No-Fault Case Law
Williams v Kemper Independence Ins. Co. (2025 NY Slip Op 50101(U))
January 10, 2025
The court considered that the plaintiff was seeking $1,949.69 in unpaid medical bills related to services provided to Damally Caine, but failed to submit a completed No-Fault Application within the required time frame of thirty days following the alleged accident. The primary issues were whether the plaintiff had complied with the conditions precedent for coverage under the No-Fault Insurance Law and whether the defendant was entitled to summary judgment due to the plaintiff's failure to provide the necessary application. The court ruled that the failure to submit a completed No-Fault Application constituted a breach of condition precedent, precluding coverage for the claim. It found that the defendant had made a prima facie showing of entitlement to summary judgment, as the plaintiff did not establish any material issues of fact in opposition to the motion. Consequently, the court granted the defendant's motion for summary judgment, dismissing the complaint in its entirety.
Williams v Kemper Independence Ins. Co. (2025 NY Slip Op 50101(U))
January 10, 2025
In this case, the court considered relevant facts surrounding the failure of the plaintiff to submit a completed No-Fault Application within thirty days following an alleged accident, which the defendant argued precluded the plaintiff from receiving coverage for unpaid medical bills totaling $1,949.69. The main issue was whether the defendant's claim for a lack of timely submission of this application constituted a valid defense to the plaintiff's demand for payment. The court found that the defendant established a prima facie case by demonstrating the non-receipt of the necessary paperwork, while the plaintiff argued that the defendant could not invoke the thirty-day rule defense without issuing a timely denial of the claim. Ultimately, the court held that the failure to submit a completed No-Fault Application constituted a breach of a condition precedent to coverage, granting the defendant's motion for summary judgment and dismissing the plaintiff's complaint in its entirety.
Hereford Ins. Co. v Interdependent Acupuncture PLLC (2025 NY Slip Op 00021)
January 2, 2025
The court considered the motions of the defendants-appellants to vacate default judgments that were previously granted in favor of Hereford Insurance Company, which had denied them no-fault insurance coverage. The main issues decided included whether the appellants provided a reasonable excuse for their defaults and whether the default judgments were null and void due to the plaintiff's failure to submit evidentiary proof as required by law. The court affirmed the lower court's decision to deny the motion to vacate, stating that the appellants failed to demonstrate a reasonable excuse for not responding to the complaint and that their arguments lacked merit. Additionally, the court noted that the failure to submit the required proof for default judgments was not a jurisdictional defect, thus not rendering the judgments null. Ultimately, the court upheld the denial of the appellants' motions, affirming the plaintiff's position on the issue of coverage.
Ocean View Med. Care, P.C. v Good2Go Auto Ins. (2024 NY Slip Op 51832(U))
December 20, 2024
In this case, the court considered whether the action brought by Ocean View Medical Care to recover assigned no-fault benefits was barred by the statute of limitations. The main issue was whether the claim determination period had been tolled due to requests for verification from the insurance company. The court found that the argument presented by the defendant regarding the accrual date of the cause of action, which arose in response to new evidence submitted by the plaintiff, was appropriately considered. Ultimately, the Civil Court granted the defendant's cross-motion to dismiss the complaint on statute of limitations grounds and denied the plaintiff's motion for a default judgment as moot. The order was affirmed with costs.
Ocean View Med. Care, P.C. v Good2Go Auto Ins. (2024 NY Slip Op 51832(U))
December 20, 2024
In this case, the court considered the relevant timeline regarding the accrual of a claim for first-party no-fault benefits and whether the statute of limitations had expired. The main issues involved whether the plaintiff's action was barred by the statute of limitations and the appropriateness of the defendant's arguments raised in response to new evidence submitted by the plaintiff. The court found that the Civil Court correctly dismissed the complaint, concluding that the action was indeed barred by the statute of limitations, despite the plaintiff's claims of additional verification requests that allegedly tolled the time period. Ultimately, the court affirmed the order, dismissing the plaintiff's appeal and upholding the lower court's decision denying the motion for a default judgment as moot.
