No-Fault Case Law
Optimum Health Acupuncture, P.C. v Integon Natl. Ins. Co. (2022 NY Slip Op 50068(U))
January 5, 2022
The court considered the defendant's motion for summary judgment seeking to dismiss the plaintiff's complaint for reimbursement of first-party no-fault benefits for medical services. The plaintiff sought reimbursement for treatments provided to the assignor from February 6, 2019, through March 19, 2020, following a car accident on January 28, 2019. The defendant denied the claims based on excessive billing and lack of medical necessity for certain treatments, as supported by expert evaluations and reports. In opposition to the motion, the plaintiff presented affidavits to rebut the defendant's claims. Ultimately, the court found that the defendant had established proper mailing practices for its denials, and that the plaintiff's opposition lacked evidence to create a genuine issue of material fact. Therefore, the court granted the defendant's motion for summary judgment, resulting in the dismissal of the plaintiff's complaint.
Arcadia Acupuncture, P.C. v Nationwide Ins. Co. (2021 NY Slip Op 51258(U))
December 22, 2021
The court considered the fact that Arcadia Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits, and that Nationwide Ins. Co. had moved for summary judgment dismissing the complaint on the ground that Arcadia Acupuncture, P.C. had failed to appear for duly scheduled examinations under oath (EUOs). Plaintiff cross-moved for summary judgment. The main issue decided was whether the EUOs were scheduled in a place that was "reasonably convenient" to plaintiff, and thus, whether Nationwide Ins. Co. was entitled to summary judgment dismissing the complaint. The holding of the case was that a triable issue of fact existed as to whether the EUOs were scheduled to be held at a place that was "reasonably convenient" to plaintiff, and that consequently, neither party was entitled to summary judgment upon those claims. The order was modified to deny the branches of plaintiff's cross motion seeking summary judgment dismissing defendant's affirmative defense that plaintiff had failed to appear for duly scheduled EUOs and partial summary judgment on liability.
Blackman Pelham Med., P.C. v Ocean Harbor Cas. Ins. Co. (2021 NY Slip Op 51257(U))
December 22, 2021
The relevant facts considered by the court included an investigation that revealed the policyholder and assignor did not reside or garage the vehicle in Florida at the time the policy was renewed, about three weeks before the accident. Defendant moved for summary judgment dismissing the complaint on the ground that the Florida automobile insurance policy in question was validly rescinded, ab initio, pursuant to Florida law. Plaintiff contended that New York law, which does not permit retroactive rescission, should control and that defendant failed to demonstrate that the insurance policy had been properly rescinded in accordance with Florida law. The main issue decided was whether the insurer had properly rescinded the automobile insurance policy ab initio in accordance with Florida law. The holding of the case was that the Civil Court properly applied Florida law to the substantive issue involved and that the defendant had established, prima facie, that it had voided the policy ab initio pursuant to Florida law, and plaintiff failed to raise a triable issue of fact in opposition to the motion, so the order was affirmed.
BSS Med., P.C. v Metropolitan Prop. & Cas. Ins. (2021 NY Slip Op 51255(U))
December 22, 2021
The court considered the fact that the provider, BSS Medical, P.C., as the assignee of two individuals, was seeking to recover first-party no-fault benefits. The main issue in this case was whether the defendant's motion for summary judgment to dismiss the complaint was untimely. The court ultimately held that the defendant's motion for summary judgment was not untimely under CPLR 3212(a) because it was made within the required 120 days after the filing of the notice of trial, which is the equivalent of a note of issue in Civil Court. As a result, the court reversed the order denying the defendant's motion and remitted the matter back to the Civil Court for a determination of the defendant's motion on the merits.
Chiropractic Life, P.C. v Unitrin Advantage Ins. Co. (2021 NY Slip Op 51221(U))
December 21, 2021
The court considered the case of Chiropractic Life, P.C. v Unitrin Advantage Insurance Company, in which the plaintiff sued the defendant for unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor. The defendant moved to dismiss the complaint on the ground that the action was commenced after the statute of limitations had expired. The main issue decided was whether the defendant met its burden to show that the time to commence the cause of action had expired. The court held that the defendant did not establish the accrual date of the plaintiff's claim, so it could not be determined if the plaintiff commenced the action before the expiration of the statute of limitations. As a result, the defendant's motion to dismiss the complaint on the ground of statute of limitations was denied, and the defendant's request for costs against the plaintiff was also denied.
