No-Fault Case Law

The court considered the defendant's appeal from an order of the Civil Court of the City of New York, Bronx County, which denied its motion for summary judgment dismissing the complaint. The main issue was whether the defendant had established its entitlement to summary judgment dismissing the complaint based on the plaintiff's alleged untimely submission of the claims beyond the applicable 45-day time limit. The court held that the defendant had failed to meet its burden as it did not establish its regular practices and procedures in retrieving, opening, and indexing its mail and in maintaining its files on existing claims. Therefore, the denial of the defendant's motion was required, regardless of the sufficiency of the plaintiff's opposition papers. As a result, the court affirmed the order of the Civil Court, denying the defendant's motion for summary judgment.

In this case, American Transit Insurance Company sought a declaration that Jaga Medical Services, P.C. and other defendants were not entitled to a no-fault benefits due to the claimant's failure to appear for scheduled examinations under oath (EUO). The defendants-appellants argued that it was the responsibility of the plaintiff to request the EUO and demonstrate that it was properly scheduled and timely. The court considered these arguments and determined that the reason for the EUO request was essential to justify the opposition to plaintiff's summary judgment motion, and that such fact was exclusively within the knowledge and control of the movant. Therefore, further discovery on the plaintiff's handling of the claim was necessary to determine whether the EUOs were timely and correctly requested. Consequently, the underlying motion for summary judgment was denied, and the judgment was vacated.

The court considered a motion for summary judgment in an action by a medical supply company to recover assigned first-party no-fault benefits from an insurance company. The insurance company had timely mailed requests for additional verification and the main issue for trial was whether the medical supply company had served responses to the verification requests. The court found that the medical supply company failed to establish the absence of a material issue of fact and therefore was not entitled to summary judgment. The court affirmed the order denying the motion for summary judgment, as the medical supply company's remaining contentions were found to lack merit.

The main issue in this case was whether the insurance policy was fraudulently procured by the plaintiff's assignor, who allegedly misrepresented his address in order to obtain insurance at a lower premium. The court considered evidence in the form of the assignor's testimony at an examination under oath, as well as the insurer's investigator's report. The court concluded that the plaintiff's assignor's testimony failed to eliminate all material issues of fact as to whether he lived in Queens County, rather than the address he provided on the insurance policy. Additionally, the investigator's report was deemed insufficient to establish the assignor's actual residence during the relevant period. Because the defendant failed to make a prima facie showing that there were material misrepresentations made in order to obtain the insurance at reduced premiums, the court affirmed the denial of defendant's motion for summary judgment dismissing the complaint.

The relevant facts that the court considered in this case involved the service of process in a legal action to recover assigned first-party no-fault benefits. The plaintiff mailed a copy of the summons and complaint to the defendant in 2004, but the record did not contain the signed acknowledgment of receipt required by law. Rather, the defendant had served a verified answer asserting lack of personal jurisdiction and other defenses. Defendant subsequently moved to dismiss the complaint on the ground of lack of personal jurisdiction, which the Civil Court had denied. However, defendant's motion was untimely and the record indicated that the parties charted a summary judgment course, so the court decided to apply the standard applicable to motions for summary judgment. The main issue decided was whether personal jurisdiction was acquired over the defendant in the legal action brought by the plaintiff to recover no-fault benefits. The court found that the plaintiff failed to properly serve the defendant and it never acquired personal jurisdiction over the defendant. As a result, the court reversed the amended order and granted defendant's motion seeking summary judgment dismissing the complaint. The holding of the case was that, because the plaintiff failed to properly serve the defendant and acquire personal jurisdiction, the court reversed the amended order and granted defendant's motion for summary judgment dismissing the complaint. The court also took the opportunity to remind the Judge of the need to maintain the dignity and integrity of judicial opinion writing.

The relevant facts of the case are that Gaetane Physical Therapy, P.C. was seeking to recover first-party no-fault benefits from Great Northern Insurance Company as the assignee of Kevin Raymond. Great Northern Insurance Company moved for summary judgment to dismiss the complaint, arguing that there was a lack of medical necessity for the treatment at issue. In support of its motion, the defendant submitted an affirmed medical report by a doctor who had performed an orthopedic independent medical examination on their behalf, stating that there was a lack of medical necessity for the treatment. Plaintiff failed to raise a triable issue of fact as to medical necessity, as they did not offer any medical evidence to rebut the conclusions of the IME report. The main issue decided was whether the plaintiff had presented enough evidence to establish medical necessity for the treatment being sought. The court held that the plaintiff had failed to raise a triable issue of fact as to medical necessity, as they did not offer any medical evidence to rebut the conclusions of the IME report, and reversed the order denying the defendant's motion for summary judgment, granting the motion to dismiss the complaint.

The main issue in this case was whether the insurance company had the right to deny the plaintiff's claim for first-party no-fault benefits based on the failure of the plaintiff's assignor to appear for scheduled examinations under oath (EUOs). The court held that an appearance at an EUO is a condition precedent to the insurer's liability on the policy and that the insurer did not need to set forth any objective standards for requesting an EUO. The court found that the insurance company had established that it had timely denied the plaintiff's claims and that the plaintiff's objections regarding the EUO requests would not be heard as the plaintiff did not respond in any way to the requests. Therefore, the court reversed the order and granted the insurance company's motion for summary judgment dismissing the complaint.

The relevant facts the court considered were whether the denial of claim forms had been timely and properly mailed, as well as established medical necessity for the services in question. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted based on lack of medical necessity. The holding of the case was that the order denying the defendant's motion for summary judgment was affirmed, as the plaintiff provided a sufficient doctor's affirmation in opposition to raise a triable issue of fact as to whether the services were medically necessary.

The relevant facts the court considered were that Geico General Insurance Company (Geico) initiated a subrogation action against Class 1 Transport and Laurel E. Stone to recover the amount paid for property damage and loss of use of the insured's vehicle due to an accident. Prior to the commencement of this action, Geico had sought to recoup benefits from Daily Underwriters of America (DUOA) through mandatory loss-transfer arbitration, but the arbitrator determined that Geico was not entitled to recover because they had not proven any negligence on the part of DUOA's insureds. Defendants then moved for summary judgment dismissing the complaint based on collateral estoppel, arguing that the arbitrator's decision precluded Geico from litigating the action. The main issue decided was whether the AFI rule limiting the preclusive effect of the arbitrator's decision should be given effect, and whether this ruled precluded Geico from bringing the action against the defendants. The holding of the case was that the AFI rule limiting the preclusive effect of the arbitrator's decision was clear and unambiguous, and should be given effect. Therefore, defendants' motion for summary judgment dismissing the complaint on collateral estoppel grounds should have been denied. As a result, the judgment was reversed, the order entered on March 22, 2013 was vacated, and defendants' motion for summary judgment was denied.

The main issue in this case was whether the Civil Court properly denied defendant's motion to dismiss the complaint based on plaintiff's failure to prosecute the action. The court considered the fact that the plaintiff, a provider seeking to recover no-fault benefits, failed to comply with a 90-day demand and did not provide a justifiable excuse or demonstrate a meritorious cause of action. The court held that the plaintiff's failure to comply with the 90-day requirement warranted the dismissal of the case. The court also emphasized the importance of honoring the balance struck by the generous statutory protections built into CPLR 3216 and stated that plaintiff's lack of a valid excuse for non-compliance placed the culpability for the dismissal squarely at the plaintiff's door. As a result, the court reversed the order and granted the defendant's motion to dismiss the complaint.