No-Fault Case Law

The issue in this case was whether the causes of action brought by Ahmed Medical Care, P.C. against State Farm Mutual Automobile Ins. Co. were barred by the doctrine of res judicata due to a prior declaratory judgment action brought by State Farm against Ahmed. The court considered the dates of services provided by Ahmed to its assignor, Sigmund October, and the date of the motor vehicle accident that resulted in the injuries. State Farm argued that the causes of action were precluded by the prior declaratory judgment, which declared that Ahmed had no right to receive payment from State Farm for any claims set forth in the chart attached to the Supreme Court complaint. The court held that the causes of action (1), (2), (3), (4) and (6) were indeed barred under the doctrine of res judicata, concluding that any judgment in favor of Ahmed in this action would destroy or impair rights or interests established by the prior declaratory judgment. Therefore, the court affirmed the decision of the Civil Court to grant State Farm's motion for summary judgment dismissing those causes of action.

The case involves a dispute between Ahmed Medical Care, P.C. (Ahmed) and State Farm Mutual Automobile Ins. Co. (State Farm) over $892.14 in assigned first-party no-fault benefits for services provided to their assignor, Celeste October, after a motor vehicle accident. State Farm moved for summary judgment to dismiss certain causes of action, claiming they were barred by the doctrine of res judicata and/or collateral estoppel due to a previous declaratory judgment issued by the Supreme Court. The court granted State Farm's motion to dismiss causes of action (1), (2), (4) and (6), and also granted Ahmed's cross motion for summary judgment with respect to causes of action (3) and (5). Ahmed appealed the decision, but the Appellate Term affirmed the lower court's decision, citing a similar case with Sigmund v State Farm Mut. Auto. Ins. Co. as precedent.

The court considered a dispute involving a no-fault insurance arbitration award. The central issue revolved around the interpretation of the phrase "incorrect as a matter of law" in 11 NYCRR 65-4.10(a)(4) within the context of substantive versus evidentiary matters. The court held that this phrase should be limited to substantive issues, excluding evidentiary considerations. It emphasized that procedural or factual errors during arbitration were not grounds for review under this provision. The court discussed relevant case law, distinguishing between issues of law and matters related to the admissibility or evaluation of evidence. Ultimately, the court denied the petitioner's request to vacate the arbitration award, finding no grounds such as corruption, fraud, or procedural defects.

The court considered the facts surrounding an insurance dispute arising from an accident in which Melito Bonilla was injured as a passenger in a parked car. Plaintiffs, Liberty Mutual Insurance Company and LM General Insurance Company, sought a declaratory judgment that they did not owe no-fault coverage for Bonilla's medical fees because he failed to appear for an examination under oath (EUO) as required by his insurance policy. Two of Bonilla's medical providers, who are defendants in the case, also brought eight separate actions seeking payment for treatment of Bonilla's injuries from Liberty. The main issue decided was whether the plaintiffs' motion to consolidate Bonilla's case with the eight separate Civil Court actions was improvidently denied. The holding of the court was that it was an improper exercise of discretion to deny the motion to consolidate, as the issue of Bonilla's failure to submit to the EUO and whether that entitled Liberty to disclaim coverage would affect the outcome of each case, and there was a risk of inconsistent verdicts and multiple trials if the actions were not consolidated.

The court considered the lower arbitrator's award in favor of Refill Rx Pharmacy, Inc., as assignee of Kimberly Rosas, against Country-Wide Insurance Company, in the amount of $2,715.48, and denied respondent's cross motion for attorneys' fees. The main issue decided was whether the lower arbitrator exceeded his power by issuing an award exceeding the contractual limit for the subject no-fault coverage policy of $50,000, and whether the master arbitrator erred in affirming. The holding of the court was that vacatur of the award was warranted under CPLR 7511 (b) (1) (iii) as the lower arbitrator exceeded his power by issuing an award exceeding the contractual limit for the subject no-fault coverage policy of $50,000. Moreover, the court found that Country-Wide properly exhausted the policy prior to the underlying arbitration, and Refill was not entitled to attorneys' fees.

The court considered the appeal from an order of the Civil Court of the City of New York, Kings County, which denied the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the action by the provider to recover assigned first-party no-fault benefits was barred by the statute of limitations. The holding of the court was that the order denying the defendant's motion for summary judgment was affirmed, with $25 costs. The court affirmed the order based on the reasons stated in New Millennium Med. Imaging, P.C. v GEICO, and the justices concurred with the decision.

The main issue in this case was whether the defendant insurer was entitled to summary judgment dismissing the complaint filed by the plaintiff chiropractic healthcare provider, who sought to recover first-party no-fault benefits. The court considered the fact that the insurer had twice demanded the plaintiff to appear for examinations under oath (EUOs), and that the plaintiff had twice failed to appear, as well as the timely denials of the claims issued by the insurer. The court found that the insurer had established its prima facie entitlement to summary judgment, and that the only remaining issue for trial was the reasonableness of the insurer's EUO requests. The holding of the case was that the order denying the insurer's motion for summary judgment was reversed, and the insurer's motion for summary judgment dismissing the complaint was granted. The court found that the plaintiff had failed to raise a triable issue of fact, and therefore the insurer was entitled to summary judgment.

The court considered a motion to dismiss a declaratory judgment action and a motion for a protective order in a case where plaintiffs sought to make a declaration regarding the eligibility of defendants to recover no-fault benefits under relevant policies. The main issues decided were whether proper causes of action for declaratory judgment had been stated and whether the court should exercise its discretion to dismiss the claims, grant a protective order, or sever the claims into separate actions. The court held that plaintiffs had stated proper causes of action for declaratory judgment and that their request for a declaration regarding the eligibility of defendants to recover no-fault benefits constituted a justiciable controversy. The court also held that it properly declined to dismiss the claims, grant a protective order, or sever the claims, and declined to dismiss the claims that had also been asserted by the defendants in separate Civil Court actions.

The main issue in this case was whether the provider was entitled to recover first-party no-fault benefits, despite failing to appear for scheduled examinations under oath (EUOs). The court considered the fact that the defendant had filed a motion for summary judgment, arguing that the plaintiff had failed to appear for the EUOs and had therefore forfeited their right to the benefits. The court also considered the plaintiff's cross motion for summary judgment. The court held that the defendant's motion failed to establish that the claims had been timely denied after the assignor's failure to appear for the EUOs. Therefore, the defendant's motion for summary judgment was denied. However, the plaintiff also failed to demonstrate their entitlement to summary judgment, as they did not establish that the claims had not been timely denied, or that the denial of claim forms issued by the defendant were without merit. Therefore, the court modified the order to deny the defendant's motion for summary judgment, but also denied the plaintiff's cross motion for summary judgment.

The relevant facts considered in this case were that MSB Physical Therapy, P.C. was seeking to recover assigned first-party no-fault benefits from Nationwide Ins. The main issue decided was whether defendant was entitled to summary judgment dismissing the complaint on the ground that plaintiff had failed to appear for scheduled examinations under oath (EUOs). The holding of the case was that the defendant had failed to establish that it had timely denied plaintiff's claims after plaintiff's failure to appear for an EUO, and therefore defendant's motion for summary judgment dismissing the complaint was properly denied. The court also found that the defendant's papers were insufficient to demonstrate that there is a triable issue of fact as to its EUO no-show defense, and therefore plaintiff's cross motion for summary judgment was affirmed.