No-Fault Case Law

The court considered the requirements for verification requests for examinations under oath (EUOs) as contained in 11 NYCRR §§65-3.5 and 3.6, which do not apply to EUOs scheduled prior to an insurance company's receipt of claim forms. The main issue decided in the case was whether or not the defendant insurance company, Hartford Insurance Co., properly denied the claim based on the assignor's failure to appear at two EUOs. The court held that the insurance company's consent to an adjournment of the initial EUO vitiated its right to count the assignor's failure to appear as a no-show. Furthermore, once the defendant received the claim, it was required to adhere to statutory and regulatory scheme of verification for the processing of no-fault claims, which requires sending a follow-up request for an EUO pursuant to 11 NYCRR §65-3.6(b), once the assignor failed to appear for the scheduled EUO. The court denied the defendant's motion for summary judgment, and the case is to proceed to trial.

The court considered the fact that the order which had granted plaintiff's motion for summary judgment was ruled on default, and, as a result, defendant's opposing papers as well as its cross motion for summary judgment dismissing the complaint were not considered as they were declared untimely due to a briefing schedule set by the Civil Court. Defendant appealed from the denial of its motion to vacate the default order and requested a new determination of plaintiff's motion for summary judgment and defendant's cross motion for summary judgment. The issue was whether defendant had a reasonable excuse for the default and a meritorious defense to the action. The court held that defendant proffered a reasonable excuse for its failure to submit its papers timely and also set forth a meritorious defense. As a result, the judgment was reversed, the order was vacated, and both plaintiff's motion for summary judgment and defendant's cross motion for summary judgment dismissing the complaint were remitted to the Civil Court for a new determination.

The relevant facts considered by the court were that East Gun Hill Medical, P.C. was seeking to recover first-party no-fault benefits in a lawsuit against Fiduciary Insurance Company of America. The main issue decided was whether the defendant's motion to vacate a prior order granting summary judgment to the plaintiff should be denied. The holding of the case was that the defendant failed to demonstrate a reasonable excuse for the default and a meritorious defense to the action, and therefore the judgment in favor of the plaintiff was affirmed.

The main issues in this case were whether the defendant had a reasonable excuse for their default and whether they had a meritorious defense to the action. The court considered the fact that the defendant's moving papers failed to proffer a reasonable excuse for the default. As a result, the court affirmed the judgment in favor of the plaintiff, as the defendant did not demonstrate a valid reason for their default and failed to establish a meritorious defense to the action. Therefore, the appeal from the order entered December 20, 2010 was deemed to be from the judgment, and the court affirmed the judgment without costs.

The court considered an appeal from an order denying a motion to vacate a prior order granting the plaintiff's unopposed motion for summary judgment in a case to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had demonstrated a reasonable excuse for the default and a meritorious defense to the action in seeking to vacate the prior order entered on default. The court held that the defendant's moving papers failed to proffer a reasonable excuse for the default and did not establish a meritorious defense, and therefore affirmed the judgment in favor of the plaintiff for the amount of $3,780.82.

The court considered whether the plaintiff, Top Choice Medical, P.C., had established its entitlement to summary judgment in a case to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant, Geico General Insurance Company, had failed to pay or deny the claim within the requisite 30-day period, or had issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. The holding of the court was that the plaintiff had failed to demonstrate that the defendant's denial of claim forms were either untimely or without merit as a matter of law, and therefore, the order denying the plaintiff's motion for summary judgment was affirmed.

The main issue decided in this case was whether a provider, All Boro Psychological Services, P.C., was obligated to respond to certain discovery demands made by the defendant, Auto One Ins. Co., as a condition for their claim to recover assigned first-party no-fault benefits. The court held that the provider was obligated to provide the requested information, except for matters which were privileged or palpably improper. The defendant had set forth specific reasons for its belief that the provider may be ineligible to recover assigned first-party no-fault benefits, and by obtaining the requested discovery, the defendant would be able to ascertain whether the provider was indeed ineligible. The court affirmed the order denying the provider's motion for summary judgment and granting the defendant's cross motion to dismiss the complaint in part, compelling the provider to respond to the defendant's discovery demands.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, in which plaintiff's motion for summary judgment was granted, allowing the plaintiff, Jamhil Medical, P.C. to recover assigned first-party no-fault benefits from Allstate Ins. Co. Defendant, Allstate Ins. Co., appealed the decision. The main issue decided was whether plaintiff had established its prima facie entitlement to summary judgment. The court held that plaintiff had failed to demonstrate that claim forms annexed to its motion papers were admissible under the business records exception to the hearsay rule, and therefore, plaintiff failed to make out its prima facie case. The judgment was reversed, the order granting plaintiff's motion for summary judgment was vacated, and plaintiff's motion was denied.

The court considered the fact that the defendant had timely mailed requests for verification and follow-up requests for first-party no-fault benefits, and that the plaintiff had failed to respond to those requests. The main issue decided was whether the 30-day period within which the defendant was required to pay or deny the plaintiff's claims had commenced to run, and whether the plaintiff's action was premature. The holding of the court was that the defendant's cross motion for summary judgment dismissing the complaint should have been granted, as the plaintiff's action was indeed premature. As a result, the judgment was reversed, the order granting the plaintiff's motion for summary judgment was vacated, and the defendant's cross motion for summary judgment was granted.

The main issue in this case was whether the provider, Eagle Surgical Supply, Inc., was entitled to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Co. Plaintiff's assignor failed to appear for examinations under oath (EUOs), which led to the dismissal of plaintiff's claims in the sums of $1,013.25, $549.18 and $844.13. The main argument on appeal was that the insurance policy did not contain a provision entitling the defendant to EUOs. However, the court found that this argument lacked merit based on previous legal precedents. The court also determined that plaintiff's remaining contention was not properly before the court since it was raised for the first time on appeal. As a result, the order granting the branches of defendant's motion seeking summary judgment dismissing plaintiff's claims was affirmed.