No-Fault Case Law
Maiga Prods. Corp. v American Ind. Ins. Co. (2021 NY Slip Op 50638(U))
July 2, 2021
The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which had granted the plaintiff's motion for the entry of a default judgment. The main issue decided was whether the plaintiff should be granted a default judgment in their action to recover assigned first-party no-fault benefits. The holding of the court was that the order granting the plaintiff's motion for the entry of a default judgment was reversed and the motion was denied. The court cited a similar case, Daily Med. Equip. Distrib. Ctr., Inc., as Assignee of Balderrna, David v American Ind. Ins. Co., and based their decision on the reasons stated in that case. The decision was entered on July 2, 2021 by the Appellate Term, Second Department.
PFJ Med. Care, P.C. v Hereford Ins. Co. (2021 NY Slip Op 50637(U))
July 2, 2021
The relevant facts in this case were that PFJ Medical Care, P.C. was seeking to recover assigned first-party no-fault benefits from Hereford Insurance Co. The main issue decided was whether there was coverage for no-fault benefits as Hereford Insurance Co. had not issued an automobile insurance policy which would cover the underlying accident. The holding of the court was that the judgment of the Civil Court denying Hereford Insurance Co.'s motion for summary judgment dismissing the complaint and granting PFJ Medical Care, P.C.'s cross motion for summary judgment was reversed. This means that the judgment was in favor of Hereford Insurance Co., and their motion for summary judgment dismissing the complaint was granted while PFJ Medical Care, P.C.'s cross motion for summary judgment was denied.
Sure Way NY, Inc. v Farm Bur. Mut. Ins. Co. (2021 NY Slip Op 50632(U))
July 2, 2021
The court considered the fact that defendant had failed to appear or answer the complaint in this action by a provider to recover assigned first-party no-fault benefits. The main issue decided was whether the denial of defendant's motion to vacate a judgment of the lower court was appropriate. The holding of the court was that the order denying defendant's motion to vacate the default judgment was reversed, and defendant's motion to vacate the default judgment was granted. This decision was based on the reasoning stated in another case with a similar issue.
Medalliance Med. Health Servs. v Travelers Prop. Cas. Ins. Co. (2021 NY Slip Op 50737(U))
June 30, 2021
The court considered that the defendant improperly mailed verification requests to the plaintiff provider at the wrong address. The verification requests were not mailed to the address specified by the plaintiff provider in its NF-3 notice of claim forms, as a result, the plaintiff was excused from non-compliance. The Court awarded summary judgment to the non-moving plaintiff in the sum of $597.43. The Court also awarded summary judgment to the non-moving plaintiff in the sum of $1,050.14 and denied the part of defendant's motion seeking summary judgment of dismissal for certain NF-3 claim forms. The Court also denied the part of the motion by defendant seeking summary judgment of dismissal for the NF-3 claim forms with dates of service, and held that the defendant repudiated liability which excused plaintiff from compliance with the time limitations for submitting medical proofs contained in the policy.
Burke Physical Therapy, PC v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50624(U))
June 30, 2021
The relevant facts in this case involve a no-fault action in which a medical provider sought reimbursement for seven bills covering medical services provided from October 2, 2018 through January 24, 2019. The defendant moved for summary judgment on its outstanding verification request defense, while the plaintiff cross-moved for summary judgment to dismiss the defendant's affirmative defenses. The main issues decided were whether the defendant had established that the plaintiff failed to comply with verification requests and whether the plaintiff had complied with the requests or if the requests themselves were proper. The court held that the defendant established timely mailing of verification requests, but failed to establish its outstanding verification defense. The court also held that the plaintiff's cross-motion for summary judgment was granted in part, but denied in part, and that the defendant's outstanding verification defense remains an issue of fact for trial.
