No-Fault Case Law

The main issue in this case was an appeal from an order entered by the Civil Court of the City of New York, Queens County, denying the defendant's motion seeking summary judgment dismissing the complaint and granting the plaintiff's cross motion seeking summary judgment with respect to the reimbursement for services rendered between December 2008 and February 2009. The court determined that the affidavit submitted by plaintiff was sufficient to establish plaintiff's prima facie entitlement to summary judgment with respect to the services at issue. Additionally, the defendant failed to demonstrate that its denials were timely with respect to the bills at issue, and based on relevant regulations, defendant was required to deny each of the bills at issue within 30 days of receipt or 30 days after a specific date. The court affirmed the order and awarded $25 in costs.

The case involved a dispute over first-party no-fault benefits for medical services provided by Starlite Acupuncture, P.C. as assignee of Fatima Horton. Starlite Acupuncture moved for summary judgment, claiming that it had mailed three bills to Praetorian Ins. Co. on March 5, 2010, and that the defendant had not timely paid or denied them. Defendant claimed that it had received one bill on April 5, 2010, and the other two on October 8, 2010, and that it had timely denied the bills due to the assignor's failure to appear for scheduled examinations under oath and independent medical examinations. The court found that defendant had not rebutted plaintiff's showing that the bills had been submitted and not timely denied, and therefore, plaintiff was entitled to summary judgment on the first and second causes of action. However, with a triable issue of fact regarding when the defendant received the bill for the third cause of action, the branch of defendant's cross motion seeking summary judgment to dismiss it was denied. The court also rejected plaintiff's argument for a protective order. The decision was modified to grant summary judgment to plaintiff on the first and second causes of action and deny defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that the defendant had submitted affidavits from the president of the company responsible for scheduling independent medical examinations (IMEs), as well as affidavits from the healthcare professionals who were to perform the IMEs, which established that the plaintiff's assignor had failed to appear for the duly scheduled IMEs. The court also considered an affidavit executed by the defendant's claims examiner, which described the standard mailing practices and procedures to establish the timely mailing of the denial of claim form. The main issue decided was whether defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the case was that since an assignor's appearance at an IME is a condition precedent to the insurer's liability on the policy, the defendant's motion for summary judgment dismissing the complaint should have been granted. Therefore, the court reversed the order and granted defendant's motion for summary judgment dismissing the complaint.

The relevant facts in this case involve a taxi insured by Fiduciary Insurance Company that was involved in a collision with a horse, causing serious injuries. Fiduciary then sought reimbursement of the no-fault benefits paid to the rider from American Bankers Insurance Company of Florida, the carrier that provided commercial liability coverage to the stables where the horse was boarded. The main issue decided was whether American Bankers was an insurer subject to the mandatory arbitration provisions of Insurance Law § 5105, given the accident involving a horse and not a motor vehicle. The court held that American Bankers did not meet the definition of an insurer or self-insurer under the No-Fault Law and its regulations, and thus, the claims against it were not subject to compulsory arbitration. Therefore, the court affirmed the order denying the petition to vacate the arbitrator's award and granting the cross petition to confirm the award.

The relevant facts the court considered in this case were that Delta Diagnostics Radiology, P.C. (the plaintiff) filed a lawsuit to recover assigned first-party no-fault benefits from Delos Insurance Company (the defendant). The defendant served demands for discovery, including a notice for a deposition of the plaintiff, but the plaintiff failed to appear for the deposition scheduled by the defendant. The defendant then moved to compel the plaintiff to appear for a deposition, but the Civil Court denied the defendant's motion on the ground that the defendant had failed to proffer an affidavit from an investigator in support of its motion. The main issue decided by the court was whether the Civil Court properly exercised its discretion in denying the defendant's motion to compel the plaintiff to appear for a deposition. The holding of the case was that the Civil Court did not improvidently exercise its discretion in denying the defendant's motion to compel the plaintiff to appear for a deposition. Therefore, the order was affirmed.

The main issues in this case involved a dispute over the disclosure of the plaintiff's assignor's treating provider for a deposition in a first-party no-fault benefits action. The court considered the arguments made by the plaintiff that the disclosure was stayed under CPLR 3214(b) and that the notice to take the deposition was palpably improper. The court held that under CPLR 3101(a), parties are entitled to full disclosure of all material and necessary matter in the prosecution or defense of an action, and in this case, the deposition of the treating provider was deemed to be material and necessary to the defendant's defense. As a result, the court affirmed the order that compelled the plaintiff's treating provider to appear for a deposition and denied the plaintiff's cross motion for a protective order and sanctions.

The court considered the appeal from an order of the Civil Court, Queens County, which denied the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant's motion for summary judgment was untimely, as it was not made within 60 days of the filing of the notice of trial, as required by the rules of Part 41 of the Civil Court. The holding of the case was that the Civil Court properly denied the defendant's motion as untimely, as they failed to offer any explanation for the delay. The appellate court affirmed the order, stating that arguments or factual assertions raised for the first time on appeal were not considered.

The court considered a provider's appeal to recover assigned first-party no-fault benefits and whether the action was premature due to the provider's failure to provide verification as requested by the defendant insurance company. The main issue decided was whether the action to recover payment was premature when the provider had failed to respond to a request for verification. The court held that since a claim need not be paid or denied until all demanded verification is provided, any action to recover payment is premature when the provider has failed to respond to a request for verification. The court reversed the order and denied the defendant's motion for summary judgment dismissing the complaint, as the defendant did not demonstrate that it had not received the requested verification.

The relevant facts considered by the court in this case were that Acuhealth Acupuncture provided health services to an individual injured in a car accident, and Country-Wide Insurance Company denied payment for acupuncture services on the basis that the company was owned and controlled by a person who did not meet the licensing requirements necessary to perform such services in New York. The main issue decided was whether the Master Arbitrator's award should be vacated, and the holding of the court was that the award should not be vacated. The court found that the petitioner did not provide evidence to demonstrate that the arbitrators acted in any way that was against public policy, completely irrational, or manifestly exceeded a specific enumerated limit on the arbitrator's powers. Therefore, the motion to vacate or remand the arbitration award was denied, and the Master Arbitrator's award was confirmed.

The case involved an action for a judgement declaring that the plaintiff is not obligated to pay certain no-fault claims submitted to it by the defendants. The plaintiff argued that the collisions in question were staged as part of an insurance fraud scheme and therefore should not be covered. However, the plaintiff failed to provide evidence from someone with personal knowledge of the mailings of the deposition requests. Further, the police accident reports submitted were not admissible and an unsigned and unsworn deposition transcript was deemed inadmissible. The court found that the plaintiff failed to establish its prima facie entitlement to judgement as a matter of law, and reversed the judgement that had been in its favor.