No-Fault Case Law

The court considered the appeal from an order of the Civil Court of New York, dated January 24, 2006, which granted the plaintiff Devonshire Surgical Facility summary judgment in the amount of $3,000 and granted plaintiff Carnegie Hill Orthopedic Services partial summary judgment in the amount of $41,157.88. The court dismissed the appeal due to the untimeliness of the notice of appeal, as it was not filed within 30 days of the service of the order with notice of entry. If the appeal had been properly before the court, they would have affirmed the decision, as the plaintiffs had established their entitlement to first-party no-fault benefits and the defendant failed to raise a triable issue to defeat summary judgment. The holding of the court was that the appeal was dismissed, and if it had been properly before them, they would have affirmed the decision of the lower court.

The court considered the appeal from an order of the Civil Court of New York granting plaintiff Devonshire Surgical Facility summary judgment in the amount of $3,000. The main issue decided was whether the notice of appeal from the order was filed within the required 30 days of service, and whether the plaintiff had established a prima facie case for entitlement to first party no-fault benefits. The holding of the court was that the appeal was dismissed as untimely, as the notice of appeal was not filed within the required 30 days of service. Additionally, the court stated that if the appeal had been properly before them, they would have affirmed the decision, as plaintiff Devonshire had established a prima facie case for entitlement to first party no-fault benefits and the defendant failed to raise a triable issue to defeat summary judgment.

The court considered the procedural background of the case, including the initial action to recover first-party no-fault benefits and the subsequent motion to vacate the judgment. The main issues decided were whether the judgment entered against defendant should be vacated based on newly discovered evidence, whether there was a meeting of the minds when the parties entered into a written stipulation of settlement, and whether the case was subject to a stay issued by the Supreme Court in a separate action involving the same parties. The holding of the case was that the defendant's motion to vacate the judgment was denied in its entirety because they failed to meet any of the criteria necessary for the court to vacate the voluntary stipulation of settlement. The court emphasized that stipulations of settlement are judicially favored, should not be lightly set aside, and should only be invalidated if there is cause sufficient to do so, such as fraud, collusion, mistake, or accident. The court pointed out that the evidence and allegations provided by the defendant were insufficient to support their claim that the settlement was procured through fraud or mistake.

The main issues decided in this case were whether the action to recover first-party no-fault benefits was brought within the six-year statute of limitations and whether the plaintiff had provided sufficient admissible proof to establish its prima facie case. The court held that the action to recover the no-fault benefits was timely initiated, as the statute of limitations began to run when the benefits became overdue, not when the defendant denied the claim. The court also ruled that the plaintiff did not provide enough admissible proof to establish its case, as there was no affidavit from someone familiar with the plaintiff's business practices to establish the admissibility of the claim form as a business record. Therefore, the court denied both the defendant's motion for summary judgment and the plaintiff's cross-motion for summary judgment.

The main issues for consideration were whether the defendant was entitled to medical expenses and lost earnings relating to a hospitalization because of an auto accident. The court considered the no-fault statute, evidence provided by the plaintiff's expert witness, an anesthesiologist, that the condition was unrelated to the accident and the testimony of the defendant's expert witness, a neurologist. The holding of the court was that the evidence could not support the determination by the Supreme Court regarding the plaintiff's condition was not causally related to the accident. It held that the testimony of the plaintiff's expert was speculative, and the defendant's expert was reliable in his determination that the condition was causally related to the accident. Regarding the defendant's lost wages, the court held that the evidence was insufficient to establish his alleged lost earnings with reasonable certainty and therefore sustained the Supreme Court's determination that the defendant failed to demonstrate a compensable lost wage claim.

