No-Fault Case Law

The relevant facts considered by the court were that plaintiff's subrogor was injured in a car accident and received no-fault benefits from the plaintiff in the sum of $14,511.93. A default judgment had been entered against the defendants in 2001. Defendant George German had moved multiple times to vacate the default judgment against him, and the judgment was reinstated when he failed to appear for trial. The main issue decided was whether the defendant had a reasonable excuse for the default and a meritorious defense to the action, as required to vacate the judgment. The holding of the case was that the court reversed the lower court's decision, denied the defendant's motion to vacate the default judgment, and reinstated the default judgment against the defendant. The court found that the defendant's consistent and repeated defaults demonstrated a pattern of neglect, and the default should not be excused. Therefore, it was an improvident exercise of discretion for the lower court to have granted the defendant's motion to vacate the default judgment.

The main issue in this case was whether the defendant had raised triable issues of fact in opposition to the plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits. The court considered the submission of a statutory claim form and the payment of no-fault benefits to be overdue as evidence of the plaintiff's entitlement to summary judgment. However, the defendant opposed the motion on the grounds of lack of coverage, failure by plaintiffs' assignors to appear for independent medical examinations, and lack of medical necessity. In support of their defense, the defendant submitted various evidence including the affidavit of its litigation examiner, the police report, the affidavit of its investigator, and transcripts of statements made by the assignors and the insured. The court ultimately affirmed the denial of the plaintiff's motion for summary judgment, albeit on other grounds. Holding: The denial of the plaintiff's motion for summary judgment was affirmed due to the triable issues of fact raised by the defendant.

The relevant facts the court considered were that the defendant argued it timely denied the plaintiff's claims based on the owner's failure to appear for scheduled examinations under oath (EUOs). The main issues decided were whether the defendant complied with the EUO scheduling regulations and whether the initial EUO was scheduled within 30 days of receiving the plaintiff's claims. The holding of the court was that the defendant did not comply with the EUO scheduling regulations and that the initial EUO was not scheduled within 30 days of receiving the plaintiff's claims. Therefore, the judgment was reversed, the order entered on November 15, 2007 was vacated, plaintiff's cross-motion for summary judgment was denied, defendant's motion for summary judgment was granted, and the complaint was dismissed.

The main issues considered in this case involve the recent amendment to CPLR 2001 and its application to an action that has been commenced by service of process, and how commencement errors should be dealt with. The court considered the effect of the stipulation of discontinuance and whether the plaintiff's recommencement of the action was valid without purchasing a new index number. The main legal issue decided was the interpretation of CPLR 2001, the effect of commencement infirmities, and the effect of the defendant's failure to timely object to the plaintiff's commencement errors. The holding of the court was that technical, nonprejudicial procedural defects in the commencement of the action should be excused and can be disregarded, whether by application of the 2007 revision of CPLR 2001 or by following the former CPLR 2001. The court also held that defendant waived objections to commencement infirmities by failing to move to dismiss the case based on those grounds within 60 days after serving its answer. In conclusion, the court denied the defendant's motion for discontinuance or dismissal of the case based on commencement errors.

In the case of East Acupuncture, P.C. v Allstate Ins. Co., the Appellate Division, Second Department, grappled with the principal issue of whether a toll on the accrual of statutory interest on overdue no-fault claims applies to claims submitted to insurers by medical providers as assignees of policyholders, or if it is restricted to claims submitted directly by the policyholders themselves. East Acupuncture, a healthcare provider, treated several individuals injured in automobile accidents and received assignments of their no-fault benefits. The court held that the tolling regulation applies to both assignees and injured persons for claims submitted to insurers for no-fault benefits. The court noted that the interest which accrues on overdue no-fault benefits is a statutory penalty designed to encourage prompt adjustments of claims and that the Superintendent's interpretation of the term "applicant" to include both injured persons and provider/assignees is consistent with the spirit and purpose of the No-Fault Law. The court concluded that the Appellate Term properly reversed the order of the Civil Court and remitted the matter for a new interest calculation, holding that interest pursuant to Insurance Law § 5106 (a) did not begin to accrue on the claims that were untimely denied until East Acupuncture filed its complaint.

The relevant facts considered by the court were that the plaintiff, a provider, was seeking to recover assigned first-party no-fault benefits from the defendant, State Farm Mutual Automobile Insurance Company. The plaintiff moved for summary judgment, while the defendant cross-moved for summary judgment, arguing that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs). The affidavit submitted by the defendant's employee was found to be sufficient in establishing that the requests and follow-up requests for IMEs were mailed to the plaintiff's assignor. As a result, the District Court granted the defendant's cross-motion for summary judgment, which was affirmed on appeal by the Appellate Term, Second Department. The main issue decided was whether the affidavit submitted by the defendant was sufficient to establish that the requests and follow-up requests for IMEs were mailed to the plaintiff's assignor, and the holding of the case was that the affidavit was indeed sufficient, and therefore the order granting summary judgment to the defendant was affirmed.

The court considered the circumstances of a case where a provider was seeking to recover first-party no-fault benefits, and had moved for summary judgment. The main issue decided was whether the affidavit submitted by the provider's billing manager and corporate officer laid a proper foundation for the admission of the documents annexed to the provider's moving papers. The court held that the affidavit was insufficient to establish that the individual possessed personal knowledge of the provider's practices and procedures, and therefore failed to make a prima facie showing of its entitlement to summary judgment. As a result, the judgment awarding the provider the principal sum of $2,217.50 was reversed, the order granting the provider's motion for summary judgment was vacated, and the provider's motion for summary judgment was denied.

The court considered the plaintiff's motion to compel the deposition of the defendant in an action to recover assigned first-party no-fault benefits. The defendant failed to oppose the motion or seek a protective order. The main issue decided was whether the plaintiff's motion to compel the defendant to appear for a deposition should be granted. The court held that the motion should have been granted to the extent that the defendant is ordered to appear for a deposition within 30 days of the date of the order entered. The court reversed the order of the Civil Court of the City of New York, Kings County, and granted the plaintiff's motion.

The main issue of this case was whether the denial of claim form was timely mailed by the defendant in an action to recover assigned first-party no-fault benefits. The court considered the affidavit submitted by the defendant's litigation examiner, which failed to establish that the denial of claim form was timely mailed based upon the defendant's standard office practice or procedure. The court found that the affidavit did not sufficiently set forth the steps which comprise the defendant's mailing practices and procedures. Therefore, the court held that the defendant failed to establish that its defense of lack of medical necessity was not precluded, and reversed the order granting the defendant's motion for summary judgment, denying the motion instead. The main holding of the court was that the defendant did not establish that the denial of claim form was timely mailed, and therefore failed to prove its defense of lack of medical necessity.

The relevant facts that the court considered were that Dr. Robert Schepp, through a group of professional service corporations, submitted a large number of no-fault claims to several insurance companies. The insurers denied many claims on the ground that the professional corporations were ineligible for no-fault reimbursement, citing violations of state licensing requirements and the fact that radiology services were performed by independent contractors. The main issue decided was whether the professional service corporations were ineligible for no-fault reimbursement due to licensing requirement violations and the use of independent contractors. The court held that while the professional service corporations were permitted to recover no-fault claims paid prior to April 4, 2002, they could not recover claims submitted after this date by using independent contractors for radiology services, and that the corporations lacked standing to bring the lawsuits. The court granted the motion for summary judgment in part and denied it in part.