No-Fault Case Law

The court was ruling on a case in which American Transit Insurance Company was suing to declare that they had no duty to defend and indemnify their insureds in a personal injury action brought by the defendant-appellant, Judith Klausner. The court upheld a previous decision to grant the insurer's motion for summary judgment. It was found that although the appellant had provided the insurer with information about the accident soon after it occurred, she did not provide notice of her suit against the insured until 14 months after the suit was commenced and had obtained an order for a default judgment. The disclaimer of coverage from the insurer was ruled as proper by the court. The court implicitly concluded that the insurer was required to show that it was prejudiced by the failure of appellant Klausner to provide timely notice of the action she had commenced against the insured. Despite timely notice of the accident, the insurer could still disclaim coverage based on untimely notice of the claimant's commencement of litigation unless it was prejudiced by the late notice. Therefore, appellant Klausner failed to exercise her independent right to fulfill the policy obligation of timely notice, and the insurer's disclaimer for lack of timely notice of the underlying action was upheld.

The court considered the relevant facts that the plaintiff commenced an action against the defendant to recover first-party no-fault benefits for medical services rendered, and the defendant moved to dismiss the complaint on the grounds that the plaintiff's assignor failed to appear for scheduled independent medical examinations (IMEs). The main issue decided was whether the insurance policy required the assignor to appear before a physician or any other healthcare provider. The court held that the insurance policy, although it stated "physician," required the assignor to appear before an independent medical examiner, which included physicians, surgeons, podiatrists, chiropractors, or psychologists. The court also determined that the defendant's request for verification was untimely, and thus the defense of failure to attend an IME was waived, and granted summary judgment in favor of the plaintiff.

The main issue in this case was whether the notice to admit from the provider was sufficient to establish a prima facie case for recovery of assigned first-party no-fault benefits. The court considered the provider's notice to admit, defendant's response, and oral arguments. The court held that the provider's notice to admit failed to establish a prima facie case, as they did not call any witnesses to lay a foundation to demonstrate that their claim form was admissible as a business record. The judgment of the Civil Court of the City of New York, Queens County, dismissing the complaint was affirmed by the appellate court. The court did not reach any other issue in the case.

The court considered a case in which a medical supplies company sought to recover first-party no-fault benefits through a settled action. Plaintiff entered into a stipulation of settlement with the defendant insurance company, and subsequently moved for an order to enter a judgment after settlement including provisions for additional interest and costs. However, the court denied the motion, as the plaintiff failed to prove its tender of the release and stipulation of discontinuance to the defendant. The main issue decided was whether the plaintiff had followed the requirements of CPLR 5003-a, which authorizes a settling plaintiff to enter judgment against a settling defendant who fails to pay all sums due within 21 days of tender of the release and stipulation. The holding was that the order denying the plaintiff's motion was affirmed due to the insufficient proof of tender to the defendant.

The court considered the fact that the plaintiff, a medical provider, was seeking to recover first-party no-fault benefits from the defendant insurance company for medical services provided to the defendant's insured. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on the insured's failure to appear for independent medical examinations (IMEs). The court held that the defendant was entitled to summary judgment because the chiropractor who was to perform the IME of the insured established that the insured failed to appear for the IME at the address set forth in the scheduling letters, and the plaintiff's argument was unsupported by the record. The court also found that the plaintiff's remaining contentions, raised for the first time on appeal, lacked merit. Therefore, the court upheld the decision of the lower court to grant the defendant's motion for summary judgment dismissing the complaint.

The relevant facts of the case were that A.M. Medical, P.C., as the assignee of Arkadiy Yusufov, sued State Farm Mutual Insurance Co. to recover assigned first-party no-fault benefits. State Farm moved to dismiss the case based on A.M. Medical's failure to take action in the lawsuit, and the court granted the motion. A.M. Medical argued that the demand to dismiss the case was defective because it did not contain the required caption setting forth the name of the court, venue, and index number of the action. However, the court found that the omissions were merely defects in form that could have been objected to by returning the demand to the defendant, specifying the nature of the defect. A.M. Medical's failure to do so waived any objection to the defect. Therefore, the court affirmed the judgment dismissing the complaint.

The court considered a case in which a medical provider, Vincent Medical Services, P.C., sought to recover first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The main issues decided were whether the insurer's claim denials were timely and whether the insurer had coverage for the vehicle involved in the underlying motor vehicle accident. The court held that the insurer's proof failed to eliminate all triable issues of material fact, and therefore, the insurer's cross motion for summary judgment was denied. The insurer failed to establish prima facie that its claim denials were timely, and it also failed to allege, much less prove prima facie, that it did not insure the vehicle on the date of the loss. The court affirmed the order denying the insurer's cross motion for summary judgment.

The case involved a dispute between St. Barnabas Hospital and American Transit Insurance Company over the payment of no-fault medical benefits under insurance contracts. St. Barnabas Hospital sought summary judgment on the first cause of action, claiming that it had made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that the prescribed statutory billing forms were mailed to and received by the defendant and that payment was overdue. However, the defendant challenged this claim by arguing that the Hospital did not timely comply with the demand for verification, which raised a triable issue of fact. The court ultimately denied the defendant's cross motion for summary judgment dismissing the first cause of action and also denied the Hospital's motion for summary judgment on the first cause of action, finding that the defendant was not obligated to pay or deny the claim until all demanded verification was provided by the Hospital. Therefore, the court affirmed the order in part and modified it in part.

The relevant facts considered by the court were that the plaintiff provided first-party no-fault benefits to a person covered by a policy of insurance issued by the defendant. The plaintiff treated the insured between September 11, 2007 and October 4, 2007 and billed on November 2, 2007. The main issue decided by the court was whether the defendant had reasonable cause to believe that the accidents and later treatment by the plaintiff were the result of intoxication and thus excluded from coverage. The court held that summary judgment is denied to both the plaintiff and the defendant as to the Second and Third Causes of Action. The court also ordered all parties to appear at a Preliminary Conference at the Supreme Courthouse.

The relevant facts of the case are that A.B. Medical Services, PLLC, LVOV Acupuncture, P.C., and RW Health Plus Chiropractic, P.C. were seeking to recover first-party no-fault benefits from Country-Wide Insurance Company. The main issue decided was whether the plaintiffs were entitled to summary judgment on their claims, and the holding of the court was that A.B. Medical Services, PLLC was awarded summary judgment on several claims, LVOV Acupuncture, P.C. was awarded summary judgment on some claims, and RW Health Plus Chiropractic, P.C. was awarded summary judgment on certain claims. The matter was remanded to the court for the calculation of interest and attorney's fees, and for further proceedings on all remaining claims. The court also addressed the issue of an insurer's 30-day period to pay or deny a claim, and the evidence submitted by the defendant to support its denial of certain claims.