Northern Med. Care, P.C. v Nationwide Affinity Ins. Co. of Am. (2024 NY Slip Op 51822(U))
December 19, 2024
The court considered several relevant facts in this case, particularly focusing on the plaintiff's failure to comply with scheduled examinations under oath (EUOs). Although the owner of the plaintiff appeared for an EUO on April 10, 2018, their counsel refused to allow answers to the questions posed, leading the defendant to view it as a no-show. Subsequently, the defendant scheduled four additional EUOs, but the plaintiff’s owner left the last scheduled EUO on September 6, 2018, before it could commence. The main issues decided included whether the plaintiff's actions constituted a failure to appear for the EUOs and whether the defendant's denial of the claim was timely issued following these failures. The court held that the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's non-compliance with the EUO requirements, affirming the lower court's decision.
Northern Med. Care, P.C. v Nationwide Affinity Ins. Co. of Am. (2024 NY Slip Op 51822(U))
December 19, 2024
The court considered several key facts regarding the plaintiff's failure to appear for duly scheduled examinations under oath (EUOs) in a case seeking recovery of assigned first-party no-fault benefits. The plaintiff's owner attended one EUO but was instructed by counsel not to answer questions, resulting in the attorney characterizing it as a "no show." Subsequently, the defendant scheduled four additional EUOs, but the owner left before the last scheduled session could begin. The main issues decided were whether the defendant timely issued a denial of the claim based on the plaintiff’s failure to comply with the EUO requests and whether the insurer was entitled to summary judgment. The holding affirmed the Civil Court's order granting the defendant's motion for summary judgment, confirming that the insurer had complied with the requirements for a valid denial based on the failure to appear at the EUOs.
Quick v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 06268)
December 12, 2024
The court considered relevant facts surrounding an injury sustained by the plaintiff while operating a tractor trailer during his employment with Casa Builders, Inc., which did not provide workers' compensation coverage. The primary issue was whether the plaintiff was entitled to no-fault insurance benefits despite not applying for workers' compensation benefits through the Uninsured Employers' Fund, particularly since the employer lacked workers' compensation coverage at the time of the accident. The court held that the plaintiff must first seek workers' compensation benefits, as they are the primary source for recovery in such cases, before pursuing no-fault insurance benefits. Consequently, the Supreme Court properly granted the defendant's motion for summary judgment dismissing the complaint, reinforcing the principle that benefits from workers' compensation and no-fault insurance cannot be pursued simultaneously.
Atlantic Med. & Diagnostic, P.C. v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 51785(U))
December 12, 2024
The court considered the plaintiffs' entitlement to first-party no-fault benefits for interventional pain management services, specifically for radiologic assistance used in administering trigger point injections. The main issue was whether the plaintiffs were entitled to reimbursement for multiple units of radiology services (CPT 76942) billed in conjunction with the trigger point injection code (CPT 20553). The defendant contended that only one unit of the radiology service was reimbursable, relying on expert testimony that referenced coding opinions from the American Medical Association. In contrast, the plaintiffs argued for multiple reimbursements based on the guidance provided in the New York State Workers' Compensation Medical Fee Schedule. Ultimately, the court held that the Fee Schedule allowed for multiple billing and reimbursement of the radiology codes, thus ruling in favor of the plaintiffs and awarding them the stipulated amounts.
Ola v American Family Connect Ins. Co. (2024 NY Slip Op 51804(U))
November 15, 2024
In this case, the court considered the petitions and cross-petitions relating to an arbitrator's award that denied a claim for first-party no-fault benefits for medical services rendered to Eufrosine Ola. The main issues decided included whether the arbitrator’s award and the master arbitrator’s affirmation of that award were valid, and whether the matter should be remitted for a rehearing before a new arbitrator. The Civil Court initially vacated the arbitrator's awards, finding them arbitrary and contrary to settled law, but did not order a rehearing. Upon reargument, the court affirmed the vacatur of the awards and specifically ordered that the case be heard before a new arbitrator, effectively granting the insured’s request for a rehearing. The final holding confirmed that both the petition to vacate the awards was properly granted and the insurer's cross-petition was denied.