No-Fault Case Law
Jenkins v Clarendon Ins. Co. (2021 NY Slip Op 50030(U))
January 15, 2021
The court considered the fact that the defendant moved for summary judgment dismissing the complaint on the basis that the plaintiff had failed to comply with a discovery order, and as a result, should be precluded from offering testimony at trial. The main issue decided in the case was whether the plaintiff's failure to comply with the discovery order warranted preclusion of testimony at trial. The holding of the court was that upon a review of the record, they agreed with the Civil Court's implicit determination that preclusion was not warranted under the circumstances presented. As a result, the order denying the defendant's motion for summary judgment was affirmed.
Allstate Ins. Co. v DHD Med., P.C. (2021 NY Slip Op 50011(U))
January 8, 2021
The main issue in this case was whether Allstate Insurance Company was liable to pay no-fault insurance benefits to DHD Medical, P.C. after an arbitration award in DHD Medical's favor of $5,786.91. Allstate had denied DHD Medical's claim for benefits on the ground that the treatment provided was not medically necessary. DHD Medical challenged the denial of benefits in a no-fault arbitration proceeding under Insurance Law § 5106 (b) and the arbitrator ruled in DHD Medical's favor. Allstate then brought this action under Insurance Law § 5106 (c) seeking a de novo adjudication of the benefits dispute. The court ultimately denied both Allstate and DHD Medical's motions for summary judgment, as well as DHD Medical's motion for default judgment on its counterclaims. Allstate's motion to compel DHD Medical to accept its untimely reply to the counterclaim was granted. The parties were ordered to inform the court how they intended to proceed with the action at a future status conference.
Schottenstein Pain & Neuro, PLLC v Travelers Ins. Co. (2020 NY Slip Op 51549(U))
December 23, 2020
The case was about a provider of health services who was attempting to recover first-party no-fault benefits from an insurance company. The insurance company was trying to dismiss the complaint, arguing that New Jersey law should apply to the case, as the accident took place there. However, the court held that the conflict of law should be resolved following the relevant law to contracts, not torts. They used a flexible "center of gravity" or "grouping of contacts" approach to give controlling effect to the state's law with the most significant relationship to the transaction and the parties. In this case, it was held that New York law applied, and the decision to grant the plaintiff's motion for summary judgment and denying the defendant's cross motion for summary judgment stood.
Mollo Chiropractic, PLLC v American Commerce Ins. Co. (2020 NY Slip Op 51548(U))
December 23, 2020
The court considered two actions by a provider to recover assigned first-party no-fault benefits. After a consolidated nonjury trial, each complaint was dismissed on the ground of lack of medical necessity. The main issues decided were whether there was a lack of medical necessity for the services at issue, specifically for manipulation under anesthesia (MUA), and whether the evidence provided by defendant's expert impermissibly went beyond the scope of the peer review report. The holding of the court was that the judgments were affirmed, as the defendant's expert provided a factual basis and medical rationale for the conclusion that there was no medical necessity for the services at issue, and the court was entitled to credit that testimony. The court also found that the plaintiff's witness's testimony was less credible and failed to sufficiently rebut the defendant's expert's testimony.
GPM Chiropractic, P.C. v State Farm Mut. Ins. Co. (2020 NY Slip Op 51521(U))
December 18, 2020
The court considered a case involving GPM Chiropractic, P.C. as the appellant and State Farm Mutual Insurance Co. as the respondent. The appellant sought to recover no-fault statutory interest for services rendered in 2001, and the issue was joined in December 2002. The Civil Court initially denied the respondent's cross motion for summary judgment dismissing the complaint, and upon reargument, adhered to its prior determination. The court ultimately ruled that the accrual of interest is tolled from November 26, 2005 to April 13, 2018, as the appellant took no meaningful action to prosecute the case after the court's decision on the respondent's motion. The holding of the case was that the accrual of interest is tolled within the specified timeframe.
A.M. Med. Servs., P.C. v State Farm Mut. Ins. Co. (2020 NY Slip Op 51520(U))
December 18, 2020
The main issue in this case was whether the accrual of no-fault statutory interest should be tolled due to plaintiff's delay in prosecuting the action. The court considered the fact that the action was commenced in 2002 to recover assigned first-party no-fault benefits for services allegedly rendered in 2001. The court noted that issue was joined in July 2002, a motion for summary judgment was denied in December 2004, and plaintiff filed a notice of trial in July 2017, showing a lack of meaningful action to prosecute the case after the motion was denied. The holding of the court was that the Civil Court properly tolled the no-fault interest until July 12, 2017, as the plaintiff unreasonably delayed the action after the motion for summary judgment was denied. The court also rejected plaintiff's assertion that defendant's failure to serve responses to discovery demands was a basis to find that defendant unreasonably delayed the action.
Midland Acupuncture, P.C. v GEICO Ins. Co. (2020 NY Slip Op 51509(U))
December 11, 2020
The main issue in this case was whether the Civil Court should have denied defendant's motion to dismiss the complaint pursuant to CPLR 3216. The court considered the fact that the plaintiff did not dispute receipt of the 90-day demand and did not make the required showing of prejudice. Furthermore, the plaintiff did not file a notice of trial within 90 days after receiving the 90-day demand and had not moved prior to vacate the demand or to extend the 90-day period. The holding of the court was that defendant's motion to dismiss the complaint pursuant to CPLR 3216 should have been granted. The court found that plaintiff's claim of law office failure did not rise to the level of a justifiable excuse, and therefore, it was unnecessary to consider whether the plaintiff demonstrated the existence of a meritorious cause of action.
Modern Acupuncture, P.C. v Omni Ins. Co. (2020 NY Slip Op 51506(U))
December 11, 2020
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.
Pacific Med. Servs., P.C. v Country-Wide Ins. Co. (2020 NY Slip Op 51502(U))
December 11, 2020
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.
Trans Med. Supply, Inc. v Country Wide Ins. Co. (2020 NY Slip Op 20364)
November 27, 2020
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.