No-Fault Case Law

The court considered the master arbitrator's award in a no-fault matter, in which the initial arbitrator denied the health service provider's claim for no-fault benefits. The main issue was whether the health service provider had to prove medical necessity and if there was a rational basis for the denial of the claim. The holding of the court was that the master arbitrator's decision lacked a rational basis and was contrary to settled law, therefore the court granted the petition by the health service provider to vacate the master arbitrator's award and entered judgment in favor of the petitioner. This meant that the health service provider was entitled to the amount of $1,790.67, with statutory interest and attorney's fees, as well as costs and disbursements of the proceeding.

The court considered the lack of contacts between the Pennsylvania-based petitioner, American Independent Insurance, and New York, as well as petitioner's lack of solicitation of business or licensing to write insurance policies in New York. The main issue was whether the arbitral forum had jurisdiction over the petitioner. The court held that the arbitration award should be vacated, based on the lack of jurisdiction. They argued that American Independent Insurance was not subject to personal jurisdiction under New York's long-arm statute, and Insurance Law § 1213 did not apply to the petitioner's circumstances. Additionally, the court found that the petitioner was not required to appeal the arbitrator's decision to a master arbitrator before bringing the proceeding, and that petitioner's financial connection to an insurance carrier that is licensed to issue policies in New York did not change their status as a foreign corporation. Therefore, the petition was granted and the arbitration award was vacated.

The main issue in the case was whether Nationwide Mutual Insurance Company was justified in denying coverage to Penny Mackey and Deanna Delaney under the policy's supplemental uninsured motorist (SUM) coverage. Mackey's daughter, Delaney, was injured in a car accident, and Mackey's attorney notified Nationwide of the potential SUM claim. Nationwide sent a "Proof of Claim" form in January 2004, but did not receive it back until April 2004 due to its misplacement. Nationwide then disclaimed coverage, arguing that the form was not returned as soon as practicable. The court held that since Mackey's attorney had promptly notified Nationwide of the claim and provided all necessary documentation, and Nationwide had not proven prejudice, it was unjust for the company to disclaim SUM coverage. The court therefore affirmed the lower court's decision denying Nationwide's application to stay arbitration and ruled in favor of Mackey and Delaney, holding Nationwide responsible for the SUM coverage.

The relevant facts the court considered in this case were that the plaintiff, a medical provider, sought payment for medical services rendered to an assignor, which was rejected by the defendant-insurer on the grounds of lack of medical necessity. At trial, the plaintiff's bills were not accepted into evidence because its computer copies were unsigned. The defendant's interrogatories, however, established that a deficiency in the amount of $1261.81 remained outstanding. The main issue decided by the court was whether the plaintiff met its prima facie burden by a preponderance of the credible evidence. The holding of the court was that the plaintiff did indeed meet its burden, and the court directed the Clerk to enter judgment for the plaintiff in the amount of $1261.81, together with statutory interest, attorney's fees, and costs.

The court considered evidence including witness testimony and reports from an investigator and claims representative to determine if the alleged accident was staged or not as part of an insurance fraud scheme. The main issue decided was whether a collision was a true accident and unintentional, regardless of the motivation behind it. The holding of the case was that the deliberate or intentional nature of the accident determines whether the incident is eligible for no-fault coverage, and not whether it was in furtherance of an insurance fraud scheme. This means that if the collision was deliberate, it would not be covered under the no-fault policy.

The main issue in this case was whether the arbitrator had the power to award respondent benefits payable by petitioner. The relevant facts the court considered included the petitioner's contacts with New York, the requirement that insurers submit to arbitration, the arbitration award, and other relevant facts. The holding of the court was that the issue at hand was not whether the court had jurisdiction over petitioner, but whether the arbitrator did, or had the power to award respondent benefits payable by petitioner. As the facts determinative of this issue were absent, the court denied the petition to vacate the arbitration award.

The main issue in this case was whether the defendant insurance company, Utica Mutual Ins. Co., was entitled to deny payment for first-party no-fault benefits for health care services rendered by the plaintiff health care provider. The plaintiff established a prima facie entitlement to summary judgment by proving that it submitted claims for the services and that payment of no-fault benefits was overdue. The defendant failed to pay or deny the claims within the prescribed 30-day period, precluding them from raising most defenses. However, the defendant was not precluded from asserting the defense that the alleged injuries did not arise out of an insured incident. The court ruled that the defendant demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage, therefore the plaintiff's motion for summary judgment was denied, and the order was reversed without costs.

The relevant facts the court considered were that 11 plaintiffs were seeking to recover attorney's fees and interest on 14 first-party no-fault claims from Liberty Mutual Insurance Company. The claims were based on 14 unrelated assignors involved in accidents on 14 different dates, with no common contract of insurance between the claims. The main issue before the court was whether the causes of action should be severed, and if the court below should have determined the summary judgment motion on behalf of one of the plaintiffs. The holding of the case was that the court did not abuse its discretion in severing the causes of action for the sake of convenience, and the case was remanded for the court below to determine the summary judgment motion on behalf of one of the plaintiffs.

The relevant fact that the court considered was that a health care provider submitted a claim for payment of no-fault benefits and that there was a dispute over whether the claim forms were actually mailed to the insurance company. The main issue decided was whether the health care provider had established a prima facie case that the claim forms were properly sent and that the insurance company failed to pay or deny the claims within the required time period. The holding of the case was that the health care provider had failed to provide competent proof that the claim forms were submitted to the insurance company, and therefore, they did not make the requisite showing to establish a prima facie entitlement to summary judgment. As a result, the order granting the motion for summary judgment was reversed, and the insurance company's motion for summary judgment was denied.

The relevant facts considered by the court in this case were that Ocean Diagnostic Imaging P.C. sought to recover first-party no-fault benefits for medical services rendered to its assignor. The plaintiff established a prima facie entitlement to summary judgment by demonstrating that it had submitted claims for the losses sustained and that the payment of benefits was overdue. The main issue decided by the court was whether the defendant, AIU Insurance Company, was precluded from raising defenses due to its failure to pay or deny the claims within the prescribed 30-day period. The holding of the court was that while the defendant was precluded from raising most defenses, it could assert the defense that the alleged injuries did not arise out of a covered accident. The court found that the defendant had demonstrated the existence of a triable issue of fact as to the lack of coverage, and therefore, the plaintiff's motion for summary judgment was properly denied.