No-Fault Case Law

The court considered a case in which a provider was seeking to recover assigned first-party no-fault benefits, but the defendant insurance company had filed a motion for summary judgment, asserting that the plaintiff's assignor had failed to appear for scheduled examinations under oath. The main issue was whether the defendant's motion for summary judgment should have been granted, and whether the plaintiff's cross motion for summary judgment should have been denied. The court held that the defendant's motion for summary judgment dismissing the complaint should have been denied, as the defendant did not establish that it was not precluded from raising its defense. The court also upheld the denial of the plaintiff's cross motion as untimely, as there was no reasonable excuse provided for the delay in filing the cross motion.

The main issues in this case were whether the provider, as the assignee of the injured party, was entitled to recover first-party no-fault benefits and whether the assignor's failure to appear for scheduled examinations under oath was a valid reason for the insurance company to deny benefits. The court considered the fact that the assignor had failed to appear for these examinations and that the insurance company had moved for summary judgment to dismiss the complaint. The court also took into account the provider's cross motion for summary judgment, which was denied as untimely. The holding of the court was that the insurance company's motion for summary judgment was denied, and the provider's appeal from the order granting the insurance company's motion for summary judgment was upheld.

The court considered a case where PFJ Medical Care, P.C., as the assignee of Zuniga, Karla, appealed an order of the Civil Court of the City of New York, Kings County, which granted the branches of the defendant's motion seeking summary judgment dismissing the first through fourth causes of action and denied plaintiff's cross motion for summary judgment. The main issue decided was whether the action was premature due to the plaintiff's failure to provide requested verification for first-party no-fault benefits. The holding of the case was that while the defendant demonstrated that it had timely mailed initial and follow-up requests for verification, the affidavit submitted by the plaintiff in opposition to the motion was sufficient to raise an issue of fact as to whether the requested verification had been mailed to and received by the defendant. As a result, the branches of the defendant's motion seeking summary judgment dismissing the first through fourth causes of action were denied.

The court considered whether the insurance company was entitled to summary judgment dismissing the complaint by a medical provider seeking to recover no-fault benefits. The main issue decided was whether the insurance company had demonstrated, as a matter of law, that it twice duly demanded examinations under oath (EUOs) from the provider, that the provider twice failed to appear, and that the insurer issued a timely denial of the claims. The holding of the case was that the insurance company was entitled to summary judgment dismissing the complaint, as they had established their prima facie entitlement to summary judgment by demonstrating the timely demand for EUOs, the provider's failure to appear for the EUOs, and the insurer's timely denial of the claims. The court also determined that the insurance company was not required to set forth objective reasons for requesting EUOs in order to establish its prima facie entitlement to summary judgment.

The relevant facts considered in this case were that Queens Neurology, P.C. had filed a claim for no-fault benefits with Kemper Ins. Co. in 2000, which was not paid within 30 days and was never actually denied. In 2019, following arbitration and a trial de novo in which the defendant failed to appear, Queens Neurology was awarded the principal sum of $1,972.80, plus interest accruing from the date the notice of trial was filed in 2015. On appeal, Queens Neurology argued that interest should have started to accrue from 30 days after the claim was submitted and that the court improperly tolled the accrual of interest until the notice of trial was filed. The main issues decided were whether the claim had been timely denied, and whether the accrual of interest was properly tolled by the court. The holding of the court was that Queens Neurology failed to establish that interest should have started to accrue any earlier than the commencement of the action and that the court properly delayed the start of interest until the notice of trial based on the finding that Queens Neurology unreasonably delayed the proceedings. Therefore, the judgment of the District Court was affirmed.

The relevant facts in the case involved Biotech Surgical Supply seeking to recover first-party no-fault benefits from Country Wide Insurance Company for claims submitted in 2001. A judgment was entered pursuant to a settlement, which awarded statutory no-fault interest at a simple rate. Biotech Surgical Supply then moved to have the interest recalculated at a compound rate based on pre-2002 regulations. The Civil Court initially denied the motion, citing the absence of a copy of the stipulation of settlement in the motion papers. However, the Appellate Term found that the absence of the stipulation of settlement was not necessary to demonstrate Biotech Surgical Supply's entitlement to interest at a compound rate, and that the motion should have been granted, as Country Wide Insurance Company did not demonstrate that the plaintiff prevented it from paying the settlement amount. Therefore, the Appellate Term reversed the initial decision and granted Biotech Surgical Supply's motion to recalculate the interest at a compound rate.

The court considered a motion by the defendant to dismiss the complaint on the grounds of forum non conveniens, arguing that the action should have been commenced in Pennsylvania or New Jersey rather than New York. The defendant also argued that the complaint should be dismissed because the statute of limitations had expired under the laws of Pennsylvania and New Jersey. The court reversed the decision to grant the motion to dismiss the complaint based on forum non conveniens, finding that the evidence presented did not support the dismissal and that the defendant failed to show hardship for possible witnesses or any burden on the New York courts. The matter was remitted to the Civil Court for a determination of the remaining branch of the defendant's motion and the merits of the plaintiff's cross motion.

The court considered that SB Chiropractic, P.C provided medical care to Eddie Rivera after a car accident in 2017. The court noted that SB Chiropractic, P.C forwarded ten bills to GEICO Insurance Co. for the medical care provided. GEICO partially paid or denied each of these bills. The court discussed the legal obligations set forth by no-fault insurance regulations for GEICO with regards to timely denial of claim forms. The main issue decided was whether the Plaintiff is entitled to summary judgment, based on the insufficiency of the denial of claim forms issued by GEICO. The holding was that the Plaintiff was not entitled to summary judgment, because GEICO's denial of claim forms were sufficient and ADmissible in court.

The court considered the fact that the insurer had paid the full monetary limits set forth in the policy, which meant that its duties under the contract of insurance had ceased. The issue at hand was whether an insurer can be required to pay in excess of the monetary limit of a no-fault insurance policy, and whether a defense that the coverage limits of the policy have been exhausted can be asserted by an insurer despite its failure to issue a denial of the claim within the 30-day period. The holding of the court was that an arbitrator's award directing payment in excess of the monetary limit of a no-fault insurance policy exceeds the arbitrator's power and constitutes grounds for vacating the award. The court also found that the insurer was not precluded by the regulations from paying other legitimate claims subsequent to the denial of the respondent's claims, and that the alleged defect in the insurer's proof could have been raised at the framed issue hearing. Additionally, the court held that the respondent, who had admitted in its papers that the assignor was a pedestrian, may not now claim that additional personal injury protection benefits are payable.

The relevant facts the court considered included the proceeding pursuant to CPLR article 75 to vacate an award of a master arbitrator dated April 10, 2018, which vacated an arbitration award in favor of the petitioner. The petitioner appealed from an order denying the petition to vacate the award. The main issue decided was whether the master arbitrator's determination could be overturned, and the holding of the case was that the order denying the petition was reversed, and the petition to vacate the award of the master arbitrator was granted. The matter was remitted to the Supreme Court, Nassau County for further proceedings consistent herewith. The court found that there was no rational basis to support the award of the master arbitrator and that the application of certain regulations was irrational, allowing the insurer to avoid statutory timeliness requirements.