No-Fault Case Law
Berenblit v Country Wide Ins. Co. (2025 NY Slip Op 50487(U))
March 21, 2025
The provider's delay in entering judgment on an unpaid settlement did not justify tolling statutory no-fault interest. Under CPLR 5003-a, the insurer owed payment after settlement without a demand, and it did not show that the provider prevented payment. The Appellate Term, Second Department, reversed the judgment, insofar as appealed from, vacated the denial of the provider's CPLR 5019 (a) correction motion and the interest toll, granted the motion, and remitted for a new judgment. Because the claim preceded April 5, 2002, former 11 NYCRR 65.15 (h) required interest compounded at 2% monthly. Insurance Law § 5106 (a) and that regulation also superseded CPLR 5004's general postjudgment rate.
Unitrin Safeguard Ins. Co. v Manuel (2025 NY Slip Op 01727)
March 20, 2025
The insurer established a founded belief that the claimants' injuries did not arise from the reported accident. An investigator's affidavit identified suspicious circumstances; adverse-vehicle occupants described a bumper tap and stated that the insured vehicle had no passengers. The insurer also identified credibility concerns in the claimants' EUOs. The providers offered no admissible evidence rebutting that showing, and the claimants' defaults were treated as admissions that their EUO accounts were false and their injuries unrelated to the accident. The providers' prematurity argument failed under CPLR 3212 (f) because they did not show necessary evidence was exclusively within the insurer's possession or further attempts to obtain it. The Appellate Division, First Department, affirmed summary judgment declaring no duty to pay the providers' claims.
Pedro Torres-Jimenez MD, P.C. v American Access Cas. Co. (2025 NY Slip Op 50358(U))
March 13, 2025
The provider's default judgment motion failed because Vehicle and Traffic Law § 253 did not authorize service on the out-of-state insurer. The Civil Court, Kings County, denied the unopposed motion under CPLR 3215 and 320 and dismissed the assigned no-fault action without prejudice. The service affidavit invoked Vehicle and Traffic Law § 253, which addresses nonresident owners or operators involved in New York motor vehicle accidents. The Illinois insurer was neither a nonresident operator nor a nonresident owner within that provision. Because the defect appeared on the affidavit's face, the court resolved service as a matter of law without a traverse hearing and found personal jurisdiction lacking.
American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C. (2025 NY Slip Op 01337)
March 12, 2025
Separate master arbitration awards cannot be combined to meet the $5,000 threshold for de novo review of no-fault claims. The insurer sought review of four awards for separately billed chiropractic treatments, each below the threshold. Under Insurance Law § 5106 (c) and 11 NYCRR 65-4.10 (h) (1) (ii), a single award must reach $5,000, exclusive of interest and attorney's fees. The statutory language and legislative purpose did not permit aggregation despite common parties, services and arbitrator. The Appellate Division, Second Department, reversed, granted the provider's motion under CPLR 3211 (a) (2) to dismiss for lack of subject matter jurisdiction, awarded attorney's fees under 11 NYCRR 65-4.10 (j) (4), and remitted for determination of the reasonable fee.
Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C. (2025 NY Slip Op 01363)
March 12, 2025
The provider was entitled to attorney's fees after defeating the insurer's petition to vacate its arbitration award. The Supreme Court, Kings County, denied the insurer's CPLR article 75 petition and confirmed the award, but denied the provider's request for attorney's fees. Insurance Law § 5106 (a) permits recovery of reasonable fees for securing payment of overdue no-fault claims, and 11 NYCRR 65-4.10 (j) (4) requires the court to fix fees for a court appeal from a master arbitration award. The Appellate Division, Second Department, reversed the order and judgment, insofar as appealed from, granted the provider's fee request, and remitted for determination of the reasonable fee.
Big Apple Delivery Supply Corp. v Plymouth Rock Assur. Corp. of N.Y. (2025 NY Slip Op 50315(U))
March 11, 2025
Electronically signed peer review reports are admissible when properly subscribed and affirmed under CPLR 2106. The Civil Court, Richmond County, granted the insurer summary judgment dismissing both assigned no-fault claims for lack of medical necessity. Applying State Technology Law §§ 302 (3) and 304 (2), the court treated the electronic signatures as subscribed writings; the reports' penalty-of-perjury language satisfied the then-applicable affirmation requirement. The insurer also established timely mailing of denials through evidence of its processing and mailing procedures. The provider offered no affirmation or testimony rebutting the peer reviews' medical conclusions. The court did not reach the fee-schedule or policy-exhaustion defenses.
Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50306(U))
March 7, 2025
The insurer's verification requests for records bearing on the provider's licensing eligibility were proper. The requests sought management agreements, W-2 forms, business bank records and leases to assess eligibility under 11 NYCRR 65-3.16 (a) (12) and Mallela. The Appellate Term, Second Department, affirmed the order granting the insurer summary judgment dismissing the complaint and denying the provider's cross motion for summary judgment and separate motion to dismiss affirmative defenses. Denial of the insurer's summary judgment motion in a declaratory judgment action had no preclusive effect because it was not a final determination on the merits. The court did not reach the provider's amended cross motion because the appealed order had not addressed it.
KBJ Med. Practice, P.C. v Lancer Ins. Co. (2025 NY Slip Op 50277(U))
March 3, 2025
The insurer established the assignor's EUO nonappearance but failed to eliminate factual issues concerning mailing of the notices. On the insurer's CPLR 3212 (b) motion, the Civil Court, Bronx County, found that counsel's mailing submissions lacked demonstrated personal knowledge and conflicted with the attached notices concerning certified mailing. The examiner's description of office procedures did not ensure that notices were properly addressed and mailed. A certified transcript from a noninterested reporter and counsel's affidavit of personal knowledge established nonappearance. The court granted the motion only to establish that fact and left proper mailing for trial.
Medical Supply of NY Servs. Inc. v State Farm Mut. Auto Ins. Co. (2025 NY Slip Op 50301(U))
February 21, 2025
The insurer's reargument motion was denied because its attorney's affidavit failed to establish personal knowledge of the EUO nonappearance. The Civil Court, Richmond County, left standing its denial of summary judgment based on the assignor's alleged failure to attend two EUOs. Under CPLR 2221, the affidavit had not been overlooked: it stated only that the attorney placed a default statement on the record, without stating that the attorney was present at the scheduled time and location. The nonappearance assertion was therefore conclusory hearsay. The default transcript also lacked an admissibility foundation under CPLR 3116 and 3117 and could not establish the attorney's presence or the assignor's nonappearance.
Rombom v Liberty Mut. Ins. Co. (2025 NY Slip Op 25040)
February 14, 2025
An insurer's filing of a discontinuance without paying the settlement did not bar judgment under CPLR 5003-a (e). The Appellate Term, Second Department, reversed the order vacating the provider's default judgment under CPLR 5015 (a) (4), denied that branch, and remitted the remaining branches for determination. The provider had tendered an executed release and stipulation, which the insurer filed without paying the settlement. Under CPLR 5003-a (a) and (e), failure to pay within 21 days of tender permits entry of judgment without further notice. Tender of the stipulation is a condition of that relief, and its filing here did not eliminate jurisdiction. Discretionary vacatur under CPLR 5015 (a) (1) remained undecided.