No-Fault Case Law

The court considered that the petitioner, Patricia A. Snyder, had been injured in a motor vehicle accident in 1996 while working for her employer and had received workers' compensation benefits from her employer's insurance carrier, CNA Insurance Companies, as well as first-party benefits pursuant to the no-fault provisions of the Insurance Law. After settling a third-party negligence action against the driver of the other vehicle involved in the accident for $32,500, Snyder failed to obtain consent of the settlement from respondent CNA Insurance Companies as required by law. The main issue decided by the court was whether Snyder's request for judicial approval, nunc pro tunc, of the third-party settlement should be granted. The holding of the case was that the Supreme Court had not abused its discretion in approving the settlement, as it found that it would have been difficult for Snyder to prove that she had suffered a serious injury as a result of the accident and that respondent had suffered no prejudice from her delay in seeking approval. Therefore, the order granting approval of the settlement was affirmed.

The main issue in Allstate Ins. Co. v Belt Parkway Imaging, P.C. is whether the insurance companies can withhold payment for medical services provided by fraudulently incorporated enterprises and if they can bring actions for fraud and unjust enrichment to recover payments made after a particular regulation's effective date. The court considered the fact that the insurance carriers could sue for fraud and unjust enrichment to recover payments made after the regulation's effective date. The holding of the case was that the insurance companies could withhold payment for medical services that fraudulently incorporated enterprises provided and to which patients have assigned their claims, as well as bring actions for fraud and unjust enrichment to recover payments made after the regulation's effective date. Also, the court deemed it appropriate to certify the question to the New York Court of Appeals regarding the entitlement of a fraudulently incorporated medical corporation to be reimbursed by insurers.

The relevant facts that the court considered in this case were that Mount Sinai Hospital brought a suit against Allstate Insurance Company to recover no-fault medical payments under an insurance contract. The main issue in the case was determining whether Allstate had failed to pay or deny Mount Sinai's claim for no-fault medical payments within 30 days as required by 11 NYCRR 65-3.8 (c), as well as whether Mount Sinai had complied with a demand for verification in accordance with 11 NYCRR former 65.15 (g) (1) (i) and (2) (iii). The holding of the case was that the court modified the order and granted Allstate's request for summary judgment, as they had raised a triable issue of fact regarding Mount Sinai's compliance with the demands for verification. The court agreed that any claim for payment was premature until it was established when the 30-day period within which Allstate was required to respond began to run, and as such, the order was modified, and the case was affirmed.

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.