No-Fault Case Law

The case involved a dispute between Patricia Simmons and State Farm Mutual Automobile Insurance Company. After State Farm refused to continue providing no-fault insurance benefits to Patricia Simmons, she and other plaintiffs commenced legal action against the insurance company. The main issue was whether State Farm had met its burden of showing lack of cooperation of its insured and had established that the plaintiff was able to return to work. The court decided that State Farm failed to meet its burden of showing lack of cooperation of its insured and was unable to establish that the plaintiff was able to return to work. Therefore, the court affirmed the lower court's decision to grant State Farm's motion only in part and denied it with respect to the first cause of action, ultimately dismissing the complaint.

The court considered a dispute between a health care provider and an insurance company over the refusal of the insurance company to pay for services rendered to a patient. The key issue in this case was the proper scope of an examination before trial (EBT) in an action by a health care provider for no-fault first-party benefits. The court had to decide whether the questioning at an EBT should be confined to the insurer's denial of claim form, the NF-10, or whether other matters should be allowed. The court also noted that the defendant's attorney had served the court with a motion four months late, without excuse or justification. The court held that the briefing schedules should be adhered to, and judges should scrupulously enforce deadlines set by fellow judges. Furthermore, the court would not consider papers that were untimely under a schedule.

The court considered whether an insurer was required to provide uninsured motorist coverage in a claim involving an accident and whether or not the policy holder had options to pursue coverage from another source. The main issue was whether the alleged tortfeasor's insurer, who was now insolvent, triggered the harmful uninsured motorist coverage. The court held that under these circumstances, the coverage was not provided, and that the insured party's recourse was against the Public Motor Vehicle Liability Security Fund rather than his own insurer. They also discussed whether a request for recovery from the Fund would result in a denial of coverage from the Fund, thereby triggering the insured party's right to coverage from his own provider. It was determined that the matter should be remitted back to the Supreme Court for further proceedings.

The court considered the appellant's claim that he was entitled to a de novo trial of his no-fault claim based on the amount in controversy, as the master arbitrator made no monetary award, and the statutory predicate for a de novo court adjudication was not satisfied. The main issue decided by the court was whether the appellant was entitled to a de novo trial under Insurance Law § 5106 (c) as the master arbitrator's award was $5,000 or greater. The court decided that the appellant was not entitled to a de novo trial because the master arbitrator made no monetary award and thus the statutory predicate for a de novo court adjudication was not satisfied. The holding of the case was that the appellant was not constitutionally entitled to a de novo trial, as the Insurance Law § 5106(c) does not violate due process and equal protection because the classification it creates between claimants and insurance carriers is reasonably related to a legitimate state interest and has a rational basis.

The court considered the plaintiff's motion for summary judgment pursuant to CPLR 3212, where Vista Surgical Supplies, Inc. sought to recover first-party no-fault benefits in the amount of $1,282 for medical supplies furnished to the plaintiff's assignor. Plaintiff's argument was that the defendant had failed to timely deny its no-fault claims. The court held that in a no-fault context, a health care provider must establish prima facie entitlement to summary judgment as a matter of law by submitting admissible proof that it is an assignee under a properly executed assignment, that the statutory claim form was mailed to and received by the defendant, and that payment of no-fault benefits is overdue. However, the court found that plaintiff's evidence was insufficient, as the affidavit submitted by plaintiff's officer contained boilerplate language and did not provide specific material facts. Therefore, the plaintiff's motion for summary judgment was denied.

The main issue in the case was whether the alleged injuries in automobile collisions arose from "staged accidents" and the subsequent impact on coverage for first-party no-fault benefits. The court considered the insurer's "founded belief" that the collisions were "staged" and whether State Farm had provided enough evidence to establish this belief. The court held in favor of State Farm, dismissing the claims and finding that the State Farm policies did not provide coverage for the claims at issue. The court considered the burden of proof in establishing coverage under the policy, the evidence submitted by the insurer, and the failure of the plaintiffs to rebut the insurer's belief. The court also discussed the inadmissibility of certain information used by State Farm and highlighted the repercussions for the providers and the assignor if the insurer does not pay due to lack of coverage.

The main issues considered in this case were whether Geico, the petitioner, was aware of the respondents' uninsured motorist claim in June 2003 and whether they failed to request discovery for 10 months, as well as whether the notice of intention to make a claim for UM benefits constituted notice of the UM claim. The court considered the fact that the respondents had served a notice of intention to make a claim for UM benefits in June 2003 and Geico did not request discovery until after they demanded arbitration. The court held that, based on the facts presented, the petitioner failed to timely request discovery and denied Geico's petition to permanently or temporarily stay the UM arbitration demanded by the respondents pending their provision of such discovery. The court affirmed its original determination and adhered to it upon reargument.

The main issue in this case was whether the defendant, State-Wide Insurance Co., was legally bound by an alleged settlement agreement reached with the plaintiff, Brooklyn Heights Medical, to pay first-party No-Fault benefits for healthcare services rendered to the plaintiff's assignor. The court considered the facts surrounding the negotiation and communication of the settlement agreement, including the exchange of unsigned documents, and whether the defendant's failure to sign and submit payment constituted rejection of the settlement offer. The court held that the defendant was not legally bound by the settlement agreement as neither the plaintiff nor plaintiff's counsel signed the stipulation at issue. The court also denied both the defendant's motion to vacate the judgment against it and enforce the settlement, as well as the plaintiff's cross-motion for sanctions and costs, finding that neither party acted in bad faith. Therefore, the motion and cross-motion were both denied.

The court considered the plaintiff's motion for summary judgment and the defendant's cross-motion to compel depositions of plaintiff, plaintiff's assignor, and plaintiff's treating physicians. The main issue decided was whether the plaintiff was entitled to first-party No-Fault benefits for healthcare services rendered to plaintiff's assignor following an accident. The court held that the plaintiff had submitted proof demonstrating its entitlement for the benefits, shifting the burden to the defendant. The court also held that the defendant's denials based on the assignor's failure to attend independent medical examinations were ineffective, and that the defendant's lack of coverage defense was not supported by sufficient evidence. Therefore, the plaintiff was awarded summary judgment in the amount of $2,299 plus statutory interest, costs, and attorneys' fees.

The main issue the court had to decide in this case was whether the plaintiff health care providers were entitled to summary judgment for first-party no-fault benefits for medical services rendered to their assignors for injuries sustained in a motor vehicle accident. The court found that with the exception of three out of 58 claims, the plaintiffs had established a prima facie entitlement to summary judgment by showing that they submitted claims setting forth the fact and amount of the loss sustained, and that payment of no-fault benefits was overdue. The court also found that the defendant insurance company failed to pay or properly deny 55 of the claims within the prescribed 30-day period, precluding it from raising most defenses. The holding of the case was that the plaintiffs were entitled to partial summary judgment in the sum of $22,851.16 on the claims for which summary judgment was granted, and the matter was remanded to the court for a calculation of the statutory interest and an assessment of attorney's fees due on that sum, as well as for further proceedings on the remaining three claims.