No-Fault Case Law

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the branches of defendant's motion seeking summary judgment dismissing the first through seventh and tenth causes of action, and denied plaintiff's cross motion for summary judgment. The main issues decided were whether the defendant was entitled to summary judgment dismissing the causes of action and whether the plaintiff was entitled to summary judgment on the eighth and ninth causes of action. The court affirmed the order, ruling that the defendant was entitled to summary judgment dismissing the first through seventh and tenth causes of action, and that the plaintiff's contention lacked merit. Additionally, the court found that the affidavit submitted by the plaintiff's owner was insufficient to give rise to a presumption that the claim forms had been timely mailed to and received by the defendant, and therefore, the branches of plaintiff's cross motion seeking summary judgment on the eighth and ninth causes of action were properly denied.

The court considered an appeal from a provider seeking to recover assigned first-party no-fault benefits, in which the defendant had moved for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for duly scheduled examinations under oath (EUOs). The court also considered the plaintiff's cross motion for summary judgment. The main issue decided was whether the plaintiff's assignor had failed to appear for the scheduled EUOs, and whether the plaintiff's remaining argument, which was raised for the first time on appeal, should be considered. The court affirmed the lower court's order, holding that the defendant had established that the plaintiff's assignor had failed to appear for the EUOs and declined to consider the plaintiff's remaining argument.

In the case American Tr. Ins. Co. v Mark S. McMahon MD, P.C., the issue involved a special proceeding arising from a no-fault arbitration. Petitioner American Transit Insurance Company (ATIC) sought to vacate the determination of a master arbitrator affirming the award of a no-fault arbitrator, which granted respondent first-party no-fault benefits for arthroscopic surgery performed on Rubin Gomez. ATIC denied the claims based on a peer review report, asserting no medical necessity and no causal relationship between the accident and the shoulder surgery. However, the no-fault arbitrator ruled in favor of respondent, finding that the surgery was medically necessary and causally related to the injury from the accident. Master Arbitrator Robert Trestman affirmed the original arbitrator's award, leading ATIC to commence a proceeding to vacate the master arbitrator's award. The main issue decided by the court was whether the no-fault arbitrator's award was supported by evidence or other basis in reason and whether the master arbitrator exceeded his powers. The court ultimately denied ATIC's petition to vacate the master arbitrator's award, confirming the arbitration award and awarding respondent the disputed amount, interest, and attorney's fees. The court found that the evidence was sufficient to support the arbitrator's determination and that the arbitrator did not exceed their powers. The court also addressed the computation of interest and attorney's fees awarded and confirmed the total amount to be paid to respondent.

The court considered the denial of plaintiff's claims for no-fault benefits for acupuncture services provided by Allstate Insurance Company, based on the report of an Independent Medical Examination ("IME") conducted by Dr. Thomas McLaughlin. The main issue decided was whether the denial of benefits by Allstate was justified based on lack of medical necessity, as determined by the IME report. The holding of the court was that the IME report did not conclusively demonstrate that any future treatment would not be medically necessary, and shifted the burden to the plaintiff to demonstrate by a preponderance of the credible evidence that the treatment at issue was medically necessary. The court found that the plaintiff's testimony and evidence sufficiently demonstrated that the treatments were medically necessary, and rendered judgment in favor of the plaintiff for the amount of $2018.77, plus statutory interest and attorney fees.

The main issue considered in this case was whether the defendant provided a reasonable excuse for its default and a meritorious defense to the action in order to vacate a default judgment. The court held that the defendant did not provide a detailed explanation of its default, as its attorney only stated that the wrong index number reflected on the initial answer was due to law office failure, without explaining why both answers were mailed to the wrong address. The court also found that the action was not barred based on an order in a declaratory judgment action as it was entered after the default judgment had been entered, and there was no disposition against the plaintiff in that judgment. Therefore, the court reversed the order and denied the defendant's motion to vacate the default judgment.

The court considered the issue of whether Parisien was entitled to no-fault benefits for medical services provided to Jeremy Jagdeo, after he was injured in an automobile accident in 2013. The defendant, Kemper Insurance Company, previously sued Parisien in a declaratory judgment action, where the court ruled that Parisien and other providers were "not entitled to no-fault coverage." The main issue decided in this case was whether the defendant was entitled to summary judgment dismissing the complaint on the ground of collateral estoppel, as the issue was previously decided in the declaratory judgment action. The holding of the court was that the defendant established that the issue of no-fault benefits in connection with the 2013 accident was identical to the issue previously decided in the declaratory judgment action. Therefore, the order was affirmed. The court also noted that while the defendant failed to raise the affirmative defense of collateral estoppel in its initial answer, the better practice would have been to amend the answer, but the unpleaded defense could serve as the basis for granting summary judgment in the absence of prejudice to the opposing party.

The Civil Court of the City of New York, Queens County, considered the case of Advanced Recovery Equipment & Supplies v Travelers Insurance Company on July 21, 2022. The background of the case involved the Plaintiff suing the Defendant insurance company to recover unpaid first-party No-Fault benefits for medical services provided, plus attorneys' fees and statutory interest. The Defendant insurance company moved for summary judgment dismissing the Plaintiff's complaint on the ground that they timely paid the Plaintiff's claim according to the applicable fee schedule. The main issue decided was whether the Plaintiff properly applied the fee schedules in billing for the services provided, and whether Plaintiff's cross-motion for summary judgment on its claim against Defendant was justified. The court held that Defendant's motion for summary judgment dismissing Plaintiff's complaint was denied, and Plaintiff's cross-motion for summary judgment on its claim against Defendant was also denied.

The main issue in this case was whether the insurer, GEICO General Ins. Co., was entitled to summary judgment dismissing the complaint brought by Chi P&L Acupuncture, P.C. as the assignee of several individuals, on the ground that the plaintiff failed to appear for duly scheduled examinations under oath. The relevant facts considered by the court were that the plaintiff was seeking to recover assigned first-party no-fault benefits, and the defendant sought to dismiss the complaint based on the plaintiff's failure to appear for examinations under oath. The court ultimately held that, for the reasons stated in a related case, the order denying the defendant's motion for summary judgment was affirmed. Therefore, the defendant's motion for summary judgment dismissing the complaint was denied, and the order, insofar as appealed from, was affirmed.

The court considered an appeal from an order of the Civil Court denying the defendant's motion for summary judgment to dismiss the complaint by a provider seeking first-party no-fault benefits. The issue was whether the defendant's motion had established that the plaintiff had failed to appear for scheduled examinations under oath (EUOs) and whether the defendant had timely denied the plaintiff's claims after the plaintiff's failure to appear for the EUOs. The holding was that the defendant's motion failed to demonstrate that it was not precluded from raising its defense, and thus the motion for summary judgment dismissing the complaint was properly denied. The order was affirmed, and the decision was made on July 15, 2022.

The court considered the fact that the defendant, GEICO General Insurance Company, had sought to dismiss the complaint on the grounds that the plaintiff, Chi P&L Acupuncture, P.C., had failed to appear for scheduled examinations under oath. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the order denying the defendant's motion for summary judgment was affirmed, with the court stating that for the reasons stated in a similar case, the order was affirmed.