No-Fault Case Law

The issue in this case was whether the respondent followed the provisions of the insurance policy that require prompt notice be given of any third-party litigation or any claim for uninsured/underinsured motorist (SUM) benefits, and if not, whether the insurance company was prejudiced by the delayed notice. The appellant, Liberty Mutual Insurance Company, contended that the respondent failed to provide timely notice of his lawsuit against a third party and his claim for SUM benefits. However, the court found that while the respondent failed to provide prompt notice as required by the policy, the insurance company was not prejudiced in any meaningful way by the delay. Therefore, the court concluded that the insurance company's application to stay arbitration was properly denied. The court considered the facts that the respondent was involved in an automobile accident and, three weeks after the accident, his counsel sent a letter to the insurance company notifying it of the accident and the potential implications for the insurance policy, and that the insurance company was put on notice of the existence of the accident within three weeks of its occurrence and received ample information to properly investigate the claim and protect its interests. The court held that although the respondent did not satisfy his obligation to provide prompt notice, the insurance company failed to demonstrate that the respondent's delay in notifying it of the third-party action or the SUM claim compromised its ability to investigate the circumstances surrounding the accident or to protect its interests under the policy. Therefore, the order denying the application to stay arbitration was affirmed.

The case involved an appeal from a trial court order that granted the defendants' motion to vacate a judgment in favor of the plaintiff in an action to recover no-fault insurance benefits. The defendants' employee had mistakenly believed that the action had been discontinued after advising the plaintiff's counsel's office that no-fault benefits had been exhausted, which the appellate court found to be a reasonable excuse for their delay in appearing and answering. Additionally, the defendants established that the policy limits had been partially exhausted through the payment of claims for prior services, a potentially meritorious defense to the action. The plaintiff did not demonstrate prejudice from the defendants' short delay in appearing and answering, and the court held that the trial court had properly exercised its discretion in granting the defendants' motion to vacate the judgment.

The main issue in the case was whether the plaintiff had established a prima facie case for summary judgment in an action to recover assigned first-party no-fault benefits. The court held that the plaintiff had established its prima facie entitlement to summary judgment by proving the submission of a claim form, setting forth the fact and amount of the loss sustained, and that payment of no-fault benefits was overdue. The court also addressed the defendant's attempt to demonstrate an issue of fact as to the medical necessity of the services rendered, and found that the defendant's claims representative's affidavit did not establish actual mailing of the denials nor give rise to the presumption that they were mailed. As a result, the defendant was precluded from raising its proffered defense of lack of medical necessity, and the judgment in favor of the plaintiff was affirmed.

The main issues in this case were whether the plaintiff had properly submitted claims for no-fault benefits, whether she had standing to sue, and if the insurance company had valid reasons for denying the claims. The court considered evidence of claims submitted by medical providers, the plaintiff's assignment of benefits to those providers, and the regulations regarding assignment of benefits. The court held that the plaintiff did not need to prove she had issued payment for treatment, but did need to show that claims were submitted and not paid within 30 days. The court found that the plaintiff's causes of action seeking reimbursement for services provided by Dr. Patricia D'Imperio were valid, but those seeking reimbursement for services provided by other medical providers had been properly dismissed. The court also found that the plaintiff had demonstrated a cause of action and that the litigation was not frivolous, so the award of attorney's fees to the defendant was reversed. The court remanded the case for further determination of the plaintiff's cross motion to strike the defendant's answer.

The relevant facts considered by the court were that the plaintiff, Brian Gokey, was involved in an automobile accident in March 2003 and suffered serious injuries, ultimately leading to his inability to perform his job as a house painter and the failure of his business. When he submitted a claim for lost wages and other benefits available under no-fault coverage to Blue Ridge Insurance Company, the payments ceased in mid-November 2003. The main issue decided by the court was whether the plaintiff properly submitted a claim for benefits and whether he was entitled to receive these benefits. The holding of the case was that the plaintiff had submitted a proper claim for benefits and was entitled to these benefits, and thus the court ordered Blue Ridge to pay the plaintiff the unpaid principal balance in addition to interest, as calculated from thirty days after the payments were due until the present time.

