No-Fault Case Law
Pavlova v Nationwide Ins. (2022 NY Slip Op 50559(U))
June 3, 2022
The relevant facts considered by the court in this case were that the plaintiff, Ksenia Pavlova, as the assignee of Pollen, Faith, brought an action to recover assigned first-party no-fault benefits from the defendant, Nationwide Ins. The defendant had moved for summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor had failed to appear for duly scheduled examinations under oath (EUOs), and the plaintiff had also filed a cross motion for summary judgment. The main issue decided by the court was whether the insurer had twice duly demanded an EUO from the assignor, that the assignor had twice failed to appear, and that the insurer had issued a timely denial of the claims. The holding of the court was that the insurer had established proper mailing of the EUO scheduling letters and had therefore demonstrated its prima facie entitlement to summary judgment dismissing the complaint, affirming the order of the Civil Court.
AB Quality Health Supply Corp. v Nationwide Ins. (2022 NY Slip Op 50558(U))
June 3, 2022
The court considered the fact that the defendant in this case had moved for summary judgment dismissing the complaint filed by the plaintiff, who was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff's assignor had failed to appear for duly scheduled examinations under oath (EUOs). The holding of the case was that the defendant established that the EUO scheduling letters had been timely mailed and that the plaintiff's assignor had failed to appear for the scheduled EUOs. Consequently, the defendant was entitled to summary judgment dismissing the complaint, as the plaintiff failed to raise a triable issue of fact in opposition to the defendant's motion. Therefore, the order denying the defendant's motion for summary judgment was reversed.
EA Chiropractic Diagnostics, P.C. v GEICO Ins. (2022 NY Slip Op 50557(U))
June 3, 2022
The main issue in this case was whether the defendant, GEICO Insurance, had timely denied the claims after the plaintiff, EA Chiropractic Diagnostics, P.C., had failed to appear for scheduled examinations under oath (EUOs). The court held that GEICO Insurance's motion failed to establish that it had timely denied the claims at issue after the plaintiff failed to appear for the EUOs. The court also ruled that as the defendant did not demonstrate that it was not precluded from raising its proffered defense, the branches of the defendant's motion seeking summary judgment dismissing the claims for services rendered to certain individuals were properly denied. Therefore, the appellate term affirmed the lower court's decision.
Columbus Imaging Ctr., LLC v National Liab. & Fire Ins. Co. (2022 NY Slip Op 50556(U))
June 3, 2022
The main issues in the case were whether the defendant had provided sufficient evidence that the letters scheduling independent medical examinations (IMEs) were properly addressed and timely mailed, and whether the plaintiff had demonstrated its entitlement to summary judgment. The court considered the failure of the defendant to demonstrate that the IMEs were properly scheduled and, therefore, failed to show that the plaintiff's assignor had failed to appear at the duly scheduled IMEs. On the other hand, the court found that the plaintiff had also failed to demonstrate its entitlement to summary judgment, as the affidavit submitted in support of its motion failed to establish that the claim at issue had not been timely denied. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was denied, but the order was affirmed with modification.
Warton Supplies, Inc. v GEICO Gen. Ins. Co. (2022 NY Slip Op 50554(U))
June 3, 2022
The court considered the issue of whether the plaintiff, Warton Supplies, Inc. as Assignee of Judith Darius, failed to appear for scheduled examinations under oath (EUOs), which was the basis for the defendant, GEICO General Ins. Co.'s, motion for summary judgment dismissing the complaint. The defendant established that the EUO scheduling letters and denial of claim forms had been timely mailed and that plaintiff had failed to appear for the scheduled EUOs. As a result, the defendant demonstrated its entitlement to summary judgment. The plaintiff failed to raise a triable issue of fact in opposition to the defendant's motion, and therefore the court reversed the order of the Civil Court and granted the defendant's motion for summary judgment dismissing the complaint.
