No-Fault Case Law

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.

The relevant facts considered by the court were that Metro Pain Specialist, P.C. was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue decided was whether the amount of available coverage had been exhausted, and the court granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The holding of the case was that the defendant's payment log was properly considered by the court, and therefore, the order granting the defendant's motion for summary judgment and dismissing the complaint was affirmed.

The court considered the appeal of an order from the Civil Court of New York, Kings County, which granted the plaintiff's cross motion for summary judgment in a case to recover assigned first-party no-fault benefits. Upon review of the record, the court found that the defendant demonstrated the existence of issues of fact as to whether a misrepresentation had been made to the defendant in connection with the insurance policy and, if such a misrepresentation was made, whether it was material. The main issue decided was whether there were issues of fact regarding the misrepresentation in connection with the insurance policy and if it was material. The holding of the court was that the defendant demonstrated the existence of issues of fact and for this reason, the order granting the plaintiff's cross motion for summary judgment was reversed and the motion was denied.

The court considered an appeal from an order denying the defendant's motion for summary judgment dismissing the complaint and granting the plaintiff's cross motion for summary judgment. The main issue in the case was whether the defendant had established that there was no coverage for no-fault benefits since they had not issued an automobile insurance policy which would cover the underlying accident. The court held that the lack of coverage defense may be raised without regard to the propriety or timeliness of an insurer's denial of claim form. The papers submitted by the defendant in support of its motion were sufficient to establish that the policy being sued upon was a workers' compensation insurance policy which did not cover the plaintiff's claim to receive reimbursement of assigned first-party no-fault benefits. Therefore, the court reversed the judgment, vacated the order, granted the defendant's motion for summary judgment dismissing the complaint, and denied the plaintiff's cross motion.