No-Fault Case Law

The main issue in this case was the application of the workers' compensation fee schedule in a lawsuit by a provider to recover assigned first-party no-fault benefits. The court consolidated this action for trial with two other actions involving the same provider and insurer. After a nonjury trial, the Civil Court found in favor of the plaintiff and awarded them the principal sum of $2,807.40. The Appellate Term, Second Department affirmed the judgment, stating that for the reasons stated in another related case, the judgment in this case is affirmed. The court also deemed the notice of appeal from a previous decision as a premature notice of appeal from the final judgment.

The relevant facts considered by the court include the issue of whether the plaintiff, as the assignee of David Wright, was entitled to recover first-party no-fault benefits from the defendant insurer. The main issue decided was the application of the workers' compensation fee schedule, as the trial focused on this specific issue. The holding of the court was that the judgment awarding the plaintiff the principal sum of $2,111.94 was affirmed. The court stated that the defendant failed to demonstrate that the amount plaintiff sought to recover exceeded the amount permitted by the workers' compensation fee schedule, and therefore, there was no basis to disturb the Civil Court's determination.

The court considered the plaintiff's argument that they were entitled to a default judgment in the amount of $1,221.96, as well as interest on the original sum sought, costs, and disbursements. The main issue decided was whether the plaintiff was entitled to vacate the administrative dismissal of the action and, upon such vacatur, the entry of a default judgment. The court, in an order dated June 13, 2019, denied the plaintiff's motion to vacate the administrative dismissal of the action and for the entry of a default judgment. The court directed the defendant to pay the $50.00 difference between the payment made and the stipulation within 30 days, but affirmed that the order, insofar as appealed from, without costs.

The main issue in this case was whether the failure of the Civil Court to decide on the branch of the defendant's motion seeking to toll the accrual of no-fault statutory interest was appealable. The Court considered the fact that the Civil Court denied the branch of the defendant's motion seeking to dismiss the complaint, granted the branches seeking to strike the notice of trial and compel discovery, and did not decide the branch seeking to toll the accrual of no-fault statutory interest. The Appellate Term, Second Department ultimately held that no appeal lies from an order or portion thereof which fails to determine a motion or branch thereof, and as such, dismissed the appeal. Therefore, the higher court did not make a decision on the issue of tolling the accrual of no-fault statutory interest.

The court considered a case in which Englinton Medical, P.C., as assignee of Kavita Sewdat, sought to recover first-party no-fault benefits from Ameriprise Insurance Company in the amount of $7,570.30 for unspecified claims. Ameriprise moved for summary judgment to dismiss the complaint, arguing they had denied bills due to plaintiff's failure to appear for examinations under oath (EUOs) and lack of medical necessity. They also pointed out that they had already paid $3,253.92 for services rendered on September 1, 2016. Plaintiff cross-moved for summary judgment, but did not provide any bills or dispute the $3,253.92 claim that had been paid in a separate arbitration. The court ultimately reversed the order, granting summary judgment to Ameriprise and denying it to Englinton Medical, P.C. It held that Ameriprise was entitled to dismissal of the complaint in its entirety, finding that plaintiff had failed to appear for the EUOs, which was a condition precedent to the insurer's liability on the policy. The court also dismissed the $3,253.92 claim, as it had already been paid in a separate arbitration.

The Appellate Division, Second Department considered a case involving a dispute over the proper rate of interest to accrue on a judgment entered in favor of B.Z. Chiropractic, P.C. against Allstate Insurance Company. The case involved several procedural and substantive history, including an appeal from the Civil Court to the Appellate Term, as well as a subsequent Supreme Court action seeking declaratory judgment on the correct interest rate. Allstate sought to preclude the Supreme Court from considering the interest issue claiming that it had been resolved by the Appellate Term. The court held that an advisory opinion or dicta in an order by a court does not qualify under res judicata, collateral estoppel, or the law of the case doctrines to preclude a court in a later proceeding from considering the same issue. Therefore, the Supreme Court properly determined the rate of interest as 2% per month compounded, which applied in this case based on New York Insurance Law. The court held that there was no reason or opportunity for BZ to earlier litigate the rate of interest to which it was entitled as to trigger res judicata or collateral estoppel. Arguments as to the operation of CPLR 5019 (a) and whether the declaratory judgment represented an improper collateral attack upon the 2001 judgment itself were not raised by any party on appeal and were therefore not properly before the court.

Defendant moved for summary judgment to dismiss the complaint due to plaintiff's failure to appear at Examinations Under Oath (EUOs) on four separate occasions. However, the plaintiff argued that the defendant refused plaintiff's requests to reschedule the EUOs for lengthy adjournments of two to three months and did not present any evidence that the defendant had otherwise sent any requests for additional verification on the relevant 30-day periods for some of those bills. The Court considered the dates plaintiff failed to appear at EUOs, in this action seeking to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff raised triable issues of fact as to whether plaintiff had failed to appear at the EUOs. Another issue was whether the EUOs scheduled before the defendant received the billed amounts at issue tolled the 30-day period for defendant to pay or deny the bills received. The prior decision and order decided both the motion and cross-motion, but it was recalled and vacated. The Court found in favor of the plaintiff and granted the motion to compel defendant to provide discovery.

Defendant filed this action in order to stop the plaintiff from making meaningful responses to its discovery requests, with the plaintiff contending that it has complied with the court's earlier orders. The main issue was whether defendant's motion to strike the complaint could be granted in part. The court decided to grant the defendant’s motion to an extent, as the plaintiff had failed to provide the necessary discovery documents in response to the defendant's prior demands. The holding was that discovery is important and necessary in any case, and in this instance the defendant's request was relevant and discoverable in order to assist in preparing for trial.

The court considered whether the defendant's motion for summary judgment dismissing the complaint was correctly denied by the Civil Court. The main issue decided was whether the rule against successive motions for summary judgment and the law of the case applied in this situation. The holding of the case was that the rule against successive motions did not apply because the defendant's initial cross motion for summary judgment was not considered by the court. Additionally, the statement in the previous order that the case shall proceed to trial on the defenses raised was not a directive for the case to proceed to trial, and therefore the law of the case did not apply. Therefore, the court reversed the order and remitted the matter to the Civil Court for a determination of the defendant's motion on the merits.

The court considered the service of the summons and complaint, which were served by certified mail, return receipt requested, pursuant to CPLR 312-a. The main issue decided was whether plaintiff had acquired personal jurisdiction over defendant, as service was not completed within 120 days of the filing of the summons and complaint. The holding of the case was that the order granting plaintiff's motion for the entry of a default judgment was reversed, with costs, and plaintiff's motion for the entry of a default judgment was denied. Therefore, the court determined that the plaintiff had failed to establish that it had acquired personal jurisdiction over the defendant, and as a result, the motion for a default judgment should have been denied.