No-Fault Case Law

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.

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.

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.

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.