No-Fault Case Law

The court considered several relevant facts, including that the plaintiff, Trinity Medicine, P.C., was seeking first-party no-fault benefits for medical services provided to its assignor due to a motor vehicle accident. The defendant, National General Insurance Company, failed to serve its answer after being served the summons and complaint in December 2020. Upon the plaintiff's attempt to obtain a default judgment, the defendant moved to open its default, claiming a reasonable excuse for the delay due to a clerical oversight and asserting a meritorious defense based on a previous declaratory judgment that indicated no coverage was owed due to the nature of the accident. The main issues were whether the defendant had a reasonable excuse for its default and whether it had a potentially meritorious defense. The court held that the defendant provided a reasonable excuse for its default and demonstrated a potential meritorious defense related to res judicata, affirming the lower court's decision to allow the defendant to file a late answer and denying the plaintiff's motion for summary judgment.

The court considered the case where Quick Health Pharmacy Corp. sought to vacate a master arbitrator's award denying its claim for first-party no-fault benefits of $1,454.70. The initial judgment awarded Quick Health a sum including interest and a specific amount for attorney's fees, but the appellant argued that this fee was inadequate given the circumstances. The main issues decided included whether the awarded attorney's fees complied with regulatory requirements and if they accurately reflected the fees incurred during the arbitration and subsequent court proceedings. The holding reversed the previous judgment, determining that the calculation of attorney's fees was incorrect due to an improper application of a cap, and remitted the matter to the District Court for a new judgment to determine the reasonable attorney's fees entitled to Quick Health without the regulatory cap.

The court considered several relevant facts, including that the plaintiff established a prima facie case for recovery of first-party no-fault benefits, and that the defendant had timely denied the claim based on a lack of medical necessity. It was also stipulated that the insurance policy limits were exhausted after the denial due to the defendant's subsequent payments on other claims. The main issue decided was whether the defendant could rely on the exhaustion of policy limits from subsequent payments to avoid liability for the claim denied. The court held that the defendant's argument was without merit, affirming the judgment in favor of the plaintiff and awarding the claimed amount.

The court considered the facts surrounding a motor vehicle accident involving the assignor, Jose David Torres, who sustained injuries and for whom the plaintiff, Flatbush Acupuncture P.C., provided medical services and sought payment from Repwest Insurance Company. The key issues included whether the assignor's failure to appear for scheduled examinations under oath (EUOs) constituted a breach of a condition precedent for payment, and whether the insurer had a legitimate basis for requiring such examinations prior to making payment. The court ultimately decided that the insurer was justified in denying the claim due to the assignor's failure to attend the EUOs, which were deemed necessary under the relevant regulations. Consequently, the court granted the defendant's motion for summary judgment and denied the plaintiff's motion.

The court considered the facts surrounding a no-fault insurance claim, specifically focusing on Stacey Kapeleris's counterclaim against Allstate Insurance for benefits related to medical expenses. The main issues included whether the awarded amount of $25,109.88 for medical treatment was appropriate, as well as the reasonableness of the awarded attorneys' fees totaling $76,856.67. After a nonjury trial, the court found that Kapeleris incurred reasonable medical expenses and that her settlement with medical providers justified the amount claimed. Ultimately, the court affirmed the trial court's judgment in favor of the defendant, concluding that both the compensation for the medical expenses and the attorneys' fees were warranted.

The court considered facts surrounding a motor vehicle collision on April 15, 2019, in which the individual defendants, allegedly without reported injuries and no citations issued, sought medical treatment from the defendant medical providers. The plaintiffs, as no-fault insurance providers, denied claims for reimbursement made by the medical providers, which were assignees of the individual defendants, asserting that the individual defendants failed to complete required examinations under oath (EUOs) as a condition for coverage. The main issues decided included the justification for the EUOs and whether the defendants' noncompliance voided the insurance policy. The court held that the plaintiffs were justified in requesting the EUOs and that the individual defendants' failure to comply constituted a breach of a condition precedent to coverage, thereby affirming the denial of reimbursement claims.

The court considered the facts surrounding a no-fault benefits claim made by Trapezius Diagnostic Chiropractic, P.C. for medical services allegedly rendered due to injuries from a motor vehicle accident on November 4, 2017. Adirondack Insurance Exchange contended that the claim was barred by a prior declaratory judgment in which a different accident on November 14, 2017 was declared a "staged accident," relieving them of the obligation to provide coverage for related services. The primary issues decided included whether res judicata applied to bar the current claim and whether the evidence presented justifiably supported each party's motions for summary judgment. The court held that Adirondack failed to demonstrate that the current action was barred by res judicata, but also found that there was a material factual dispute regarding the date of the accident, thus denying Trapezius's cross-motion for summary judgment while affirming the denial of Adirondack's summary judgment motion.

The court considered several key facts in this case, including the timely mailing of examination under oath (EUO) scheduling letters by the defendant, State Farm, and the plaintiffs' failure to appear for two scheduled EUOs. The main issues decided included whether the defendant's denial of claims was timely and if the plaintiff had effectively rebutted the defendant's arguments regarding the denial of one particular bill, which was denied after a missed EUO. The court held that the defendant's denial was indeed timely, as the time to deny remained tolled due to the pending EUO request when subsequent bills were submitted. As a result, the court granted the defendant's cross-motion for summary judgment, denied the plaintiff's motion, and dismissed the case with prejudice.

The court considered relevant facts including the plaintiff's claim for unpaid medical bills incurred by the claimant, Edouard Eguelino, and the defendant's assertion that the claimant failed to appear for required Examinations Under Oath (EUO) and Independent Medical Exams (IME). The main issues decided included whether the defendant had adequately established the claimant's non-appearance for the EUOs and IMEs and whether Florida or New York law applied to the case. The court found that the defendant failed to provide sufficient evidence from a person with personal knowledge of the nonappearances, and therefore did not meet its burden for summary judgment. Ultimately, the court denied the defendant's motion for summary judgment, allowing the case to proceed to trial to determine the facts surrounding the claimant's alleged failure to comply with preconditions for reimbursement.

The court considered several key facts, including the plaintiff's claim for $558.02 in unpaid medical bills for services rendered to claimant Edouard Eguelino and the defendant's assertion that the claimant failed to appear for scheduled Examinations Under Oath (EUOs) and Independent Medical Exams (IMEs). The main issues decided included whether the defendant could successfully argue the lack of coverage due to the claimant's alleged non-appearance and whether Florida law or New York law applied to the case. The plaintiff's argument noted the relevance of New York law, given the treatment and the accident location. Ultimately, the court held that the defendant failed to establish a prima facie case for summary judgment, as it did not provide admissible evidence demonstrating the claimant’s failure to appear for the appointments, resulting in the denial of the defendant’s motion for summary judgment and allowing the case to proceed to trial.