No-Fault Case Law
NYU-Hospital for Joint Diseases v Praetorian Ins. Co. (2012 NY Slip Op 06288)
September 26, 2012
The case involves an action to recover no-fault benefits under a policy of automobile insurance. NYU-Hospital for Joint Diseases, as the assignee of Gladys Feliz, appealed from an order granting the defendant's motion to vacate a default judgment and to compel the plaintiff to accept the defendant's answer. The Supreme Court granted the defendant's motion based on the lack of prejudice to the plaintiff from the delay, the lack of willfulness on the part of the defendant, the existence of a potentially meritorious defense, and the public policy favoring the resolution of cases on the merits. Due to these factors, the defendant's default in appearing or answering the complaint was properly excused according to the court.
Overall, the court considered the lack of prejudice to the plaintiff, the lack of willfulness on the part of the defendant, the potentially meritorious defense, and the public policy favoring the resolution of cases on the merits in deciding to affirm the order granting the defendant's motion to vacate the default judgment and to compel the plaintiff to accept the defendant's answer.
All Boro Psychological Servs., P.C. v Hartford Ins. Co. (2012 NY Slip Op 51849(U))
September 19, 2012
The relevant facts considered by the court were that the plaintiff, a provider seeking first-party no-fault benefits, had failed to appear at the scheduled examinations under oath (EUOs) as required by the insurance company. The main issue decided was whether the insurance company had met the conditions for liability on the policy by timely mailing the EUO scheduling letters and the denial of claim form, and whether the plaintiff's failure to appear at the EUOs was a valid defense for the insurance company. The holding of the court was that the insurance company had met the conditions for liability on the policy, and the plaintiff's failure to appear at the EUOs was a valid defense for the insurance company. Therefore, the court affirmed the judgment in favor of the insurance company.
Muhammad Tahir, M.D., P.C. v Travelers Prop. Cas. Ins. Co. (2012 NY Slip Op 51802(U))
September 19, 2012
The court considered the case of Muhammad Tahir, M.D., P.C. against Travelers Property Casualty Ins. Co., in which the defendant appealed a judgment in favor of the plaintiff awarding damages in the amount of $1,277.64. The main issue decided was whether the 30-day period within which an insurer must pay or deny a claim for first-party no-fault benefits is tolled until it receives a response to properly issued verification requests. The holding of the court was that the judgment in favor of the plaintiff was reversed and a judgment was awarded in favor of the defendant dismissing the complaint. This decision was based on evidence presented by the defendant that they had timely and properly mailed initial and follow-up verification requests to the plaintiff medical provider's attorney, as authorized by plaintiff's counsel's prior correspondence to the defendant, and that the plaintiff had failed to respond.
Arco Med. N.Y., P.C. v Lancer Ins. Co. (2012 NY Slip Op 22278)
September 19, 2012
The main issues in this case involved a provider seeking first-party no-fault benefits from an insurance company. The provider filed a motion for summary judgment, while the insurance company cross-moved to compel the provider to produce witnesses for depositions. The insurance company had failed to raise a triable issue of fact in opposition to the provider's motion for summary judgment in the lower court, but raised a triable issue with respect to some of the causes of action upon appeal. The main holding of the case was that the provider was entitled to summary judgment on the first two causes of action, but not on the third through ninth causes of action. The decision was modified to reflect the above.
RAZ Acupuncture, P.C. v GEICO Gen. Ins. Co. (2012 NY Slip Op 51826(U))
September 13, 2012
The court considered a dispute regarding unpaid medical bills for acupuncture services provided to a patient under a no-fault insurance claim. The main issue decided was whether the insurance company had fully paid the plaintiff for the acupuncture services rendered in accordance with the workers' compensation fee schedule. The court held that the insurance company had demonstrated that it had fully paid the plaintiff for the acupuncture services at issue in accordance with the workers' compensation fee schedule. Therefore, the judgment of the lower court, which dismissed the complaint insofar as it sought to recover for those claims, was affirmed.
Arco Med. NY, P.C. v Country-Wide Ins. Co. (2012 NY Slip Op 51815(U))
September 13, 2012
The court considered the fact that the plaintiffs were appealing from an order of the Civil Court which denied their motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the affidavit in support of the plaintiffs' motion had established that the bills at issue had not been timely denied or that the defendant had issued timely denials of claim that were conclusory, vague, or without merit as a matter of law. The decision was that the affidavit in support of the plaintiffs' motion had failed to establish their prima facie entitlement to summary judgment, and therefore, the order denying their motion for summary judgment was affirmed.
Ying E. Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51805(U))
September 13, 2012
The relevant facts considered in this case were that defendant, GEICO Ins. Co., denied the plaintiff's claims for no-fault benefits on the grounds that the claims exceeded the amount permitted by the workers' compensation fee schedule. The main issue decided in this case was whether or not the denial of the claims by the defendant was proper. The Court held that the denial of the claims by the defendant was proper, as they had sufficiently established the timely mailing of the denial of claim forms and had used the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive. Therefore, the Court reversed the order granting the plaintiff's motion for summary judgment and denied the motion.
Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51757(U))
September 11, 2012
The court considered the fact that the defendant insurer timely and properly mailed its initial and follow-up verification demands to the plaintiff medical provider at the listed street address. The plaintiff's third-party biller, Spendan Service Corp., claimed that it did not receive the verification demands, but did not meaningfully challenge the procedures followed by the defendant in mailing the demands or deny its receipt of the demands. The main issues decided were whether the plaintiff's claim for assigned first-party no-fault benefits should be dismissed, and whether the verification demands were effectively mailed to the plaintiff's authorized representative. The holding was that summary judgment dismissal of the plaintiff's claim for assigned first-party no-fault benefits was warranted, as the plaintiff failed to make any showing that the verification demands were not received by the billing entity due to the absence of its suite number or otherwise. The court reversed the order, granted the defendant's motion for summary judgment, and dismissed the complaint.
Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51756(U))
September 11, 2012
The court considered the fact that the plaintiff's third-party biller acknowledged receipt of the defendant's follow-up verification demand, but failed to explain why it took no responsive action. In addition, the plaintiff neither claimed nor showed that it responded in any way to the defendant's properly issued verification demands. The main issue decided was whether the defendant-insurer's motion for summary judgment dismissing the first-party no-fault action should be granted. The holding was that the defendant's motion for summary judgment dismissing the complaint was granted, and the complaint was dismissed.
Cliffside Park Imaging v Preferred Mut. Ins. Co. (2012 NY Slip Op 51754(U))
September 11, 2012
The court considered the residence of the insured and his family as the relevant facts in this case. The main issue decided was whether the insured fraudulently procured insurance coverage by falsely listing a different residence on the insurance application. The court held that the standard for determining residency for insurance coverage requires some degree of permanence and intention to remain, and that the insured's mere intention to reside at a certain premises was not sufficient. The court found that the insured fraudulently listed a different residence on the insurance application, and that the plaintiff, as the assignee standing in the shoes of the insured, failed to raise a triable issue of fact. Therefore, the court reversed the lower court's order denying the defendant's motion for summary judgment and granted the motion, dismissing the complaint.