The court considered a group of seven actions, all involving claims for money damages by health care providers whose patients, insured by the defendants, had their no-fault claims denied and then assigned their claims to the providers. These providers served the summonses and complaints to the Superintendent of Insurance in Albany and New York City even though they were located in Buffalo. The main issue of the case was whether service in Albany and New York City allowed the City Court of Buffalo to obtain personal jurisdiction over the defendants. The court held that it had subject matter jurisdiction, and that service of process on the Superintendent of Insurance in Albany was valid. The court also found that the defendants had agreed to allow service upon the Superintendent of Insurance, and they were therefore subject to personal jurisdiction by the Court of Buffalo. As a result, the defendants' motions to dismiss the plaintiffs' complaints were denied in their entirety.

The relevant facts considered by the court were that a patient was injured in an automobile accident and received treatment at White Plains Hospital. The hospital billed the patient's insurance company, Allstate, for $26,979.83. Allstate did not pay the claim or issue a denial within the required 30 days. The main issue decided was whether the diagnosis and procedure codes adopted by the United States Department of Health and Human Services could be judicially noticed by the courts and used to decipher no-fault billing forms. The holding of the case was that the diagnosis and procedure codes key published by the United States Government on its HHS Web site may properly be given judicial notice, and that the codes submitted by Allstate were insufficient to raise a triable issue of fact in admissible evidentiary form sufficient to warrant denial of summary judgment in favor of White Plains Hospital. Therefore, the Supreme Court properly granted White Plains Hospital's motion for summary judgment.

The relevant facts the court considered in this case were that Justice Paitou was struck by a motor vehicle and sustained serious injuries, and Rosillo & Licata, P.C. was retained to represent him in a personal injury claim. Hereford Insurance Company sought to recover a statutory lien of $198,926.00 from the settlement proceeds obtained by Rosillo & Licata in their representation of Paitou. The main issue decided by the court was whether Hereford was entitled to enforce a statutory lien against Rosillo & Licata and Paitou under Worker's Compensation Law section 29. The court held that Hereford could not seek to enforce a lien against Rosillo & Licata based on the settlement of the claim and the payment of their attorney's fees, and therefore granted the motion to dismiss the complaint with prejudice as to both Rosillo & Licata and Justice Paitou.

The court considered the case of V.S. Medical Services, P.C. as assignee of Mohamad Nazir against Travelers Insurance Co. The main issue was whether the plaintiff had made a prima facie case to recover assigned first-party no-fault benefits. At trial, the plaintiff offered testimony from a former employee and sought to admit claim forms into evidence, but the defendant objected on the grounds of hearsay and failure to lay a foundation for their admission. The court reserved decision on the admissibility of the documents and on the defendant's motion to dismiss the complaint. After reviewing the submissions, the court dismissed the complaint, finding that the plaintiff had failed to make a prima facie case. The holding of the case was that the plaintiff failed to establish a prima facie case because their witness did not testify as to the generation of the claim forms, rendering them inadmissible as business records. As a result, the judgment was affirmed.

The main facts of the case are that Vista Surgical Supplies, Inc. was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Insurance Co. After a nonjury trial, the court dismissed the complaint. Plaintiff did not call any witnesses, but instead moved for the admission of its notice to admit and defendant's response to establish its case. However, the court held that the notice to admit was improper because it sought information going to the heart of the matter. The main issue decided was whether plaintiff had made a prima facie showing of its case. The holding of the case was that plaintiff failed to lay a sufficient foundation to establish that the claim form is admissible pursuant to the business records exception to the hearsay rule, and therefore, the court properly held that plaintiff failed to make a prima facie showing. The judgment was affirmed, and the court did not reach any other issues.