No-Fault Case Law

The relevant facts considered by the court were that Diamond Chiropractic, P.C. appealed a judgment from the Civil Court of the City of New York, which denied their petition to vacate the master arbitrator's award and dismissed the proceeding. The main issue decided was whether there was a rational basis for the determination of the master arbitrator upholding the arbitrator's award which denied petitioner's claims for first-party no-fault benefits. The holding of the court was that there was indeed a rational basis for the determination of the master arbitrator, and therefore the judgment was modified to confirm the master arbitrator's award. The court also noted that the petition was timely filed.

Facts: The plaintiff, East Acupuncture, P.C., brought a lawsuit against Electric Insurance Co. to recover assigned first-party no-fault benefits. The plaintiff filed two separate motions for summary judgment to recover treatment costs for different individuals. Defendant then cross-moved for summary judgment. Plaintiff’s proof of mailing of the claim forms was insufficient for one of the claims. Issues: The main issues in this case were whether the plaintiff’s motions for summary judgment should be granted and whether the defendant’s denials were untimely, and if the plaintiffs were defrauding the defendant. Holding: The court modified the order by denying plaintiff’s motions for summary judgment and affirmed without costs. The court ruled that the plaintiff’s motion for summary judgment should have been denied in one of the claims due to insufficient proof of mailing. In addition, the defendant’s denials were found to be untimely, and there was not enough proof that the plaintiffs were defrauding the defendant, so the defendant was not precluded from asserting a defense.

The relevant facts considered by the court were that the Plaintiff was seeking to recover no-fault first party benefits for medical services provided following a motor vehicle accident. The Plaintiff argued that the Defendant failed to pay or issue a valid denial within thirty days of receipt of the claim. The Defendant argued that it had issued a denial based on the untimeliness of the Plaintiff's claim. The main issue decided by the court was whether the Defendant's proof of mailing of its denial was sufficient to defeat the Plaintiff's motion for summary judgment. The holding of the court was that the Plaintiff's motion for summary judgment was granted, and the Defendant's cross-motion for summary judgment was denied. The Plaintiff was entitled to a judgment in the amount of $12,734.17, plus interest, statutory attorneys' fees, costs, and disbursements of the action.

The relevant facts of the case are that the plaintiff, VA Acutherapy Acupuncture, P.C., sought to recover assigned first-party no-fault benefits, providing evidence of the submission of a statutory claim form and overdue payment. The main issue was whether the defendant, State Farm Ins. Co., was justified in denying the plaintiff's claims due to suspicions of insurance fraud and a belief that the plaintiff was fraudulently incorporated. The holding of the case was that the denial of the plaintiff's claims by the defendant was justified based on a founded belief that the alleged injuries did not arise from an insured incident. The court also found that the defendant's opposition papers raised a genuine issue of fact as to whether the plaintiff was fraudulently incorporated and therefore ineligible for reimbursement of no-fault benefits. As a result, the plaintiff's motion for summary judgment was denied.

The court considered the fact that Respondent, Response Equipment, Inc., was seeking to recover assigned first-party no-fault benefits on claims submitted for Hypolite Francis. The main issue decided was whether Francis was acting as an employee at the time of the accident, as this would require the plaintiff to pursue a compensation claim before the Workers' Compensation Board. The court held that the defendant's proof, including the police accident report, raised a question of fact as to whether Francis was acting as an employee, and this issue must be resolved by the Workers' Compensation Board. Therefore, the order was reversed, and the matter was remanded to the court below with the direction to hold the matter in abeyance pending a prompt application to the Workers' Compensation Board for a determination of the parties' rights under the Workers' Compensation Law.

The court considered a case in which an insurance company moved for summary judgment dismissing a complaint by a provider to recover assigned first-party no-fault benefits, based on the plaintiff's assignor's failure to appear for scheduled independent medical examinations (IMEs). The plaintiff had also cross-moved for summary judgment, which was granted. The main issue was whether the plaintiff had made a prima facie showing of its entitlement to summary judgment, and whether the insurance company had proffered sufficient evidence to establish the incorrect amount for the services provided. The holding of the court was that the affidavit submitted by the plaintiff in support of the cross motion failed to lay a proper foundation for the documents annexed to the defendant's moving papers, and that the insurance company had not proffered sufficient evidence to establish as a matter of law that the claims reflected the incorrect amount for the services provided. Therefore, the judgment was reversed, and the order denying the insurance company's motion for summary judgment and granting the plaintiff's cross motion for summary judgment was vacated.

The main issue in this case was whether the insurance company, Progressive Northeastern Insurance Company was liable to pay uninsured motorist (UM) claims made by a seriously injured man. The court considered whether Progressive had to pay the claim even though the man filed for uninsured motorist claim seven months after the accident. It was decided that Progressive did not have to pay the uninsured motorist claim because the seriously injured man waited for seven months to file, which was beyond the acceptable time frame. Progressive had not waived the right to disclaim coverage on the UM claim even though it had paid benefits on the no-fault claim. Further, Progressive was not required to show prejudice before disclaiming coverage due to the man's failure to provide timely notice of the accident or claim. The court granted the petition and permanently stayed arbitration.

Facts: Sheila M. Meegan was injured in a motor vehicle accident when her vehicle was rear-ended by another vehicle. She settled with the other driver's insurance company and then sought supplementary uninsured/underinsured motorist (SUM) coverage under the policy issued by Progressive Insurance Company to her husband. Issues: The main issues decided in this case were whether Sheila Meegan sustained a serious injury as defined by the New York Insurance Law and whether the provision in the insurance policy requiring a serious injury threshold for SUM coverage is valid and enforceable. Decision: The court held that the verdict for Sheila Meegan should be set aside and a new trial should be granted on the issues of serious injury and damages. The court also concluded that the provision in the insurance policy requiring a serious injury threshold for SUM coverage is valid and enforceable. The court also determined that derivative damages awarded for loss of consortium should be added to the direct damages awarded in determining the limit of liability for bodily injury sustained by one person.

The relevant facts the court considered were the plaintiff's motion for summary judgment to recover assigned first-party no-fault benefits, and the defendant's cross motion for summary judgment citing that the plaintiff was ineligible for reimbursement of no-fault benefits and lacked standing to sue because it sold its right to collect upon the bills at issue. The main issue decided was whether the plaintiff was eligible for reimbursement of no-fault benefits and whether they sold the accounts which were the subject of the action. The holding of the case was that defendant's cross motion for summary judgment dismissing the action should have been denied since questions of fact exist as to whether the plaintiff is eligible for reimbursement of no-fault benefits and whether plaintiff sold the accounts in question. Therefore, the court reversed the order and granted defendant's cross motion for summary judgment dismissing the complaint.

The court in this case considered an appeal from a judgment entered after plaintiff's motion for summary judgment was granted. The main issue was whether defendant was liable to pay plaintiff for first-party no-fault benefits for medical services provided to assignors involved in motor vehicle accidents. Defendant had denied the claims based on assignors' failure to appear for scheduled independent medical examinations, and asserted that the injuries sustained were not causally related to the accidents. The court held that defendant failed to raise a triable issue of fact with regard to the denied claims, but that there was a triable issue of fact regarding the claims for injuries not causally related to the accidents. The judgment was reversed and remanded for further proceedings on the remaining claims.