No-Fault Case Law

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.

The main issues considered in this case were whether an insurer's motion for summary judgment should be granted in a no-fault benefits case when the plaintiff's assignor failed to appear for scheduled examinations under oath and whether the out-of-state affidavit, which was accompanied by a proper certificate of conformity, should have been considered by the court. The court ultimately decided that the defect in the certificate of conformity was appropriately cured by the defendant submitting a certificate that rectified the defect and that the out-of-state affidavit should have been treated as if it was taken within the state. The court held that since an appearance at an examination under oath is a condition precedent to an insurer's liability on a policy and the defendant established by admissible evidence that the plaintiff's assignor did not comply with this condition, the defendant's motion for summary judgment should have been granted.

The court considered an appeal from an order of the Civil Court of New York, which granted plaintiff's motion for summary judgment and denied defendant's cross motion to dismiss the complaint. The main issue decided by the court was whether the plaintiff had established its prima facie entitlement to summary judgment and whether the defendant had raised a triable issue of fact. The holding of the court was that the plaintiff had indeed established its prima facie entitlement to summary judgment by proof of submission to the defendant of the claim forms and proof that the defendant had failed to pay or deny the claims within the requisite 30-day period. The court also held that the defendant's cross motion to dismiss the complaint was properly denied and the plaintiff's motion for summary judgment was properly granted. Therefore, the judgment was affirmed.

The relevant facts the court considered in this case were that a provider, Compas Medical, P.C., was seeking to recover assigned first-party no-fault benefits from Geico Ins. Co. However, Geico had filed a declaratory judgment action in Supreme Court, Nassau County, alleging that Compas Medical and its assignor were involved in a large-scale illegal scheme involving staged accidents and fraudulent billing practices. Both Compas Medical and its assignor were named as defendants in the declaratory judgment action. The main issue decided by the court was whether to grant defendant's motion to stay the action, pursuant to CPLR 2201, pending a final determination of the declaratory judgment action. The court held that, under the circumstances presented, it was not an improvident exercise of discretion for the Civil Court to grant defendant's motion to stay the action pending the resolution of the Supreme Court declaratory judgment action. Therefore, the order to stay the action was affirmed.

The relevant facts the court considered included a medical provider suing an insurance company to recover assigned first-party no-fault benefits. The insurance company moved for summary judgment to dismiss the complaint, arguing that the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs). They submitted an affidavit from an employee of the medical review services that scheduled the IMEs, as well as an affidavit from the chiropractor/acupuncturist who was supposed to perform the IMEs. Defendant also submitted an affidavit from their claims representative, but it was executed out of state and did not comply with the necessary certification requirements. The main issue decided was whether the insurance company's motion for summary judgment should be granted, and the court held that it should be conditionally granted pending the submission of a proper certificate of conformity for the out-of-state affidavit.