had failed to comply with a condition precedent to coverage by not appearing for scheduled examinations under oath (EUOs). The main issue was whether the defendant had proven that the EUO scheduling letters and denial of claim forms were timely mailed, and that the plaintiff had failed to appear for the EUOs. The holding of the case was that the defendant had established, through affidavits and an affirmation from their attorney, that the plaintiff had failed to appear for the scheduled EUOs, and that the EUO scheduling letters and denial of claim forms had been timely mailed. The court also cited a previous case to support the decision, which held that a provider's argument for the denial of a motion on the basis of inadequate discovery regarding the reasonableness of the insurer's EUO requests was insufficient without establishing what information they hoped to discover that would demonstrate a triable issue of fact. Therefore, the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed.

The relevant facts considered by the court were that Island Life Chiropractic, P.C., as an assignee of Patrick Joseph, brought an action to recover assigned first-party no-fault benefits from National Liability & Fire Insurance Company. Plaintiff moved for summary judgment, but defendant cross-moved for summary judgment dismissing the complaint on the grounds that the action was premature due to plaintiff's failure to provide requested verification. The main issue decided was whether the action was premature and if plaintiff's failure to provide requested verification warranted the dismissal of the complaint. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint was denied, and the order was modified to reflect this decision, without costs. The court's decision was based on a similar case, Great Health Care Chiropractic, P.C., as Assignee of Carlos Thomas v Hereford Ins. Co.

The court considered the case of IMA Acupuncture, P.C. v Allstate Ins. Co. in which the plaintiff sought to recover assigned first-party no-fault benefits. Plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for examinations under oath (EUOs). The Civil Court granted the plaintiff's motion and denied the defendant's cross motion, awarding the plaintiff the principal sum of $3,092.34. The appellate court reversed the judgment, vacated the order granting plaintiff's motion for summary judgment, and denied plaintiff's motion for summary judgment. The court held that defendant had failed to establish, as a matter of law, its entitlement to summary judgment dismissing the complaint, and that plaintiff had failed to demonstrate its prima facie entitlement to summary judgment.