No-Fault Case Law

The court considered a dispute over no-fault insurance benefits resulting from a motor vehicle accident. The plaintiff sought to recover $4,748.69 for treatment provided following the accident in April 2011, but the defendant argued that the benefits under the no-fault policy had been exhausted. The main issue decided was the requirement that an insurer pay or deny a verified claim within 30 days of receipt, as well as the insurer's obligation to pay benefits directly to providers of health care services. The holding of the court was that the defendant failed to establish its entitlement to judgment as a matter of law, as it did not submit the no-fault application, verification, any request for verification, or any denial associated with the plaintiff's claim for payment, and therefore there were remaining issues of fact as to when the claim was denied and the basis and efficacy of the denial.

The court considered the fact that the defendant had scheduled independent medical examinations (IMEs) of the plaintiff's assignor, and the assignor failed to appear for the duly scheduled IMEs. The main issue decided was whether the defendant had timely denied the claim based on the assignor's failure to appear for the IMEs, which was considered a condition precedent to the insurer's liability on the policy. The holding of the case was that the defendant had properly scheduled the IMEs and timely denied the claim, and therefore the motion for summary judgment dismissing the complaint was granted.

The relevant facts of the case were that PDG Psychological, P.C. sought to recover assigned first-party no-fault benefits from State Farm Mutual Insurance Co. State Farm moved to dismiss the complaint on the ground of laches, arguing that PDG Psychological, P.C. had delayed in prosecuting the action. The Civil Court granted State Farm's motion, but PDG Psychological, P.C. appealed the decision. The main issue decided by the court was whether the delay in prosecuting the action constituted laches. The holding of the case was that the order granting State Farm's motion to dismiss the complaint on the ground of laches was reversed. The court denied the branch of the motion seeking dismissal on the ground of laches and remitted the matter to the Civil Court for a determination of the remaining branch of State Farm's motion. The court also referenced a previous case, V.S. Med. Servs., P.C. v State Farm Mut. Ins. Co., to support its decision.

The court considered an action by a provider to recover assigned first-party no-fault benefits, including a motion by the defendant to dismiss the complaint on the ground of laches due to the plaintiff's delay in prosecuting the action. The Civil Court granted the defendant's motion, finding that the branch of the motion seeking to toll statutory no-fault interest was moot. On appeal, the Appellate Term reversed the decision, denying the branch of the defendant's motion seeking to dismiss the complaint on the ground of laches and remitting the matter to the Civil Court for a determination of the remaining branch of the defendant's motion. The holding of the case was that the branch of the defendant's motion seeking to dismiss the complaint on the ground of laches was denied, and the matter was remitted to the Civil Court for a determination of the remaining branch of the defendant's motion.

The relevant facts the court considered in this case were that DJS Medical Supplies, Inc. was seeking to recover assigned first-party no-fault benefits from Metropolitan Auto Home and Life Insurance. The defendant moved to dismiss the complaint on the ground of laches, based on the plaintiff's delay in prosecuting the action. The Civil Court granted this branch of the motion and found that the branch seeking to toll statutory no-fault interest was moot. The main issue decided by the court was whether the complaint should be dismissed based on laches. The holding of the court was that the branch of defendant's motion seeking to dismiss the complaint on the ground of laches is denied, and the matter is remitted to the Civil Court for a determination of the remaining branch of the defendant's motion.

The court considered the circumstances related to a petition to vacate a master arbitrator's award in a dispute between Country-Wide Insurance Company and TC Acupuncture, P.C., as the assignee of Darrius Williams. The main issue decided was whether the motion to vacate the award should have been granted or not. The holding of the court was that the motion court effectively granted reargument for the respondent, and in doing so it limited the ability for courts to vacate arbitration awards to only circumstances not present in this case. As a result, the order to vacate the master arbitrator's award was reversed, and the award was confirmed. The matter was then remanded for a determination of respondent's attorneys' fees.

The relevant facts considered by the court were that Total Chiropractic P.C. had sought payment for medical services it provided to an assignor who had been involved in a motor vehicle accident. The insurance company, Mercury Casualty Insurance Company, had previously been granted a Declaratory Judgment in Orange County Supreme Court, which ordered that Mercury had no duty to provide any first party benefits coverage to the assignor. Plaintiff failed to respond to this judgment. The main issue decided by the court was whether the Declaratory Judgment had preclusive effects in the current case, allowing the insurance company to deny the plaintiff's claim for payment for medical services. The court held that the Declaratory Judgment was a final order and precluded the plaintiff from collecting payment for the claim, and as a result, granted the insurance company's motion for summary judgment and denied the plaintiff's cross-motion. The complaint was dismissed with prejudice.

The relevant facts the court considered were that Allay Medical Services, P.C. initiated an action to recover assigned first-party no-fault benefits for injuries sustained by "Miller, Nichole" in an accident on October 31, 2015. Defendant Nationwide Ins. served an answer and then moved to dismiss the complaint under the doctrine of res judicata, citing a previous Supreme Court declaratory judgment action. The Supreme Court order and judgment, entered in 2016, declared that Nationwide was "under no obligation to pay any of the claims" identified in the complaint. The main issue decided was whether Allay Medical Services' action to recover no-fault benefits was barred by the doctrine of res judicata due to the previous Supreme Court judgment. The holding of the appellate court was that the order denying defendant's motion for summary judgment was reversed, and defendant's motion for summary judgment dismissing the complaint was granted. This means that the court held in favor of Nationwide Ins., finding that Allay's action was indeed barred by the previous Supreme Court judgment.

The relevant facts of the case included the plaintiff, Allay Medical Services, P.C., seeking to recover first-party no-fault benefits for injuries sustained by Gregoria Diop in a car accident. The defendant, Nationwide Insurance, argued that the plaintiff's action was barred under the doctrine of res judicata due to a prior order and judgment in a Supreme Court declaratory judgment action. The prior action had declared that Nationwide was not obligated to pay any claims related to the same accident for which the plaintiff was seeking benefits. The main issue decided was whether the plaintiff's present action in the Civil Court was precluded under the doctrine of res judicata due to the prior order and judgment. The court held that defendant's moving papers sufficiently established that the claim number and date of the subject accident in the present action were identical to those in the prior action, resulting in the plaintiff's action being precluded under the doctrine of res judicata. As a result, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the plaintiff's action to recover first-party no-fault benefits was barred by the doctrine of collateral estoppel. The court considered the fact that the declaratory judgment obtained by the defendant was on default and not actually litigated on the merits in the Supreme Court. The court held that there was no identity of issues between the present action and the prior determination in the declaratory judgment action, and that the plaintiff's action was not barred under the doctrine of collateral estoppel. Therefore, the order granting the branch of defendant's motion seeking dismissal of the complaint on the ground of collateral estoppel was reversed, and the matter was remitted to the Civil Court for a determination of the remaining grounds asserted by the defendant.