No-Fault Case Law

The court considered the fact that defendant moved for summary judgment to dismiss the complaint, arguing that the South Carolina automobile insurance policy was fraudulently procured by the assignor, who had allegedly made misrepresentations on her application for insurance. The main issue decided was whether the insurance company was entitled to summary judgment dismissing the complaint based on the rescission of the policy under South Carolina law. The holding of the case was that the defendant failed to establish its entitlement to judgment as a matter of law, as it did not show that it had complied with the requirements of South Carolina law for retroactive rescission of the policy. Therefore, the order denying the defendant's motion for summary judgment was affirmed.

The main issue in this case was whether the plaintiff was entitled to have statutory no-fault interest recalculated at a compound rate, from a simple rate, for an award of interest in a judgment. The court considered the fact that the action to recover first-party no-fault benefits was settled in 2009, but the defendant did not pay the settlement amount, leading to a judgment being entered in 2017. The court ultimately held that the portion of the order vacating the judgment was not appealable, and the plaintiff's motion to recalculate the interest in the judgment was moot. The court also noted that claims submitted before April 5, 2002 are governed by former regulations providing for compound interest. Therefore, the appeal was dismissed.

The relevant facts considered by the court were that the plaintiff, a provider, was seeking to recover first-party no-fault benefits that had been settled by a two-attorney stipulation in 2003. The defendant did not pay the settlement amount, and a judgment was entered in 2017. The main issue decided by the court was whether the Civil Court erred in staying the accrual of statutory no-fault interest from the date of the settlement in 2003 through February 22, 2017. The holding of the court was that the Civil Court did err in staying the accrual of interest, as the plaintiff was not required to make a demand for payment due to being the prevailing party, and the defendant did not demonstrate that the plaintiff had prevented them from paying the settlement amount. As a result, the order staying the accrual of statutory no-fault interest was reversed and vacated.

The court considered the fact that the insurance company, Unitrin Direct Insurance Company, had submitted evidence of a medical provider claim (NF-3), and had timely requested an independent medical examination (IME) of the injured claimant within 15 days of the receipt of that claim. The injured claimant had failed to appear at two scheduled IMEs. The main issue was whether the insurer was entitled to disclaim coverage for no-fault benefits for the injured claimant. The court held that the basis for disclaimer of coverage was established as a matter of law, and granted summary judgment to the insurer, declaring that the insurer had no coverage obligation for the no-fault benefits sought by the defendants-respondents. The court also directed the clerk to enter judgment accordingly.

The court considered the facts of the case in which the defendant had failed to appear or answer the complaint and sought to vacate a judgment entered against them. The main issue decided was whether the defendant had a reasonable excuse for their default and whether they had a potentially meritorious defense to the action. The holding of the case was that the defendant failed to establish a reasonable excuse for their default, as they admitted to receiving the summons and complaint but did not review it for six months due to a high volume of claims. Therefore, the court affirmed the order denying the defendant's motion to vacate the default judgment.

The relevant facts considered by the court were that a provider sought to recover first-party no-fault benefits for services rendered in 1999, which were settled in 2008. The defendant did not pay the settlement amount, and a judgment was entered in 2017, awarding statutory no-fault interest at a simple rate. The main issue decided was whether the interest should be recalculated at a compound rate. The holding of the court was that since the judgment was vacated, the motion to recalculate the interest was moot. The court also noted that claims submitted before April 5, 2002 were governed by former regulations providing for compound interest.

The relevant facts in this case involved a dispute over whether American Transit Insurance Company was required to reimburse Surgicore of Jersey City LLC for a nerve block and surgery performed on a patient who was involved in a motor vehicle collision. Surgicore challenged the denial of reimbursement in two separate no-fault arbitration proceedings. The arbitrator awarded the amounts claimed by Surgicore, and American Transit sought a de novo adjudication of the awards under Insurance Law § 5106 (c). Surgicore argued that the court lacked subject matter jurisdiction over the de novo challenge to the award for the nerve block due to the $5,000 statutory threshold. The main issue in the case was whether the master arbitrator's decisions should be considered a single unified award for the purpose of the de novo challenge provision of Insurance Law § 5106 (c). The court held that the master arbitrator's decisions should be considered a single award, and as the amount of the award exceeded the statutory threshold, American Transit's de novo challenge stated a cause of action. In summary, the court ruled that the master arbitrator's decisions awarding reimbursement to Surgicore for the nerve block and surgery should be considered a single, unified award for the purpose of the de novo challenge provision under Insurance Law § 5106 (c). Therefore, the court denied Surgicore's motion to dismiss, as American Transit's de novo challenge to the award stated a cause of action.

The court was considering a petition to vacate a master arbitration award which affirmed the no-fault arbitrator's award of no-fault benefits to respondents. The main issue decided was whether the denial of benefits to the respondents was based on sufficient reasoning and whether there was a rational basis for the master and no-fault arbitrator's determination. The holding of the court was that the denial of benefits to the respondents lacked the degree of specificity required by statute and case law. As a result, the denial was deemed insufficient and the award of benefits to the respondents was confirmed. The court also ruled that the respondents were entitled to reasonable attorneys' fees for this appeal, to be determined by Supreme Court.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the branch of the plaintiff's motion seeking summary judgment upon the second cause of action. The main issue decided was whether the plaintiff had established its prima facie entitlement to summary judgment upon the second cause of action, which involved a provider seeking to recover assigned first-party no-fault benefits. The holding of the case was that the order, insofar as appealed from, was reversed, with $30 costs, and the branch of plaintiff's motion seeking summary judgment upon the second cause of action was denied. The court found that the plaintiff had failed to establish its entitlement to summary judgment, as it did not prove that the defendant failed to timely deny the claim at issue or that the defendant issued a timely denial of claim form that was conclusory, vague, or without merit as a matter of law.

The main issues in this case were whether the defendant's letters scheduling independent medical examinations (IMEs) had been properly addressed and mailed, and whether the plaintiff's assignor had failed to appear at duly scheduled IMEs. The court held that the defendant's moving papers were insufficient to establish that the letters scheduling IMEs had been properly addressed and mailed, and therefore failed to demonstrate that the IMEs had been properly scheduled, and thus the plaintiff's assignor had failed to appear at duly scheduled IMEs. As a result, the court affirmed the order of the Civil Court, denying the defendant's motion for summary judgment dismissing the complaint.