No-Fault Case Law

The court considered relevant facts including Eufrosine Ola's petition to vacate an arbitrator's award that denied her claims for first-party no-fault benefits related to a left shoulder surgery and the subsequent master arbitrator's award that upheld this denial. The main issues decided were whether the awards were arbitrary or contrary to settled law and whether Ola's request for a rehearing before a new arbitrator should be granted. The court ultimately held that the petition to vacate the arbitrator's awards was properly granted due to the determination that the master arbitrator's award was arbitrary and contrary to established legal principles, and it directed that the case be heard before a new arbitrator. The insurer's cross-petition to confirm the awards was denied.

The court considered several relevant facts, including that the plaintiff, AVK RX Inc., was seeking to recover No-Fault insurance benefits for medical treatment provided to an assignor, Hassan Shuaib, following a motor vehicle accident. The defendant, Progressive Advanced Insurance Co., moved for summary judgment on the grounds that the assignor had failed to attend scheduled independent medical examinations (IMEs), which the defendant claimed was a condition precedent to coverage. The court focused primarily on whether the defendant had adequately demonstrated that the assignor was properly notified of the IMEs. The main issues decided included the sufficiency of the defendant’s proof regarding the mailing of IME notices and compliance with standard office practices or procedures related to notification. The court held that the defendant failed to meet its burden of proof for summary judgment, as the affidavit provided did not satisfactorily demonstrate that the notices were indeed mailed or adequately addressed. Consequently, the motion for summary judgment was denied, and the court instructed the plaintiff to file a Notice of Trial.

The court considered the relevant fact that the plaintiff, Central Pharmacy, Inc., as the assignee of Roger Darbasie, failed to appear for scheduled examinations under oath (EUOs) as part of their claim for no-fault benefits from the defendant, Nationwide Mutual Insurance Company. The main issue decided was whether the plaintiff's absence at these EUOs justified the dismissal of the complaint. The Civil Court initially found an issue of fact regarding the reasonableness of the EUO locations, but the appellate court noted that defendants had offered the option to participate virtually, a fact the plaintiff did not dispute. Consequently, the appellate court held that the defendant was entitled to summary judgment, granting the dismissal of the complaint based on the plaintiff's failure to comply with the EUO requirements.

The court considered the case involving a provider seeking to recover assigned first-party no-fault benefits from Nationwide Mutual Insurance Company, which had denied the claim based on the plaintiff's failure to appear for scheduled examinations under oath (EUOs). The central issue was whether the plaintiff's absence could be justified, particularly in light of the defendant's offers to conduct the EUOs virtually. The Civil Court initially found that there was a factual dispute regarding the scheduling of the EUOs, which led to its denial of the defendant's motion for summary judgment. However, upon appeal, the Appellate Term reversed that decision, determining that the defendant was entitled to judgment as the plaintiff did not contest the reasonableness of the EUO scheduling. Consequently, the court granted the defendant's motion for summary judgment, dismissing the complaint entirely.

In this case, the court considered the failure of claimants to appear for scheduled examinations under oath (EUOs) as a critical factor, which vitiated the insurance policy held by the plaintiff, State Farm Mutual Automobile Insurance Company. The insurer provided evidence, including affidavits and deposition transcripts, demonstrating that notices for the EUOs were properly sent and that the claimants did not appear. The main issues decided included whether the plaintiff was required to meet the 15-day notice requirement for EUOs and whether the defendants raised a triable issue of fact regarding their need for further discovery. The court affirmed the summary judgment in favor of the plaintiff, holding that the policy was vitiated by the claimants' nonappearance, thereby relieving State Farm of the obligation to show timely denial of the claims.

The court considered the facts surrounding a motor vehicle accident in which the plaintiff, Iqbal Sakandar, sought no-fault benefits from his insurer, American Transit Insurance Company. The third amended complaint included claims for bad faith, violation of General Business Law § 349, and breach of contract regarding no-fault benefits. The main issues were whether the plaintiff could successfully allege these causes of action and if the defendant's motion to dismiss should be granted. The court ultimately held that the allegations of bad faith and the violation of General Business Law § 349 did not constitute valid claims, as they did not meet the required legal standards, and ruled that the breach of contract claim was barred because the plaintiff had assigned his right to benefits to a medical provider. As a result, the court reversed the prior decision and granted the defendant's motion to dismiss the contested causes of action.

The court considered a no-fault insurance claim case where the plaintiff, Health East Ambulatory Surgical Center, alleged that the defendant, Country-Wide Insurance Company, failed to pay a claim totaling $19,646.13. The main issue was whether the plaintiff established that the claim was overdue, as the defendant had timely requested verification of the claim, which the plaintiff did not provide. The court noted that the trial consisted of minimal proceedings, lacking sworn testimony or evidence aside from references to prior admissions by the defendant. The court ultimately held that the plaintiff failed to demonstrate that the claim was not paid or denied within the required 30-day period, leading to the dismissal of the complaint and reversal of the previous judgment in favor of the plaintiff.

In this first-party no-fault action, the court examined a case arising from a judgment rendered in favor of Health East Ambulatory Surgical Center after a nonjury trial, where the plaintiff was awarded $19,646.13. The key issue was whether the plaintiff had established that the defendant, Country-Wide Insurance Company, had overdue claims for the medical services provided. The court noted that the trial consisted of minimal proceedings with no sworn witnesses or evidence presented, relying solely on the defendant's prior admissions regarding the receipt of the claim. However, the court found that the defendant had timely requested verification, which was not provided by the plaintiff, thereby determining that the plaintiff failed to prove the claim was overdue as required by relevant regulations. Ultimately, the court reversed the judgment and dismissed the complaint, ruling that the evidence did not support the plaintiff's case.

The court considered several key facts in this case, including that GEICO Insurance Company filed a lawsuit against MV Contract Transportation Inc., Manage Transit Corp., and James J. Boynton due to a vehicle collision on October 6, 2017, which resulted in significant personal injury claims and property damage. MV Contract sought a default judgment against the codefendants, MTC and Boynton, who had not responded or appeared in the action. The main issues decided by the court revolved around whether MV Contract properly served the cross-claims to the defaulting parties and if they had a legal obligation to respond to those claims. Ultimately, the court held that MV Contract failed to effectuate proper service as required by law, and thus the motion for a default judgment was denied since the defaulting parties' obligation to respond was never triggered.

In this case, the court considered the facts surrounding an incident in which Franklin Bermeo was struck by a vehicle identified as an e-bike while crossing an intersection in New York. Bermeo sought uninsured motorist benefits from his insurance provider, Government Employees Insurance Company, which denied the claim on the grounds that the e-bike did not qualify as a motor vehicle under the policy terms. The primary issues addressed included whether the vehicle involved constituted a motor vehicle as defined by the insurance policy and whether the petitioner had met the burden of proof necessary to justify a stay of arbitration. The court ultimately held that the evidence presented, including a police report stating that no motor vehicles were involved, supported the petitioner's claim and denied Bermeo’s request for arbitration for the uninsured motorist benefits. The court's decision adhered to its original ruling after reargument, thus affirming the permanent stay of arbitration.