A.H. Physical Therapy, P.C. v 21st Century Advantage Ins. Co. (2021 NY Slip Op 21355)
December 17, 2021
The court was presented with the case of A.H. Physical Therapy, P.C., an assigned provider, seeking to recover first-party no-fault benefits from 21st Century Advantage Insurance Company. After the defendant failed to appear or answer the complaint, the Civil Court granted plaintiff's motion to enter a default judgment. Defendant then moved to vacate the default judgment and dismiss the complaint, alleging lack of personal jurisdiction and insufficient service of process. The court held that in cases of lack of personal jurisdiction, determining whether there was ever a default is a "threshold issue." The court also found that lack of service of process provided a reasonable excuse for the default, and since the plaintiff failed to seek leave to enter a default judgment within a year after the default, the action was deemed abandoned. As a result, the court reversed the order and remitted the matter to the Civil Court for a new determination.
Tyorkin v Repwest Ins. Co. (2021 NY Slip Op 51208(U))
December 10, 2021
The court considered the facts that the plaintiff, Maxim Tyorkin, as assignee of Davon Simmons, had moved for summary judgment to recover first-party no-fault benefits from the defendant, Repwest Insurance Company. The defendant cross-moved for summary judgment, arguing that the plaintiff's assignor failed to appear for duly scheduled independent medical examinations (IMEs). The main issue decided was whether the plaintiff's assignor's affidavit, stating that he did not receive the IME scheduling letters, raised a triable issue of fact. The holding of the case was that the affidavit by the plaintiff's assignor failed to raise a triable issue of fact because the plaintiff did not submit any evidence that the IME scheduling letters were not properly mailed, and the assignor's bald conclusory denial of receipt was insufficient to rebut a presumption that the letters were received. Therefore, the court affirmed the order denying plaintiff's motion for summary judgment and granting defendant's cross motion for summary judgment dismissing the complaint.
Midwood Total Rehab Med., P.C. v Republic W. Ins. Co. (2021 NY Slip Op 51206(U))
December 10, 2021
The court considered whether the defendant had a duty to provide coverage for the accident in question, based on a declaratory judgment entered in a different court. The defendant had moved for summary judgment to dismiss the complaint, while the plaintiff had opposed and also moved for summary judgment. The main issue in the case was whether the action had been commenced after the statute of limitations had expired for the defendant's cross motion for summary judgment to dismiss the complaint. The court ultimately held in favor of the defendant, ruling that the action had been commenced after the expiration of the three-year statute of limitations applicable to self-insurers. Consequently, the defendant's cross motion for summary judgment to dismiss the complaint was granted, and the appeals from the prior orders were dismissed as academic.
Midwood Total Rehab Med., P.C. v Republic W. Ins. Co. (2021 NY Slip Op 51205(U))
December 10, 2021
The relevant facts that the court considered included the ownership and insurance of the vehicle involved in the accident, the role of the defendant as a third-party claims handler processing claims on behalf of a self-insured U-Haul, Inc., and the timing of the mailing of the claim and the commencement of the action. The main issues decided were whether the defendant had a duty to provide coverage for the accident, the timeliness of the action based on the statute of limitations applicable to self-insurers, and whether the plaintiff raised a genuine issue of fact regarding the timeliness of the action. The holding of the case was that the defendant's cross motion for summary judgment dismissing the complaint was granted, as the action had been commenced after the expiration of the three-year statute of limitations applicable to self-insurers, and the appeals from the previous orders were dismissed as academic.
SK Prime Med. Supply v Country Wide Ins. Co. (2021 NY Slip Op 51204(U))
December 10, 2021
The court considered the fact that plaintiff SK Prime Medical Supply sought to recover first-party no-fault benefits assigned to them, while defendant Country Wide Insurance Company argued that they had not issued an insurance policy covering the accident in question. The main issue decided was whether there was coverage in effect at the time of the accident, and the holding of the case was that defendant's cross motion for summary judgment dismissing the complaint was granted. The court found that the affidavit from defendant's underwriting department's New Business Supervisor was sufficient to demonstrate that there was no coverage in effect at the time of the accident, and plaintiff failed to demonstrate the existence of a triable issue of fact in opposition to this showing. Therefore, defendant's cross motion for summary judgment was granted, and there was no need to remit the matter for further proceedings upon plaintiff's motion for summary judgment.