No-Fault Case Law

The main issues in the case were whether the plaintiff had failed to appear for scheduled examinations under oath (EUOs) and if the defendant's motion for summary judgment dismissing the complaint should be granted. The court considered the evidence submitted by the defendant, including an affirmation by an attorney who was assigned to conduct the EUOs of the plaintiff. However, the plaintiff argued that the defendant's motion should be denied because there was no proof that the defendant's counsel was present on the dates of the scheduled EUOs. The court held that the defendant's motion for summary judgment should be denied because the defendant failed to submit proof by someone with personal knowledge of the nonappearance of the plaintiff for the EUOs. Additionally, the court held that the plaintiff's cross motion for summary judgment was properly denied because the plaintiff failed to show that it had appeared for either of the EUOs. Therefore, the court modified the order by providing that the defendant's motion for summary judgment dismissing the complaint is denied.

The court considered the appeal of a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the provider's motion for summary judgment should have been granted. The court held that the plaintiff failed to establish its entitlement to judgment as a matter of law, as it did not show that the defendant had failed to deny the claim within the 30-day period required by law or that the denial of claim was conclusory, vague, or without merit. Therefore, the court affirmed the lower court's order denying the motion for summary judgment.

The relevant facts considered by the court included the plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits, and the defendant's cross motion for summary judgment dismissing the complaint based on the plaintiff's assignor's failure to appear for examinations under oath (EUOs). The main issue decided was whether the defendant had timely and properly denied the claim based on the assignor's failure to appear for scheduled EUOs. The holding of the court was that the defendant had demonstrated that the EUO scheduling letters had been timely mailed and that the assignor had failed to appear for the scheduled EUOs, which was a failure to comply with a condition precedent to coverage. Therefore, the defendant was entitled to summary judgment dismissing the complaint. The court affirmed the order, with $25 costs.

The court considered the denial of a provider's motion for summary judgment and the granting of the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had established its entitlement to summary judgment dismissing the complaint based on the nonappearance of the plaintiff's assignor for independent medical examinations (IMEs). The court held that the defendant had failed to establish its entitlement to summary judgment because the affirmation from the doctor who was to perform the IMEs did not demonstrate the nonappearance of the assignor. However, the court also held that the plaintiff had failed to demonstrate its entitlement to summary judgment as the affidavit submitted by plaintiff failed to establish that the claim at issue had not been timely denied or that the defendant had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. Therefore, the court modified the order to provide that the defendant's cross motion for summary judgment dismissing the complaint is denied.

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 issues decided were whether the defendant's cross-motion seeking summary judgment dismissing the third cause of action should have been denied, and whether the plaintiff was entitled to summary judgment upon its third cause of action. The holding of the case was that the branch of defendant's cross motion seeking summary judgment dismissing the third cause of action was denied and the branch of plaintiff's motion seeking summary judgment upon its third cause of action was properly denied.

The court considered the plaintiff's failure to move for entry of a default judgment within one year, as required by CPLR 3215(a). However, the court exercised its discretion to deny the defendant's motion to dismiss the complaint as abandoned pursuant to CPLR 3215(c). The main issue decided was whether the plaintiff demonstrated a meritorious cause of action for assigned first-party no-fault benefits and if the defendant was prejudiced by the plaintiff's delay. The holding of the case was that the court affirmed the order denying the defendant's motion to dismiss the complaint as abandoned, as the plaintiff demonstrated a meritorious cause of action and the defendant was not prejudiced by the plaintiff's delay.

The relevant facts the court considered were that the plaintiff was seeking to recover assigned first-party no-fault benefits from the defendant insurance company. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's alleged failure to appear for scheduled examinations under oath (EUOs). The court held that the defendant failed to establish its entitlement to summary judgment as a matter of law because it did not provide sufficient evidence that the plaintiff had failed to appear for both EUOs. As a result, the court reversed the order granting the defendant's motion for summary judgment and denied the motion, with costs.

The court considered whether defendant state wide insurance company could proactively invoke collateral estoppel to bar a medical service provider from recovering no-fault benefits due to a finding of fraudulent incorporation. In the previous trial, after it was found out that the corporations were not owned or controlled by licensed acupuncturists and their services were performed by independent contractors in violation of New York law, the plaintiff had a full and fair opportunity to contest the prior issue. The holding of the the case was that the plaintiff party could invoke the common-law doctrine of collateral estoppel to preclude the defendants from relitigating in a subsequent proceeding an issue clearly raised in a prior action and decided against the party or those in privity. This is significant in a subsequent proceeding whether or not the causes of action are the same, provided that the cause of action is similar.

In the case above, the main issue was whether the defendant made a showing of entitlement to summary judgment dismissing the action for first-party no-fault benefits. The court found that the defendant-insurer had properly mailed the notices for chiropractic/acupuncture independent medical examinations (IMEs) to plaintiff's assignor and that the assignor failed to appear. The plaintiff had claimed that the defendant was not entitled to request the IMEs prior to its receipt of plaintiff's claim forms, but the court found that was not the case. As a result, the court ruled in favor of the defendant, reversing the lower court's order and granting the motion for summary judgment, thereby dismissing the complaint.

The court considered the defendant-insurer's motion for summary judgment to dismiss the complaint regarding first-party no-fault benefits and the assignor's failure to appear for independent medical examinations (IMEs). The main issue was whether the defendant had established a prima facie showing of entitlement to summary judgment by proving timely and proper mailing of the IME notices and the assignor's nonappearance, and whether the plaintiff raised a triable issue in opposition. The holding was that the defendant had indeed made a prima facie showing and the plaintiff did not specifically deny the assignor's nonappearance or raise a triable issue, therefore the defendant's motion for summary judgment was granted and the complaint was dismissed.