No-Fault Case Law

The court considered whether interest on no-fault actions accrues at the time of filing or service of the summons and complaint and the impact of the tolling of interest provisions on this determination. The main issue decided in this case was whether section 412 of the New York City Civil Court Act applies to no-fault actions brought in Civil Court, and whether the interest on actions is governed by statutory and regulatory enforcement of the New York No-Fault Law. The court held that the statutory and regulatory language of Insurance Law supercede the CPLR, mandating that first-party no-fault benefits are overdue if not paid within thirty days after the claimant supplies proof of loss. The court further ruled that the commencement of the action is the point at which interest starts accruing. Additionally, the court clarified that the Superintendent of Insurance has interpreted the tolling of interest provision to apply regardless of whether the particular denial at issue was untimely, aiming to encourage applicants to swiftly seek to resolve any dispute.

The court considered an appeal from an order of the Civil Court which denied the defendant's motion to vacate a prior order granting the plaintiff's unopposed motion for summary judgment. The main issue decided was whether the Civil Court had improvidently exercised its discretion in denying the defendant's motion to vacate the prior order. The holding of the court was that the Civil Court did not improvidently exercise its discretion, as the defendant failed to demonstrate a reasonable excuse for its failure to submit written opposition to the plaintiff's motion. Therefore, the order denying the defendant's motion to vacate was affirmed.

The court considered the issue of whether the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, was entitled to recover upon claims for services rendered on April 2, 2008, despite the failure of the plaintiff's assignor to appear for independent medical examinations (IMEs) as requested by the defendant insurance company. The plaintiff argued that the assignor was not required to respond to the IME requests because they came from a third party, but the court disagreed, stating that the scheduling letters clearly apprised the assignor that they were being sent on defendant's behalf. The court ultimately affirmed the judgment dismissing that portion of the complaint, as it found the plaintiff's arguments to be without merit. Therefore, the holding of the case was in favor of the defendant insurance company, as the plaintiff was not entitled to recover upon the claims for services rendered.

The relevant facts of the case A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co. were that the plaintiff, a medical provider and professional service corporation, sought to recover no-fault benefits for medical services allegedly rendered to a person injured in an automobile accident. The appellant identified medical professionals on claim forms as independent contractors. The insurer failed to issue a written denial of coverage based on the independent contractor issue. The insurer moved for summary judgment, which was granted by the Civil Court and affirmed by the Appellate Term. The Appellate Division, Second Department reversed the judgment. The main issue was whether the plaintiff, as assignee of the injured person, was entitled to recover no-fault benefits from the insurer where the medical professionals were independent contractors. The court held that the insurer was precluded from raising the independent contractor defense because it failed to issue a timely denial of the claim on that ground. The court also held that the defense of lack of a valid assignment is precluded if not timely asserted. The holding of the case was that the insurer's motion for summary judgment was denied because it was precluded from raising the independent contractor defense.

The relevant facts the court considered in this case involved an insurance policy issued in Connecticut to the insured, who purportedly resided in Connecticut, for a vehicle garaged in Connecticut. The only connection to New York was that the third-party assignors were injured while riding in the insured's vehicle in New York. Plaintiff moved for summary judgment to recover first-party no-fault benefits, while defendant cross-moved for summary judgment dismissing the complaint based on the rescission of the automobile insurance policy. The main issue decided was whether Connecticut or New York law was controlling and whether the retroactive rescission of the insurance policy affected the rights of the innocent third-party assignors. The court held that Connecticut law was controlling under New York's conflict of law rules and that any retroactive rescission of the insurance policy did not affect the rights of the innocent third-party assignors, so defendant's cross motion for summary judgment dismissing the complaint was properly denied. Therefore, the court affirmed the order.

The main issue in this case was whether the defendant, New York Central Mutual Fire Insurance Company, was entitled to summary judgment dismissing the complaint brought by Infinity Health Products, Ltd as the assignee of Damian Thomas. The court considered the fact that the defendant had submitted evidence of timely mailing of independent medical examination (IME) scheduling letters and denial of claim forms, and that the plaintiff's assignor had failed to appear for the scheduled IMEs. The court held that the defendant had established its prima facie entitlement to judgment as a matter of law, as the plaintiff's evidence failed to raise a triable issue of fact. As a result, the court reversed the order of the Civil Court, and granted the defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that New Way Acupuncture, P.C. was seeking to recover first-party no-fault benefits as the assignee of Doreen L. Polanco. The main issue decided was whether the defendant was entitled to summary judgment dismissing the third, fourth, fifth, and sixth causes of action on the ground that Polanco had failed to appear for scheduled independent medical examinations (IMEs). The court held that the branches of the defendant's motion seeking summary judgment dismissing these causes of action were granted, as it was established that Polanco had failed to appear for the IMEs. Thus, the court reversed the denial of the defendant's motion and found that the defendant was entitled to judgment with respect to the causes of action.

The court considered the fact that the defendant, a medical services provider, was seeking to recover first-party no-fault benefits from the insurance company. The defendant had moved for summary judgment to dismiss the complaint, with the central issue being whether the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs), which was a condition precedent to the insurer's liability on the policy. The insurance company submitted evidence, including an affidavit of an employee of the entity that scheduled the IMEs and affirmations of its doctors, establishing that the plaintiff's assignor had indeed failed to appear for the scheduled IMEs. The court held that since the plaintiff had only submitted an affirmation from its counsel, it had failed to raise a triable issue of fact. Therefore, the court ruled in favor of the insurance company, granting its motion for summary judgment and dismissing the complaint.

The case involved an action to recover assigned first-party no-fault benefits for dental services provided to plaintiff's assignor as a result of injuries sustained in an automobile accident. Defendant Preferred Mutual Insurance Company had previously commenced a declaratory judgment action against plaintiff's assignor, in which it was declared not obligated to provide no-fault benefits or defend any claims for bodily injury or property damage on its policy issued to the assignor. The main issue in this case was whether the instant action was barred by virtue of the order in the declaratory judgment action. The court held that plaintiff was not subject to dismissal by virtue of the order in the declaratory judgment action, as it was neither named nor served in that action and had no full and fair opportunity to appear and defend its interests in that proceeding. As a result, the defendant's motion for summary judgment was properly denied, and the order of the Civil Court was affirmed.

The court considered the fact that EBM Medical Health Care, P.C. had commenced an action to recover first-party no-fault benefits for medical services provided to its assignor as a result of injuries sustained in an automobile accident. The insurance company Republic Western Insurance initiated a declaratory judgment action alleging that EBM was not properly licensed to recover no-fault benefits. A judgment was entered, on default, in the declaratory judgment action where Republic had no duty to pay no-fault benefits to EBM. After the judgment in the declaratory judgment action, Republic moved in this no-fault action for summary judgment dismissing EBM's complaint. The main issue decided was whether the no-fault action was barred by virtue of the declaratory judgment. The holding of the court was that the instant action was barred under the doctrine of res judicata and that the no-fault action falls within the ambit of the declaratory judgment as a "current" proceeding. Therefore, the order of the Civil Court was reversed and Republic's motion for summary judgment dismissing the complaint was granted.