No-Fault Case Law
Professional Health Imaging, P.C. v Old Republic Ins. Co. (2014 NY Slip Op 50200(U))
February 18, 2014
The court considered the facts surrounding a federal court's dismissal of a personal injury claim by the plaintiff's assignor, Barbara Harvey, against Ryder Truck Rental, Inc. Defendant, Old Republic Insurance Company, argued that the federal court's ruling collaterally estopped the plaintiff from seeking no-fault benefits for services provided to Ms. Harvey after the accident. However, the court noted that the federal court never ruled definitively on whether the Ryder truck was involved in the accident, and the decision granted summary judgment to Ryder based on a lack of evidence. The court also considered previous appellate term decisions regarding collateral estoppel claims by no-fault insurers in cases where the provider had not been given an opportunity to be heard. The holding of the case was that plaintiff was not collaterally estopped from pursuing its independent no-fault claim against the defendant insurer, and defendant's motion was denied.
Flatlands Med., P.C. v AAA Ins. (2014 NY Slip Op 24048)
February 14, 2014
The court addressed a case concerning an action to recover assigned first-party no-fault benefits from an out-of-state insurer for medical services that were provided to an assignor in New York. The defendant filed a cross-motion to dismiss the complaint on the grounds that it had not been properly served, and that the court lacked jurisdiction. Despite an error in the certificate of conformity for the defendant's affidavit, the court considered the evidence in the affidavit. The court ultimately found that the defendant had demonstrated prima facie evidence that it was not authorized to conduct insurance business in New York, and therefore, jurisdiction could not be obtained. The plaintiff did not provide enough evidence to show that jurisdiction was acquired over the defendant, and thus, the court held in favor of the defendant on grounds different from those stated by the Civil Court, dismissing the complaint.
Comprehensive Psychiatric Care, P.C. v Clarendon Natl. Ins. Co. (2014 NY Slip Op 50184(U))
February 11, 2014
The court considered the timeliness of a cross motion to dismiss the complaint pursuant to CPLR 3211 (a) (5) in a case involving an action to recover first-party no-fault benefits. The defendant in the case appealed from an order of the Civil Court that rejected its cross motion as untimely, despite the fact that it had been served in a timely manner according to a so-ordered stipulation. The main issue decided was whether the Civil Court erred in failing to consider the defendant's cross motion, and the holding of the case was that the order was reversed and the matter was remitted to the Civil Court for a determination of the merits of the defendant's cross motion to dismiss the complaint pursuant to CPLR 3211 (a) (5).
Provvedere, Inc. v Republic W. Ins. Co. (2014 NY Slip Op 50219(U))
February 7, 2014
The court considered the issue of whether the medical devices provided to plaintiff's assignor were medically necessary in an action to recover assigned first-party no-fault benefits. After a nonjury trial, the Civil Court awarded plaintiff the principal sum of $1,809.20. However, the defendant appealed, arguing that the medical devices provided were not medically necessary. The defendant's doctor testified that the cervical and lumbar traction units provided by the plaintiff were not medically necessary, and the court found his testimony to be "wholly credible." As a result, the judgment was reversed, and the matter was remitted to the Civil Court for the entry of judgment in favor of the defendant dismissing the complaint. The holding of the case was in favor of the defendant, as the court determined that the defendant established that the medical devices at issue were not medically necessary.
Westchester Med. Ctr. v Allstate Ins. Co. (2014 NY Slip Op 00655)
February 5, 2014
The relevant facts of the case included an action to recover no-fault benefits under a policy of automobile insurance by Westchester Medical Center, as Assignee of Christine Tachaud, against Allstate Insurance Company. The plaintiff's appeal from an order of the Supreme Court, Nassau County was denied by the court on the complaint. The plaintiff made a showing of its entitlement to judgment as a matter of law by demonstrating that the necessary billing documents were mailed to, and received by, the defendant insurer, and that payment of no-fault benefits was overdue. The appellate division reversed the order, stating that the plaintiff's motion for summary judgment on the complaint is granted, and that the Supreme Court should have granted the plaintiff's motion for summary judgment on the complaint. The main issue decided was whether the plaintiff was entitled to summary judgment as a matter of law, and the holding of the case was that the Supreme Court should have granted the plaintiff's motion for summary judgment on the complaint.