Parisien v Travelers Ins. Co. (2022 NY Slip Op 50553(U))
June 3, 2022
The main issue in Parisien v. Travelers Insurance Co. was whether the plaintiff was entitled to recover assigned first-party no-fault benefits, as defendant argued that the plaintiff failed to appear for scheduled examinations under oath (EUOs). The court considered the fact that the defendant had established that EUO letters had been timely mailed, the plaintiff had failed to appear for the scheduled EUOs, and that the claims had been timely denied by the defendant on those grounds. As a result, the court held that the defendant was entitled to summary judgement dismissing the complaint, and vacated the order granting the plaintiff's motion for summary judgement. The matter was remitted to the Civil Court for the entry of a judgement in favor of the defendant dismissing the complaint.
ACH Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50448(U))
May 13, 2022
The court considered the denial of plaintiff's motion for summary judgment and the granting of defendant's cross motion for summary judgment dismissing the complaint. The main issue decided in this case was that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). The holding of the court was that defendant had proven that plaintiff failed to appear at the EUOs through affidavits by its attorneys who were scheduled to conduct the EUOs, as well as certified transcripts of the EUOs. Plaintiff's contention that defendant failed to timely deny the claims at issue was not considered as it was raised for the first time at the oral argument of the appeal. Therefore, the court affirmed the order.
New Generation Wellness Chiropractic, P.C. v Country-Wide Ins. Co. (2022 NY Slip Op 22171)
May 13, 2022
The main issue in this case was whether the Civil Court erred in granting the defendant's cross motion to vacate the judgment and dismiss the complaint, and in denying the plaintiff's motion to recalculate the statutory no-fault interest awarded in the judgment. The court considered the fact that the plaintiff was dissolved in 2009, but had taken steps to wind up its business affairs and seek a judgment from the defendant. The court held that the defendant failed to demonstrate that the plaintiff was not in the process of winding up its business affairs and therefore did not lack the capacity to enter judgment. The court also held that the statutory no-fault interest awarded in the judgment should be recalculated from a simple rate to a compound rate as allowed by Insurance Department Regulations. Therefore, the court reversed the lower court's decision, granted plaintiff's motion, and denied the defendant's cross motion.
Country-Wide Ins. Co. v Delacruz (2022 NY Slip Op 03068)
May 10, 2022
In the case of Country-Wide Insurance Company v Delacruz, the court considered the plaintiff's motion for summary judgment regarding the denial of medical providers' application for no-fault benefits. Plaintiff argued that Delacruz's failure to appear for scheduled examinations under oath (EUOs) defeated coverage under the no-fault policy, and thus foreclosed the medical providers' claim to benefits. The main issue decided was whether the plaintiff's motion for summary judgment was premature and whether the plaintiff's failure to provide a specific objective justification for the EUO was sufficient grounds for denying the benefits. The court held that the plaintiff's motion for summary judgment was premature and that without justification for the EUO, the plaintiff failed to establish, as a matter of law, that it complied with the governing regulations. The court also rejected plaintiff's contention that the defendants waived any claim as to the reasonableness of the EUO notices by failing to object upon receipt.
Psychology After Acc., P.C. v Nationwide Ins. Co. of N.Y. (2022 NY Slip Op 50366(U))
May 6, 2022
The court considered that the defendant had failed to establish that it had timely denied the plaintiff's claims after the plaintiff failed to appear for two scheduled examinations under oath (EUOs). The main issue decided was whether the defendant was justified in seeking summary judgment dismissing the complaint based on the plaintiff's failure to appear for the EUOs. The holding of the court was that the defendant failed to demonstrate that it was not precluded from raising its defense and therefore, the motion for summary judgment dismissing the complaint was properly denied. Additionally, the court held that the plaintiff also failed to demonstrate its entitlement to summary judgment as the proof submitted in support of its cross motion failed to establish that the claims had not been timely denied or that the defendant had issued timely denial of claim forms. Therefore, the order was modified by providing that plaintiff's cross motion for summary judgment was denied.