No-Fault Case Law

The relevant facts that the court considered were that Donald Gjelaj, the plaintiff's assignor, was arrested for driving while intoxicated and was seeking no-fault benefits under his insurance policy. The defendant, State Farm Mutual Automobile Insurance Company, sent a verification request to Gjelaj seeking information about his intoxication. The plaintiff, Westchester Medical Center, then sought no-fault benefits for services it rendered to Gjelaj. The court decided that the plaintiff made a prima facie showing of entitlement to summary judgment that the defendant failed to make a prima facie showing on its cross motion for summary judgment. The holding of the court was that although the plaintiff made a prima facie showing, the defendant failed to do so and could not establish intoxication as a matter of law and that the defendant also failed to establish that Gjelaj's alleged intoxication was the proximate cause of the accident, so the motion for summary judgment was denied.

The main issue in this case was whether New York Hospital Medical Center of Queens was entitled to recover no-fault benefits under an insurance contract. This was after a motion was granted in their favor for summary judgment on the second and third causes of action, leading to a judgment in favor of New York Hospital Medical Center of Queens against Countrywide Insurance Company. New York Hospital Medical Center of Queens established prima facie entitlement to summary judgment as a matter of law, but Countrywide Insurance Company submitted admissible evidence raising triable issues of fact that were not rebutted, thus its request for additional verification tolled the time within which to pay or deny the claim. The Supreme Court should have denied summary judgment as to the second cause of action. The evidence submitted by New York Hospital Medical Center of Queens in support of its motion for summary judgment on the third cause of action satisfied its burden of establishing its entitlement to judgment as a matter of law, and the motion by Countrywide Insurance Company to strike pages of the appellant's brief was denied.

The court considered the master arbitrator's decision upholding the arbitrator's award, which denied the petitioner's claims for assigned first-party no-fault benefits. The main issue decided was whether there was a rational basis for the master arbitrator's determination to uphold the arbitrator's award. The holding of the court was that there was a rational basis for the master arbitrator's decision, and thus the petition to vacate the master arbitrator's award was properly denied. The court also confirmed the master arbitrator's award, as required by CPLR 7511 (e).

The court considered the fact that JSI Expert Services, Inc. was seeking to recover assigned first-party no-fault benefits in this case. They also considered that the plaintiff's motion for summary judgment was supported by an affirmation from plaintiff's counsel, an affidavit by an employee of plaintiff, and various documents annexed to the motion. The main issue decided in this case was whether the affidavit executed by plaintiff's employee was sufficient to establish that the officer possessed personal knowledge of plaintiff's practices and procedures so as to lay a foundation for the admission, as business records, of the documents annexed to plaintiff's moving papers. The holding of the case was that the affidavit submitted by plaintiff's employee was insufficient to establish that said officer possessed personal knowledge of plaintiff's practices and procedures, and therefore failed to make a prima facie showing of its entitlement to summary judgment. The court affirmed the denial of plaintiff's motion for summary judgment.

The main issue in this case was whether the defendant should be granted its motion to vacate a default judgment and compel the plaintiff to accept its answer. The relevant facts considered by the court were that the defendant served an untimely answer, and more than two months later, the plaintiff sought and obtained a default judgment. The court held that the plaintiff's retention of an answer without a timely objection constituted a waiver of objection as to untimeliness, precluding the grant of a default judgment. Therefore, the vacatur of the "default" judgment was warranted, regardless of whether the defendant demonstrated a meritorious defense. The court affirmed the order without costs, ruling that the court below had properly exercised its discretion in granting the defendant's motion to vacate the default judgment.

The court considered the case where defendant movants jointly moved the court under CPLR 5003-a for an order directing that plaintiff State Farm Mutual Automobile Insurance Company pay defendant Wilda Norgaisse the amount of $25,000 plus interest from September 29, 2005 in accordance with their stipulation of settlement. The underlying facts involved a claim made against a policy by Marie Mirville for injuries to the driver of another vehicle, Barry Mamadou, and two other individuals. State Farm paid Wilda Norgaisse $25,000 in connection with the underlying loss, but later stopped payment on the check after conducting an investigation and alleging the accident was staged. The main issue decided was whether CPLR 5003-a, which provides a time limit for paying settlements in actions, could be invoked to seek judicial enforcement of an agreement made before an action commences. The holding of the case was that CPLR 5003-a and 2104 are inapposite to the instant motion for the exact same reason, and therefore, judicial enforcement of the stipulation by the instant order to show cause was denied.

The court considered the Defendant's twenty-two affirmative defenses, which included allegations that the treatment in question was performed by an unlicensed psychologist, that the Plaintiff's organizational structure was defective, and that the Plaintiff limited liability company was fraudulently formed. The main issue was whether the Plaintiff could recover no-fault first party benefits for medical services performed by an unlicensed psychologist and whether the Plaintiff's organizational structure was fraudulent. The holding was that genuine issues of material fact existed concerning the Plaintiff's formation and whether the psychologist was an employee or an independent contractor. The court also held that the Plaintiff could not recover no-fault benefits for services rendered by an independent contractor, and that the Plaintiff's formation was fraudulent.

The relevant facts were that the defendant made an unopposed motion to reargue the court's denial of a prior motion for severance of two claims pending in the action, which were both brought by the same no-fault plaintiff assignee, arising out of services rendered to two unrelated assignors. The defendant cited cases suggesting that no-fault claims should be severed if they arise out of different accidents. However, the court found that the claims in this case did not pose a risk of an unwieldy trial or confusion to the trier of fact, and had been joined lawfully under CPLR 601(a). The main issue decided was whether two unrelated no-fault claims may be lawfully joined by the same plaintiff, and the holding was that the motion to reargue was denied because the court found no evidence that it had misapprehended the law.

The court was asked to review an order denying a petition to confirm an arbitration award in a dispute between Lutheran Medical Center, as assignee of Maher Kiswani, and Hereford Insurance Company. Maher Kiswani was injured in a car accident while driving a livery cab and sought medical treatment from Lutheran Medical Center. Lutheran attempted to seek payment from Hereford, the no-fault insurance carrier for the livery cab, but Hereford refused to pay and demanded arbitration. The court held that Hereford should have been given notice of the workers' compensation hearing and vacated the arbitration award, directing the parties to resubmit the employment issue to the Workers' Compensation Board. The court affirmed that Hereford should not have been bound by the Board's determination because it was not given an opportunity to participate in the hearing.

The relevant facts of the case involved an accident on February 3, 2006, resulting in serious injuries to the driver of the vehicle insured under a policy with Progressive Casualty Insurance Company. The driver was transported to Westchester Medical Center and the Hospital sought no-fault benefits from Progressive. The issue was whether Progressive had timely paid or denied the claim for no-fault medical payments within 30 days, as required by regulations. The court held that while the Hospital provided evidentiary proof that Progressive did not meet the timeline for payment or denial of the claim, Progressive timely sought additional verification regarding the driver's alleged intoxication at the time of the accident, and that such information was never received. The court ruled that under such circumstances, where there is no triable issue of fact as to whether the Hospital provided Progressive with the required information, the Hospital's claim for payment was premature, and thus correctly granted Progressive's motion for summary judgment dismissing the complaint.