Nyack Hosp. v Allstate Ins. Co. (2014 NY Slip Op 00641)
February 5, 2014
The court considered the failure of Allstate Insurance Company to timely contest the adequacy of the claim forms used by the plaintiff Richmond University Medical Center to establish proof of claim. Allstate Insurance Company waived its right to rely on any deficiencies in those forms at the litigation stage. The plaintiffs established their prima facie entitlement to judgment as a matter of law on the second cause of action by submitting evidence in admissible form that the prescribed statutory billing form had been mailed to and received by the defendant insurer, which failed to either pay or deny the claim within the requisite 30-day period. The main issue decided was whether Allstate Insurance Company waived its right to contest the adequacy of the claim forms at the litigation stage by failing to do so at the claims stage. The holding of the case was that the judgment in favor of Richmond University Medical Center, as assignee of Arnold Sealey, for the total sum of $6,698.56 was affirmed.
New York Hosp. Med. Ctr. of Queens v Allstate Ins. Co. (2014 NY Slip Op 00640)
February 5, 2014
The relevant facts in this case involved an action to recover no-fault benefits under a policy of automobile insurance. The plaintiffs submitted a postal receipt indicating that the prescribed NF-5 statutory billing form was received by the defendant on May 26, 2011. The plaintiffs' motion for summary judgment on the first cause of action was granted by the Supreme Court. The issue at hand was whether the defendant timely paid or denied the claim, or requested additional verification within the time frame set forth in the no-fault regulations. The decision was that the Supreme Court properly granted the plaintiffs' motion for summary judgment on the first cause of action, affirming insofar as appealed from, with costs.
New York Hosp. Med. Ctr. of Queens v QBE Ins. Corp. (2014 NY Slip Op 00639)
February 5, 2014
The case involves an action to recover no-fault benefits under two separate policies of automobile insurance. The appellant, QBE Insurance Corporation, appealed from a judgment entered in favor of the plaintiffs, New York Hospital Medical Center of Queens, in the sum of $66,682.29. The Supreme Court denied the defendant's cross motion for summary judgment and granted the plaintiff's motion for summary judgment in connection with the first and second causes of action.
The main issue of the case was whether the plaintiffs were entitled to recover no-fault benefits under both insurance policies. The court held that the plaintiffs were entitled to recover no-fault benefits on the second cause of action, related to the claim submitted by Westchester Medical Center. However, the court modified the judgment to dismiss the first cause of action, as the defendant, QBE Insurance Corporation, had established that payment on the claim made by the plaintiff New York Hospital Medical Center of Queens was not overdue due to outstanding verification requests.
Mendoza v Farmers Ins. Co. (2014 NY Slip Op 00613)
February 4, 2014
The court considered the mandatory arbitration process as the sole available remedy to determine issues of coverage between insurance carriers and Motor Vehicle Accident Indemnification Corporation (MVAIC). The appellant, Farmers Insurance Company, failed to participate in the arbitration proceeding, seek an adjournment, or file a petition to vacate the arbitration award regarding the alleged cancellation of the insurance policy. The main issues decided were the obligation of Farmers Insurance Company to provide coverage for the accident and the preclusive effect of the arbitration decision. The holding of the court was that appellant had a full and fair opportunity to contest the decision, and failed to do so, therefore, the order finding Farmers Insurance Company obligated to provide coverage for the accident was affirmed.
Matter of Kane v Fiduciary Ins. Co. of Am. (2014 NY Slip Op 00593)
February 4, 2014
The court considered the matter of two arbitration awards that were vacated and remanded for a new arbitration before a new arbitrator. The main issue decided was whether the arbitration awards, rendered in compulsory arbitration, were irrational or contrary to settled law, and therefore should have been confirmed. The court held that the arbitral awards were not irrational or contrary to settled law, and therefore should have been confirmed. It was also determined that the respondent insurer's disclaimer, based strictly upon primacy of coverage, was not so absolute or unequivocal as to constitute a repudiation of the policy. The court held that the petitioner failed to comply with the conditions precedent to coverage found in the implementing no-fault regulations.