Action Potiential Chiropractic, PC v Grange Mut. Cas. Ins. Co. (2021 NY Slip Op 51306(U))
June 29, 2021
The court considered the fact that a claim for first-party no-fault benefits was submitted by the plaintiff and the statute of limitations for first-party no-fault claims is six years. The main issue decided was whether the plaintiff should be granted leave to amend to add a new party, Knightbrook Insurance Company, to the action and remove Grange Mutual Casualty Ins. Co. as a defendant. The court held that the plaintiff's motion to amend should be denied because the amendment to add a party fell outside of the statute of limitations, and the plaintiff failed to demonstrate notice to, nor that the statutory prerequisites have been met with the new party. The court also held that the plaintiff failed to satisfy the three-part test for the application of the relation-back doctrine, and did not establish diligent efforts were made to ascertain the unknown party's identity prior to the expiration of the statute of limitations. Therefore, the Motion to Amend was denied.
NYS Acupuncture, P.C. v New York State Ins. Fund (2021 NY Slip Op 50659(U))
June 24, 2021
The court considered the facts of several no-fault insurance cases filed by plaintiffs against the New York State Insurance Fund (Defendant) and found that default judgments had been entered against the Defendant in each case. The main issue decided was whether the court had subject matter jurisdiction to entertain the plaintiffs' actions against the Defendant. The court granted the Defendant's motions to vacate the default judgments and to dismiss the breach of contract matters against the Defendant without prejudice, stating that the Civil Court did not have subject matter jurisdiction to render the judgments. Furthermore, the court denied the Defendant's application for sanctions against the Plaintiffs' counsel and enjoined the Plaintiffs and their counsel from commencing any future similar actions or proceedings seeking relief from the Defendant in the Civil Court without a determination from the Appellate Term.
Sutter Pharmacy v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50610(U))
June 24, 2021
The court considered the facts of the case, which involved a pharmacy seeking reimbursement of No-Fault benefits from an insurance company. The insurance company had previously filed a declaratory action in the New York Supreme Court and obtained an order declaring that they had no obligation to cover the No-Fault claims for the pharmacy. The main issue before the court was whether the pharmacy's action seeking reimbursement was barred by res judicata and collateral estoppel, based on the order issued by the Supreme Court. The court held that the insurance company's motion to dismiss the action was granted, as they had properly preserved their defenses, a declaratory judgment order was issued regarding the claim, and that order had preclusive effect given the identity of issues and parties. Therefore, the court dismissed the pharmacy's complaint with prejudice.
New York Core Chiropractic, P.C. v Ameriprise Ins. Co. (2021 NY Slip Op 50599(U))
June 24, 2021
The court considered the facts of the case to be about a dispute over unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor, as well as other charges, totaling $2,330.56. The main issues related to the timing of requested Examinations Under Oath (EUO), with the defendant seeking dismissal of the plaintiff's complaint due to the plaintiff's failure to attend scheduled EUOs. The court held that an EUO request letter constitutes "additional verification" and must be sent within fifteen business days of receipt of claims, and that transmission of an EUO request letter within thirty calendar days of receiving a claim for No Fault benefits tolls an insurer's time to pay or deny such claim, as long as the delay does not exceed the thirty days. The court ultimately granted the defendant's motion for summary judgment, dismissing the plaintiff's complaint, and denied the plaintiff's cross-motion for summary judgment.
New Millennium Med. Imaging, P.C. v Repwest Ins. Co. (2021 NY Slip Op 50577(U))
June 21, 2021
The court considered the facts that New Millennium Medical Imaging, P.C. (New Millennium) sought to recover no-fault benefits for medical services provided to assignors injured in an automobile accident on August 13, 2011. However, Repwest Insurance Company (Repwest) had commenced a declaratory judgment action alleging no duty to pay benefits relating to an accident on August 12, 2011. The main issue decided was whether res judicata barred New Millennium's action in the Civil Court after Repwest obtained a default judgment in the Supreme Court, New York County. The holding was that res judicata applied, barring the instant action, as the evidence established that the assignors sought coverage for injuries arising from an August 12, 2011 accident, and not from any accident on August 13, 2011. Therefore, the trial court's order was reversed and Repwest's motion for summary judgment dismissing the complaint was granted.