No-Fault Case Law

The court considered the failure of the defendant to attend scheduled Independent Medical Examinations (IMES) as a basis for denying all of the defendants' claims for No-Fault benefits from the plaintiff insurance company. The defendants attempted to defeat the motion on the grounds that it was premature, the plaintiff failed to prove that letters were sent to the defendant, and that the plaintiff disclaimed too late. The court held that in order to defeat a motion for summary judgment, the defendant must come forward with legally admissible evidence, which the defendants failed to do in this case. The court also ruled that a late declining of coverage will not uphold rejection when the assignor has failed to appear at designated IMES, and awarded summary judgment against the answering defendants and default judgments against the non-appearing defendants. Therefore, neither defendant Miranda nor any of her assignees may recover from the insurer American Transit Insurance Company for the accident that occurred on December 8, 2008.

The main issues in this case were whether the Civil Court of New York had obtained jurisdiction over a defendant insurance company, and if the plaintiff was entitled to discovery to determine if there was proper jurisdiction. The defendant had submitted a certificate of conformity and an affidavit stating that they did not conduct business in New York, while the plaintiff argued that the certificate of conformity was inadmissible. The court ruled that the plaintiff had the burden of proving that jurisdiction had been properly obtained, and since the plaintiff failed to show that the defendant had any contacts with the City of New York, the Civil Court properly dismissed the complaint. Therefore, the order granting the defendant's motion to dismiss the complaint was affirmed.

The relevant facts considered by the court were that Westchester Medical Center, as the assignee of Gerard R. Brown, was seeking to recover first-party no-fault insurance benefits from New South Insurance Company. The main issue decided was that the District Court denied Westchester Medical Center's motion for summary judgment. The holding of the case was that the District Court properly determined that Westchester Medical Center was not entitled to summary judgment, as it had failed to establish the absence of a material issue of fact. The appellate court affirmed the order, without costs, and declined New South Insurance Company's request to award it summary judgment dismissing the complaint.

The court considered Interboro Insurance Company's motion for leave to enter a default judgment against all defendants and the cross motion of defendants-respondents KHL Acupuncture, P.C. and South Shore Osteopathic Medicine, P.C. to compel acceptance of their answers. The main issue decided was whether no-fault insurance coverage exists solely based on defendant Perez's failure to appear for an examination under oath (EUO). The holding of the court was that the motion court properly exercised its discretion in granting defendants-respondents' cross motion to compel plaintiff to accept their belated answers. It was also found that a meritorious defense is not required to obtain relief under CPLR 3012 (d). Furthermore, there was insufficient evidence that defendant Perez was properly notified of the EUOs, thus the motion court also properly denied plaintiff's motion for a default judgment.

The relevant facts the court considered involved a plaintiff seeking to recover first-party no-fault benefits under an insurance policy issued by the defendant. The plaintiff alleged that they had timely notified the defendant of an accident, but the defendant failed to pay the bills. The defendant moved to dismiss the complaint for failure to state a cause of action, arguing that the complaint was insufficient to state a claim of indebtedness. The main issue decided was whether the complaint stated a cognizable cause of action and gave the defendant notice of the transactions intended to be proved. The holding of the court was that the complaint was afforded a liberal construction and was determined to state a cognizable cause of action, and therefore the judgment to grant the defendant's motion to dismiss the complaint was reversed and the motion was denied.

The relevant facts the court considered were that the plaintiff commenced an action in 2006 to recover assigned first-party no-fault benefits, and the defendant defaulted. More than a year later, the plaintiff moved for leave to enter a default judgment, which was granted by the Civil Court. The main issue decided was whether the default judgment and the underlying order granting the plaintiff's motion should be vacated, and whether the complaint should be dismissed. The holding of the case was that while the defendant failed to demonstrate that the default judgment should be vacated pursuant to CPLR 5015 (a) (3), the dismissal of the complaint was required pursuant to CPLR 3215 (c) as the plaintiff failed to offer any excuse for its delay in moving for leave to enter a default judgment. Furthermore, the court exercised its inherent discretionary power to vacate judgments in situations that warrant vacatur but were not specifically codified in CPLR 5015 (a), and therefore granted defendant's motion to vacate the default judgment and dismiss the complaint.

The court considered the fact that plaintiff's assignor, a New Jersey resident, was injured in a motor vehicle accident. The vehicle was insured by a New Jersey automobile insurance policy issued to the assignor, which was to be interpreted "pursuant to the laws of the state of New Jersey." Plaintiff, a New York business entity, rendered medical services to the assignor in New York and submitted claims to defendant. Plaintiff subsequently commenced this action, alleging that payment of no-fault benefits on the 10 claims it had submitted to defendant was overdue and moved for summary judgment. In opposition to plaintiff's motion, defendant argued that New Jersey law controlled and that, under New Jersey law, plaintiff had failed to establish its prima facie entitlement to summary judgment. The main issues decided were whether the insurance policy provided for mandatory arbitration, and whether plaintiff was entitled to recover no-fault benefits. The holding of the case was that the insurance policy did not provide for mandatory arbitration, and the plaintiff failed to establish the medical necessity of the rendered services and failed to show that the defendant did not properly pay any claim within 60 days. As a result, the judgment was reversed, the motion for summary judgment was denied, and defendant's cross motion was granted.

The relevant facts in the case Mollo Chiropractic, PLLC v. American Commerce Insurance Company were that the plaintiff was attempting to recover assigned first-party no-fault benefits. The defendant appealed the judgment that had been awarded to the plaintiff. The defendant specifically declined to contest the finding that the plaintiff established its prima facie case. The court decided that the defendant did not raise a triable issue of fact based on the finding that the defendant did not establish the denial of claim form was issued in duplicate. The holding of the case is that the plaintiff's motion for summary judgment was denied.

The relevant facts the court considered in this case were that plaintiff insurance company, American Transit Insurance Company, brought an action seeking a declaration that it had no obligation to pay defendant Stand-Up MRI's claims for failing to appear for independent medical examinations (IMEs). Plaintiff demonstrated its entitlement to judgment by submitting evidence that it mailed the IME notices to the injured defendant's attorney and that the defendant failed to appear for the examinations. The main issue decided was whether the insurance company had an obligation to pay the defendant's claims despite his failure to attend the IMEs. The holding of the court was that the insurance company had no obligation to pay the defendant's claims because attendance at a medical examination is a condition of coverage, and there is no requirement that the claim denial be timely made. Therefore, the motion for summary judgment was granted in favor of the plaintiff.

The court considered the fact that the plaintiff had initiated proceedings to recover first-party no-fault benefits in 2005, and the defendant defaulted in answering. More than four years later, the plaintiff moved for leave to enter a default judgment and the defendant cross-moved to dismiss the complaint. The main issue decided was whether the plaintiff had offered a reasonable excuse for the delay in moving for leave to enter a default judgment, and whether the complaint was meritorious. The holding of the case was that the plaintiff's unsubstantiated claim of law office failure was insufficient to explain the four-year delay, and thus the court reversed the order and granted the defendant's cross motion to dismiss the complaint as abandoned.