No-Fault Case Law

The court considered whether the plaintiff provided the defendant with an MRI diagnostic test and film for payment pursuant to the no-fault insurance regulations and fee schedule. The main issue was the defendant's motion for summary judgment, which was based on the grounds that the plaintiff's claim was premature as responses were outstanding to verification requests. The court ultimately held in favor of the defendant, granting their motion and dismissing the matter without prejudice as premature. The court found that the defendant's motion for summary judgment was justified based on the plaintiff's refusal to provide the MRI films until they received a $5 fee, while the defendant's response aiming to promote litigation and delay payment. Therefore, the court granted the defendant's motion and denied the plaintiff's cross motion.

The court considered the fact that plaintiff was seeking to recover assigned first-party no-fault benefits for medical services provided to defendant's insured as a result of a car accident that occurred in 2013. Plaintiff filed a motion for summary judgment, and defendant cross-moved to dismiss the complaint. The court denied both motions on the basis of defective notice/papers, as both parties had issues with timing and signature of relevant documents. The main issue decided was whether the court should disregard procedural irregularities and grant plaintiff's motion for summary judgment. The court held that it did not improvidently exercise its discretion in denying plaintiff’s motion "for defective papers," and affirmed the lower court's decision.

The court reviewed evidence provided by State Farm Mutual Automobile Insurance Company which showed that certain medical providers and individual defendants violated specific conditions preceding coverage and had a founded belief that the alleged injuries did not arise from a car accident claim. The court agreed that these parties did not take part in Examinations Under Oath and therefore could not make a claim for the alleged accident. The court agreed with State Farm that they did not have to pay any claims related to the accident. Although State Farm was not able to perform discovery on the claimants, the evidence they provided in the complaint and affidavits was deemed admissible and supported their argument. The court also acknowledged their argument that the policy was procured online to an Albany address 22 days before the collision, which called into question the legitimacy of the claims.

The main issue in the case was whether the insurance policy issued by American Transit Insurance Company was void ab initio, and whether the medical provider defendants were entitled to no-fault insurance benefits arising from the motor vehicle accident. The court found that the insurer failed to establish prima facie that it was entitled to summary judgment based on the insured's failure to appear for an independent medical examination (IME), as its motion papers did not demonstrate that it complied with New York State no-fault regulations governing the timeframes for scheduling IMEs. Specifically, the insurer did not establish that it timely requested the IMEs under the applicable regulations, and therefore, the court reversed the order granting the insurer's motion, denied the motion, and remanded the matter for further proceedings consistent with its decision. The court found that the insurer did not meet its burden of proof and compliance with the regulations, and therefore, was not entitled to summary judgment declaring the insurance policy void and denying benefits to the medical provider defendants.

The relevant facts of this case involve American Transit Insurance Company seeking a declaration that it is not obligated to pay no-fault benefits to Erika Rivera, who was involved in a vehicle collision and assigned the right to collect no-fault benefits to various treating medical providers. American Transit denied the providers' applications for no-fault benefits and brought the action for declaratory judgment. The main issue decided was whether American Transit complied with the procedural and timeliness requirements of 11 NYCRR § 65-3.5 regarding the handling of no-fault claims. The court's holding was that American Transit failed to establish that it satisfied the timeliness requirements for requesting an independent medical examination and rescheduling it, and that its motion for default judgment and summary judgment was denied. Additionally, the court ordered American Transit to respond to the discovery requests from Global Surgery and Safe Anesthesia within 30 days, and if it fails to serve a renewed motion within 60 days, the action will be administratively dismissed.

The court considered the issue of whether an insurer was entitled to summary judgment declaring that it need not honor or pay claims for defendants in connection with an accident. The main issue decided was whether the failure to appear for a scheduled medical examination (ME) by the insurer, when requested, was a breach of a condition precedent to coverage under the no-fault policy. The holding of the case was that while the failure to appear for an ME constitutes a breach of policy term, it does not entitle the insurer to void the policy ab initio. The court also concluded that the failure to appear for an ME is more similar to a policy exclusion rather than a lack of coverage and that the insurer must establish its requested MEs in accordance with specific time frames set forth in the no-fault implenting regulations.

The main issue in this case was whether the insurance company was required to honor or pay any claims from certain medical facilities and providers in connection with two separate accidents that occurred on May 22, 2018 and June 11, 2018, respectively. The court considered the fact that the insurance company had requested independent medical examinations (IMEs) for each of the claims in accordance with the procedures and time frames set forth in the no-fault implementing regulations. However, the court determined that it was impossible to discern from the record whether the insurance company complied with the requisite time frames requiring it to request IMEs within 15 days of receiving the claims and scheduling the IMEs for within 30 days of receiving their claims. Therefore, the court held that the insurance company failed to establish its prima facie entitlement to summary judgment and reversed the lower court's decisions, denying the insurance company's motion for summary judgment in both cases.

The main issue in this case was whether the defendant, an insurance company, was entitled to summary judgment dismissing the complaint for first-party no-fault benefits on the grounds that it did not receive timely notice of the accident or the claim for insurance benefits. The Court considered that under Pennsylvania substantive law, to which the case was subject, where an insured is required to provide the insurer with notice "as soon as practicable," they are governed by a "notice-prejudice" rule under which "unless the insurer establishes prejudice resulting from the insured's failure to give notice as required under the policy, the insurer cannot avoid its contractual obligation." It was undisputed that the vehicle in question was insured by the defendant under a Pennsylvania automobile insurance policy and that defendant received notice of plaintiff's claim more than 30 days after the accident. However, the record was devoid of any showing that a notice of trial was filed more than 120 days prior to when the defendant made its summary judgment motion, and as defendant's motion papers failed to establish that it had been prejudiced by reason of the lateness of the notice it received, the Civil Court properly denied defendant's motion. The holding of the case was that the order denying defendant's motion for summary judgment was affirmed.

The main issue in this case was whether the provider, JFL Medical Care, P.C., could recover assigned first-party no-fault benefits from Lancer Insurance Co. The court considered the fact that defendant had established that the independent medical examination scheduling letters had been mailed to plaintiff's assignor, which was a requirement for the case. The court found that plaintiff's cross motion for summary judgment was properly denied, and affirmed the order granting defendant's motion for summary judgment dismissing the complaint. Therefore, the holding of the case was that the order was affirmed, with $25 costs.

The relevant facts considered in this case were that the plaintiff insurance company filed a motion for a default judgment against a no-fault claimant and some of his treating medical providers, as well as a motion for summary judgment against appearing defendants. The main issue decided was whether the plaintiff had complied with the regulatory timeliness requirements for processing of no-fault insurance claims. The court held that the plaintiff had not established compliance with the timeliness requirements as mandated by the regulation, and thus denied the motion for default judgment and summary judgment. The court ordered that if the plaintiff does not bring a renewed default-judgment motion within 30 days, the action will be dismissed as to the defaulting defendants.