No-Fault Case Law

The main issue decided in this case was whether the petitioner, State Farm Automobile Insurance Company, was entitled to vacate an arbitration award after the arbitrator determined that the petitioner was primarily responsible for making no-fault payments to a pedestrian who was struck by the insured's loaner vehicle. The relevant facts considered by the court included the loaner/rental agreement signed by the insured, William Salas, before he took control of the loaner vehicle, and the policies of both the petitioner and the respondent, Harco National Insurance Company. The holding of the case was that the court denied the application to vacate the arbitration award and confirmed the award. The court determined that the arbitrator's decision was not arbitrary or capricious and was supported by credible evidence, specifically paragraph 6 of the loaner/rental agreement. The court also found that a loaner vehicle is considered a "temporary substitute vehicle" and is ordinarily covered under the insured's policy, and thus the respondent was not primarily responsible for no-fault coverage. Therefore, the petitioner was deemed primarily responsible for making no-fault payments to the pedestrian.

The main issue in this case was whether the insurance company was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to comply with the verification requests. The relevant facts considered by the court included the dates on which the verification requests were mailed by the defendant, the lack of response by the plaintiff to these requests, and the timing of the follow-up requests issued by the defendant. The court held that the insurance company was entitled to summary judgment because the plaintiff's failure to respond to the verification requests rendered the action premature. The court also found that the timing of the follow-up requests did not deprive the insurance company of the benefit of tolling the 30-day period within which it was required to pay or deny the claim. Therefore, the court reversed the order of the Civil Court and directed the entry of judgment in favor of the defendant, dismissing the complaint.

The main issue in this case was whether the defendant's motion to consolidate 82 other cases with the present case should be granted. The court considered the fact that the plaintiff had already obtained summary judgment in the present case and had been awarded a specific sum of money. The court found that there had been a final adjudication on the merits in the present case, and therefore, there was no longer a pending action with which other actions could be consolidated. As a result, the court denied the defendant's motion for consolidation. The holding of the court was that the order denying the defendant's motion for consolidation was affirmed, and no other issues were addressed.

The case involved a medical care provider's claim to recover no-fault benefits from an insurance company. The Civil Court found there was only one triable issue, and that was whether the fees charged were excessive for the care administered. The insurance provider sought to demonstrate at trial that the medical care provider was not eligible for reimbursement under the no-fault law. However, the Civil Court had barred this evidence citing the previous order. The Appellate Term found that the issue for trial was improperly limited and therefore reversed the judgment, vacated the order that limited the trial to the issue of excessive charges, and remitted the matter back to the Civil Court for a new trial.

The case involved a proceeding pursuant to CPLR article 75 to stay arbitration of an uninsured motorist claim. The appellant, Taylor Raynor, allegedly was injured in an accident caused by an uninsured vehicle and sent her insurer, Allstate Insurance Company, a notice of intention to arbitrate, claiming no-fault benefits, uninsured motorist benefits, and supplemental insurance benefits. Allstate then commenced a proceeding to stay arbitration, arguing that the offending vehicle was insured on the date of the accident. The main issue was whether the proceeding was time-barred, as the appellant's notice of intention to arbitrate was not responded to within 20 days, as required by law. The court held that the proceeding was indeed time-barred and granted the appellant's cross motion to dismiss.

The court considered the statutory and regulatory framework governing the payment of no-fault automobile benefits. The main issue decided was whether the plaintiff had established prima facie entitlement to judgment as a matter of law on its claim for benefits. The holding was that the plaintiff had failed to establish its prima facie entitlement to judgment, as the evidence demonstrated that the defendant made a partial payment and a partial denial of the claim within 30 days after receipt thereof. The court also found that the minor factual discrepancy contained in the defendant's denial of claim form did not invalidate the denial, and the denial was not conclusory or vague, and did not otherwise involve a defense which had no merit as a matter of law. Therefore, the Supreme Court properly denied the plaintiff's motion for summary judgment on the complaint.

The relevant facts the court considered were that Allstate Insurance Company and other parties moved for partial summary judgment, and the defendants, Belt Parkway Imaging, P.C., et al., opposed the motion. The issue at hand was whether a provider of health care services is eligible for reimbursement under section 5102(a) (1) of the Insurance Law if the provider fails to meet any applicable New York State or local licensing requirement. The Court of Appeals held that "insurance carriers may withhold payment for medical services provided by fraudulently incorporated enterprises" (see State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313, 319, 321 [2005]). Mallela was decided on March 29, 2005. The Legislature subsequently enacted Insurance Law § 5109, which became effective on August 2, 2005. The holding of the case was that if the services rendered by the PC defendants were medically unnecessary, then plaintiffs have stated a cause of action for unjust enrichment. The court unanimously affirmed the denial of the motion for partial summary judgment.

The Court considered a case involving an action to recover assigned first-party no-fault benefits, where the plaintiff moved for summary judgment upon the first and second causes of action, and the defendant cross-moved for summary judgment dismissing those causes of action on the ground of failure to comply with verification requests. The main issue decided was whether the defendant had established the mailing of its initial and follow-up verification requests, and whether the plaintiff had provided the requested verification. The Court held that the defendant's verification requests sought copies of NF-5 forms signed by plaintiff's assignors, but as the plaintiff had already provided the authorizations to release information and the assignments executed by the assignors, the plaintiff had complied with the requests. The Court also held that the defendant had failed to establish the mailing of its initial and follow-up verification requests. Therefore, the order was affirmed without costs.

The relevant facts of the case involved a medical imaging company seeking to recover first-party no-fault benefits from an insurance company for services rendered to a patient. The insurance company denied the claims on the grounds of lack of medical necessity. The main issue decided by the court was whether the insurance company's denial of the claims on the basis of lack of medical necessity was justified. The court held that the insurance company had provided a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the services at issue, shifting the burden to the medical imaging company to rebut the insurance company's showing. As the medical imaging company failed to submit any medical evidence sufficient to raise a triable issue of fact as to medical necessity, the court granted the insurance company's motion for summary judgment dismissing the complaint.

In the case, Elmont Open MRI & Diagnostic Radiology, P.C. v Clarendon Natl. Ins. Co., the main issue before the court was whether the peer review report provided by the defendant was sufficient to demonstrate a lack of medical necessity for the services at issue. The defendant had timely denied the plaintiff's claims on the ground of lack of medical necessity, and the District Court initially denied the defendant's motion for summary judgment, stating that the peer review report was insufficient. However, upon appeal, the Appellate Term reversed the decision, holding that the peer review report submitted by the defendant did provide a sufficient factual basis and medical rationale to demonstrate a lack of medical necessity. As a result, the defendant was entitled to summary judgment dismissing the complaint, as the plaintiff failed to submit any medical evidence to raise a triable issue of fact. Therefore, the Appellate Term reversed the lower court's decision and granted the defendant's motion for summary judgment.