No-Fault Case Law

The case of Matter of Allstate Insurance Company v. Daniel Wilen involved a proceeding to vacate the award of a master arbitrator, which vacated an award of an arbitrator. The appellate division upheld the Supreme Court's decision to deny the petition and confirm the master arbitrator's award. The court determined that the master arbitrator did not exceed his powers and was empowered to apply the law to the given set of facts, even if his conclusion differed from that of the arbitrator. The master arbitrator properly vacated the arbitration award which was "incorrect as a matter of law" in light of the evidence. The petitioner's remaining contentions were found to be without merit by the court.

The court considered the fact that the plaintiff was seeking to recover assigned first-party no-fault benefits for acupuncture services provided by its licensed acupuncturist, and the complaint sought to recover the difference between the amount billed by the plaintiff and the amount paid by the defendant-insurer. The main issue decided was whether the defendant-insurer properly limited payment to "charges permissible for similar procedures under schedules already adopted or established by the superintendent" or whether the plaintiff was entitled to any additional reimbursement. The holding of the case was that since the Superintendent of Insurance had not adopted a fee schedule for the reimbursement of acupuncture services performed by a licensed acupuncturist, the defendant properly limited payment to the workers' compensation fee schedule for acupuncture services performed by chiropractors, and therefore the plaintiff was not entitled to any additional reimbursement. As a result, the defendant's motion for summary judgment dismissing the complaint was granted and the complaint was dismissed.

The main issue in this case was whether prejudgment interest should accrue from the filing or the service of the summons and complaint in an action by a provider to recover assigned first-party no-fault benefits. The relevant facts in this case were that the plaintiff filed the summons and complaint in October 2008, but service was not completed until January 2009. A nonjury trial was subsequently held, and the Civil Court found in favor of the plaintiff, awarding them the principal sum plus interest from the date of filing. The defendant argued that interest should have been awarded from the date of service, rather than from the date of filing. The court held that interest on a no-fault claim does not accrue until the date of service of the summons and complaint and not from the date of filing. Therefore, the judgment was modified, and the matter was remitted to the Civil Court for a re-calculation of statutory interest in accordance with the court's decision.

The relevant facts were that this was a case where the plaintiff, Alev Medical Supply, Inc., was appealing the dismissal of their complaint, which sought to recover assigned first-party no-fault benefits from Geico Indemnity Company. A nonjury trial was held, and the trial court dismissed the plaintiff's complaint on the grounds that they had not established their prima facie case. The main issue decided by the appellate court was whether the plaintiff had provided sufficient evidence to support their claim for no-fault benefits. The appellate court held that the plaintiff had presented a witness at the trial who provided testimony and claim forms that established the prima facie evidence of the fact and amount of the loss sustained, thus reversing the judgment, awarding costs, and remitting the matter to the Civil Court for the entry of a judgment in favor of the plaintiff in the principal sum of $1,530, plus statutory interest and attorney's fees.

The main issue in this case was whether the default judgment should be vacated pursuant to CPLR 5015 (a) (1) in an action by a provider to recover assigned first-party no-fault benefits. The court considered the fact that defendant had subsequently been granted summary judgment dismissing the complaint, making the appeal academic. The court ultimately decided to dismiss the appeal in light of the subsequent order granting summary judgment, as it rendered the appeal unnecessary. The holding of the case was that the appeal must be dismissed as academic in light of the subsequent order granting defendant's unopposed motion for summary judgment dismissing the complaint.

The main issue in this case was whether the defendant had failed to establish its prima facie case in a no-fault benefits action by a provider. The court considered the fact that at the nonjury trial, the plaintiff presented a witness whose knowledge of the business practices and procedures of the provider was deemed sufficient to lay a foundation for the claim forms to be admitted into evidence as business records. The Civil Court had erroneously directed judgment in favor of the defendant before the plaintiff's counsel had the opportunity to move the claim forms into evidence or to elicit testimony regarding the nonpayment of the claims. The holding of the court was that the judgment was reversed and the matter was remitted to the Civil Court for a new trial.

The relevant facts of the case included the plaintiff's motion for summary judgment against defendants Multiple Medical Health Services, P.C. and Infinite Chiropractic, PLLC. The main issue decided by the court was whether the plaintiff was entitled to summary judgment based on its submission of an affidavit of service demonstrating that notices scheduling independent medical examinations were properly mailed to the defendant in connection with a no-fault insurance claim. The holding of the court was that the plaintiff was entitled to summary judgment based on the evidence provided, and that the defendant had failed to rebut the presumption of a proper mailing. The court also rejected a request for modification of the order by defendant Empire Acupuncture, PC, and upheld the decision regarding Empire.

The case of American Tr. Ins. Co. v Lucas involved two separate actions in which the plaintiff, American Transit Insurance Company, sought declarations of non-coverage for no-fault benefits against defendant-respondent Sky Acupuncture, P.C. The injured claimants in both cases had failed to attend duly scheduled medical exams, which according to the court voided the policy. The Appellate Division, First Department, determined that plaintiff owed no coverage obligation to Sky Acupuncture, P.C. for no-fault benefits for the injured claimants, as the failure to attend the scheduled medical exams was an absolute coverage defense. The court relied on competent evidence that the notices scheduling the claimants' medical examinations had been mailed and the failure of the injured claimants to appear was established through sworn affidavits of the examining physician and his employee. The presumption of proper mailing was supported by the evidence and the failure of the claimants to attend the medical exams was found to be sufficient grounds for the plaintiff to retroactively deny all claims.

The case involves George Dinstber III and Allstate Insurance Company. Dinstber notified Allstate in January 2002 of injuries sustained in a motor vehicle accident and Allstate denied his no-fault claim, leading to Dinstber filing an action in which he asserted claims of breach of contract and tort, with a request for punitive damages. The court granted Allstate's motion for partial summary judgment, dismissing Dinstber's tort claim and denying his cross motion for, among other things, leave to amend the complaint. The court held that although punitive damages may be recoverable if necessary to vindicate a public right, Dinstber's claims did not allege a breach of duty distinct from Allstate's contractual obligations. The court also ruled that Dinstber's motion for leave to amend the complaint was properly denied as he failed to establish that the proposed amendment is not plainly without merit.

The main issue in this case was whether the defendant-insurer was entitled to summary judgment dismissing the complaint made by Premier Health Choice Chiropractic, P.C. The court considered the fact that the defendant made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely denied the plaintiff's first-party no-fault claims based on a sworn independent medical examination (IME) report of its examining chiropractor. The court held that the unsworn doctor's report submitted with the plaintiff's attorney's affirmation was without probative value and did not meaningfully refer to, let alone rebut, the contrary findings made by the defendant's peer reviewer. Therefore, the court reversed the order of the Civil Court of the City of New York and granted the defendant's motion for summary judgment, directing the clerk to enter judgment accordingly.