No-Fault Case Law

The court considered the plaintiff's appeal from an order granting the defendant's motion for summary judgment dismissing the complaint. Defendant's submissions established that they timely and properly denied plaintiff's no-fault claims due to excessive fees. Plaintiff failed to raise a triable issue regarding the denial forms or fee calculations. The court held that the denial of one of plaintiff's claims was timely, but there were remaining triable issues regarding other claims. Defendant's argument about reimbursement for moxibustion and infrared treatment was found unpersuasive. The court ultimately modified the order by reinstating plaintiff's claim for first-party no-fault benefits billed under specific CPT codes, and affirmed the order with this modification.

The Appellate Division, Second Department, reviewed a trial court's judgment in a case involving an automobile accident wherein a claim for no-fault benefits was filed with Hereford Insurance Company. The court held that the plaintiff was eligible for unpaid basic no-fault benefits in the amount of $50,000, but that the defendant's contention regarding the plaintiff's eligibility for excess no-fault coverage was not properly preserved for appellate review. The court also noted that the judgment awarding compound interest on the unpaid no-fault benefits was in error. The case was remitted to the trial court for recalculation of interest by applying simple interest at the rate of 2% per month. The main issues decided revolved around whether the plaintiff was eligible for basic and excess no-fault benefits, as well as the type of interest that should accrue on the unpaid benefits. The court ultimately decided that the plaintiff was eligible for $50,000 in unpaid basic no-fault benefits, but that the defendant did not preserve its contention regarding excess no-fault coverage. The court also held that compound interest was awarded in error, and instructed the trial court to recalculate interest on the unpaid benefits.

The main issue in the American Commerce Insurance Company v Francois case was whether the plaintiff was entitled to a temporary restraining order and preliminary injunction in order to prevent all no-fault actions arising from a car accident involving its insured. The court considered the plaintiff's argument that it would suffer imminent harm and that the injuries it would sustain would not be compensable by money damages. Additionally, the plaintiff claimed that it had a likelihood of success on the merits of its cause of action. The court found that the plaintiff failed to establish a likelihood of success on the merits, failed to demonstrate imminent harm, and did not show that its injuries would not be compensable by money damages. Therefore, the holding of the court was that the plaintiff's motion for a temporary restraining order and a preliminary injunction was properly denied.

The relevant facts considered by the court were that plaintiff sought to recover assigned first-party no-fault benefits for services provided to its assignor, who was injured in a motor vehicle accident. Defendant had previously obtained a declaratory judgment in Supreme Court, New York County, finding that defendant had no obligation to pay no-fault benefits to plaintiff and its assignors arising from the accident. Plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint on the grounds of res judicata and collateral estoppel due to the prior Supreme Court order. The main issue decided was whether the instant action was barred under the doctrine of res judicata by virtue of the prior Supreme Court order, and the court held that it was. The court found that to hold otherwise could result in a judgment that would impair rights established by the prior order and that the prior order was a conclusive final determination, despite being entered on default. Therefore, the court affirmed the order of the Civil Court, denying plaintiff's motion and granting defendant's cross motion for summary judgment.

The court considered the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the action is barred by the doctrines of res judicata and collateral estoppel, in light of a previous case involving the same plaintiff and defendant. The court held that the action is indeed barred by the doctrines of res judicata and collateral estoppel, affirming the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint.

The court considered that the defendant had timely mailed initial EUO and IME requests and subsequently mailed timely follow-up requests, tolling its time to pay or deny the claims. The plaintiff's assignor failed to appear for duly scheduled chiropractic/acupuncture IMEs and orthopedic IMEs, as well as EUOs. The main issue decided was whether the insurer was entitled to summary judgment dismissing the complaint on the ground of the assignor's failure to appear for properly scheduled IMEs and EUOs. The holding of the case was that the insurer was not precluded from raising its defenses, and therefore, established its prima facie entitlement to summary judgment dismissing the complaint. The court reversed the order and granted the defendant's motion for summary judgment.

The relevant facts considered by the court were that the plaintiff was involved in an accident while operating a vehicle owned by a nonparty who had purchased an insurance policy from the defendant. The complaint alleged that the insurance policy provided for the payment of no-fault benefits, that the plaintiff had timely notified the defendant of the accident, and that the defendant had refused to pay the submitted bills. The main issue decided by the court was whether the complaint was sufficient to state a claim of indebtedness, and whether the plaintiff should be granted leave to serve an amended complaint. The holding of the court was that the complaint stated a cognizable cause of action and gave the defendant notice of the transactions intended to be proved. The court also affirmed the decision to grant the plaintiff's cross motion for leave to amend the complaint to supplement the pleading.

The case involved the appeal of the denial of a previous order of the Civil Court, in which the defendant sought to resettle part of a prior order that had decided a motion and cross motion for summary judgment. Specifically, the defendant sought to remove a notation on the prior order that stated that the order was made on "consent" and is "not appealable", or for alternative relief. The defendant argued that having the order marked as being made on "consent" could limit its ability to appeal, and provided evidence that the order was not made on "consent". The court found that the defendant's claim was made on personal knowledge and was not contradicted, and therefore, the court reversed the order and granted the branch of defendant's motion seeking to resettle the prior order. The main issue decided by the court was whether to allow the defendant's motion to resettle part of the prior order, and the court ultimately ruled in favor of the defendant, granting the motion. The holding of the court was that the order entered on January 10, 2013 was reversed, without costs, and that the branch of defendant's motion seeking to resettle the order entered September 15, 2010 so as to delete the notation on that order stating that it was made on "consent" and is "not appealable" was granted.

The relevant facts in this case were that the plaintiff, A.B. Medical, PLLC, had filed a motion to vacate a prior order granting the defendant's motion for summary judgment on default. The plaintiff's motion was denied by the Civil Court, and the plaintiff then appealed from this decision. The main issue decided was whether the plaintiff had a reasonable excuse for its default in failing to timely submit written opposition to the defendant's motion for summary judgment. The court held that the plaintiff failed to demonstrate a reasonable excuse for the default, as the plaintiff's attorney's explanation of a heavy workload amounted to mere neglect and was not accepted as an excusable default. Additionally, the plaintiff's attorney offered no reason for waiting almost 10 months to move to vacate the default order. Therefore, the order denying the plaintiff's motion was affirmed.

The main issue in this case was whether plaintiff, LMS Acupuncture, P.C., was entitled to recover first-party no-fault benefits for services provided to Kashif Edwards due to injuries sustained in a car accident. The court considered the fact that defendant, American Transit Insurance Company, had filed a declaratory judgment action in Supreme Court seeking a declaration that the defendants were not entitled to no-fault benefits. The Supreme Court granted this motion on default, which then caused the Civil Court to deny plaintiff's motion for summary judgment. Based on the doctrine of res judicata, the court held that the Civil Court action was barred by the Supreme Court's determination in the declaratory judgment action. The court also found that the record supported the granting of summary judgment in favor of the defendant, and therefore affirmed the decision of the Civil Court and awarded summary judgment dismissing the complaint to the defendant.