No-Fault Case Law

The relevant facts considered by the court were that the defendant was a Florida insurance company and the plaintiff was seeking to recover first-party no-fault benefits from the defendant. The main issue decided was whether the court had personal jurisdiction to hear the case. The holding of the court was that the defendant's motion to dismiss based on lack of personal jurisdiction had merit, and the burden was on the plaintiff to prove jurisdiction had been properly obtained. The court found that the plaintiff failed to show a basis for jurisdiction and did not establish essential facts justifying opposition to the motion, and therefore, affirmed the order dismissing the complaint without costs. Additionally, the court ruled that the defendant's motion to dismiss, which was misunderstood as a motion for summary judgment, did not cause the plaintiff any prejudice and was properly overlooked by the Civil Court. Finally, the Civil Court's decision to refuse to allow plaintiff to submit a late notice of claim to MVAIC was not considered an abuse of discretion.

The court considered whether defendant's submissions in support of its cross motion for summary judgment dismissing the complaint presented an issue of fact as to the applicability of the Workers' Compensation Law to the subject loss, which defendant alleged occurred during the course of the assignor's employment. The main issue decided was whether the determination as to the applicability of the Workers' Compensation Law should be made by the Workers' Compensation Board, given its expertise in the area. The holding of the court was that the resolution of the factual question presented on the record was best suited for determination by the Workers' Compensation Board, and the parties' respective summary judgment motions should have been held in abeyance pending a determination by the Workers' Compensation Board as to the applicability of the Workers' Compensation Law to plaintiffs' claim. Additionally, the court noted that defendant established that its denials were timely mailed within the prescribed 30-day period.

The court considered two cases for recovery of unpaid no-fault medical bills. The defendant, GEICO General Insurance Company, denied reimbursement for medical services rendered to the assignors of A-Quality Medical Supply, based on a lack of medical necessity. Defendant's denials were based on peer reviews, but the court was presented with issues regarding the admissibility of defendant's documents. The main issue decided was the admissibility of peer reviews as evidence in medical necessity defenses. The holding of the case was that defendant did not establish its prima facie case and judgment was entered in favor of plaintiff, as the peer reviews not admitted into evidence did not constitute admissible evidence and could not be used to support a lack of medical necessity defense.

The court considered the plaintiff's motion for summary judgment on a cause of action to recover no-fault medical payments from the defendant under an insurance contract. The main issue was whether the defendant should be allowed to modify the amount of the judgment because it exceeded the limits of the policy covering the plaintiff, based on payments made to other health care providers. The court held that the defendant was not collaterally estopped from seeking to modify the amount of the judgment, because the only issues decided on the motion for summary judgment were whether the defendant had failed to pay or deny the claim within the statutory time frame, and whether the defendant had received verification of the claim. The court affirmed the order, but did not pass upon the propriety of the procedural mechanism utilized by the defendant, to which the plaintiff did not object.

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.