The plaintiff, Hospital for Joint Diseases, appealed an order granting the defendant’s motion to vacate a judgment in favor of the plaintiff in an action to recover no-fault medical benefits under an insurance contract. The scope of the defendant’s motion was whether proper service of the summons and complaint was effectuated, and if the defendant had received actual notice of the summons in time to defend against the claim. The Court held that the defendant met its burden of showing it did not receive actual notice of the summons in time, with an affidavit detailing its standard office practice concerning the handling of summonses and complaints and asserting that the summons and complaint in this action were not received until after the entry of judgment. Additionally, the defendant established that it may have a meritorious defense to the action, and accordingly, the defendant's motion to vacate the clerk's judgment was properly granted.

The central facts of the case are that plaintiff insurance company, Progressive, initiated a declaratory judgment action against defendant Michelle Strough, arguing that Strough failed to cooperate with Progressive as required by her insurance policy after being injured in a motor vehicle accident. Progressive claimed that because of Strough's failure to cooperate, the company had no duty to indemnify her or to pay her no-fault insurance benefits. The main issues in this case were whether the doctrine of res judicata applied to the final arbitration award, and whether plaintiff had provided evidence to prove that Strough failed to cooperate. The Appellate Division held that the judgment issued by the Supreme Court, denying Strough's motion for summary judgment and confirming the award of the master arbitrator, was correctly affirmed. The court concluded that the action was not barred by res judicata and that Progressive had the right, under Insurance Law § 5106 (c) and 11 NYCRR 65-4.10 (h) (1) (ii), to a de novo determination of the dispute. The appellate court also determined that Progressive failed to support its motion with evidence provided by an individual with personal knowledge of the facts and therefore failed to establish its entitlement to judgment as a matter of law. Therefore, the portion of Progressive's cross-motion for summary judgment was properly denied.

The relevant facts considered in this case included the denial of no-fault benefits to Dr. Mills by Government Employees Insurance Co. (GEICO) after a motor vehicle accident and subsequent injuries. Dr. Mills petitioned the court for a trial, de novo, to challenge the decision of an Arbitrator that upheld the denial of benefits. The main issue decided by the court was whether Dr. Mills was entitled to further no-fault benefits, based on his claim of lost earnings due to his injuries. The court ultimately held that the arbitration process afforded Dr. Mills due process, and the decisions of the Arbitrator and Master Arbitrator had a sound basis in the record and were not irrational, capricious, or an abuse of discretion. Therefore, the arbitration award was affirmed, and GEICO was directed to settle judgment. The court also found that Dr. Mills was not entitled to a trial de novo and that a demand for relief under Article 75 was untimely.

The relevant facts the court considered were that the defendant insurance company issued denial of claim forms in April and May of 2001, which partially denied payment on the grounds that no fee schedule existed for the treatment provided and that payment could thus be limited to a reasonable and customary fee. The main issue decided was whether the denials of claim by the defendant's insurance company were issued on prescribed forms and whether the defendant's entitlement to summary judgment dismissing the complaint was properly submitted. The holding of the court was that the plaintiff failed to establish prima facie entitlement to judgment as a matter of law and that the defendant made a prima facie showing of its entitlement to summary judgment dismissing the complaint. Additionally, the plaintiff's contention that the defendant failed to offer sufficient evidence in support of the "similar procedure" for comparison to the services offered was not properly before the Court.

The case is about a dispute between Chubb Insurance Company and GEICO Insurance Company and STATEWIDE INSURANCE COMPANY regarding an inter-company arbitration demand after a three-vehicle accident in which Chubb paid benefits to Chenille Bonner, a New York City Transit Authority bus driver. Chubb filed for reimbursement of these benefits to GEICO and Statewide Insurance Company, with the case being submitted to arbitration. The arbitrator initially awarded Chubb a total of $42,065.56, but GEICO argued that the arbitrator had incorrectly applied New York regulations and the amended award reduced Chubb's recovery to $21,032.78. After Chubb filed a petition to vacate the amended award and reinstate the original award, the Supreme Court granted the petition but also addressed the merits. GEICO later filed a motion to vacate the default judgment, claiming that it never received any notice of the proceeding until after the entry of judgment. However, the court denied this motion and upheld its earlier decision.