No-Fault Case Law

The court considered the submissions by both the plaintiff and defendant, including the affidavit of the defendant's special investigator supported by examinations under oath taken of the plaintiff's assignor and other persons involved in the accident. The main issue decided was whether the defendant's submissions raised a triable issue of fact as to whether the collision was part of a fraudulent insurance scheme. The holding of the court was that the defendant's submissions were sufficient to raise a triable issue of fact, and therefore the plaintiff's motion for summary judgment was properly denied.

The main issue in this case was whether the plaintiff, a healthcare provider, was entitled to summary judgment on its claim for first-party no-fault benefits for services rendered to its assignor. The plaintiff had submitted a complete proof of claim to the defendant, an insurance company, and the defendant failed to pay or deny the claim within the prescribed 30-day period. The court found that the defendant's requests for examinations under oath did not toll the 30-day period, as the insurance regulations in effect at the time did not require a claimant to appear for an examination under oath. The court held that the defendant was precluded from asserting most defenses due to the untimely denial of the claims, but was not precluded from asserting the defense that the collision was in furtherance of an insurance fraud scheme. The defendant's special investigator submitted an affidavit demonstrating a "founded belief that the alleged injuries do not arise out of an insured incident," and the court found that this was sufficient to demonstrate the existence of a triable issue of fact. Therefore, the plaintiff's motion for summary judgment was properly denied by the court. Ultimately, the holding of the case was that the defendant demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage, and as a result, the plaintiff's motion for summary judgment was properly denied.

The court considered the claim by S & M Supply Inc. to recover first-party no-fault benefits for medical equipment provided to its assignors. S & M Supply Inc. established its entitlement to summary judgment by submitting properly executed claim forms. The main issue decided was that the defendant, State Farm Mutual Automobile Insurance Company, failed to pay or deny the claims within 30 days of receipt, which precluded its defense based on the assignors' failures to attend examinations under oath. However, the preclusion rule was found to be inapplicable to a claim that the underlying traffic incident was deliberate and staged as part of a scheme to defraud, which would constitute a complete defense to the action. The holding of the case was that the defendant's submissions sufficed to demonstrate a "founded belief that the alleged injury did not arise out of an insured incident," which supported their defense.

The court considered the timeliness of the defendant insurer's denial of the plaintiff, King's Medical Supply Inc., first-party no-fault benefits claim and the evidentiary support for the denial, including the necessity for the supplies provided by the medical equipment supplier to the injured party. The main issue decided was whether defendant's denial of the claim was timely and whether there was sufficient evidentiary support for the denial. The holding of the case was that the plaintiff's motion for summary judgment was granted in all respects based on the court's finding that the defendant's denial was untimely and without evidentiary support, and therefore, plaintiff was entitled to first-party no-fault benefits, attorney's fees, and costs.

The court considered the circumstances of an accident in which a pedestrian was struck by a vehicle insured by Country-wide Insurance Company, and the subsequent actions of the insurance company in response to settlement offers made by the injured party. The main issue was whether Country-wide Insurance Company acted in bad faith by failing to accept the injured party's settlement offer. The court held that to establish a prima facie case of bad faith refusal to settle, a plaintiff must demonstrate that the insurance carrier engaged in a pattern of behavior evincing a conscious or knowing indifference to the probability that an insured would be held personally accountable for a large judgment if a settlement offer within the policy limits were not accepted. The court determined that Country-wide's conduct in this matter was not a model of diligence but held that the limiting timeframe and other factors weighed against the injured party's bad faith claim, and granted the insurance company's motion for summary judgment dismissing the complaint.

The court considered a motion for summary judgment by the plaintiffs for statutory interest and attorneys' fees on no-fault claims that the defendant allegedly paid late. The main issue was whether the plaintiffs could "bundle" a series of de minimis actions that are related only by the defendant's common response to the claims underlying those actions. Additionally, the court considered whether it should grant summary judgment because the defendant had not opposed the motion and made no motion to sever. The court held that the action was based on a series of de minimis claims that may not be joined under CPLR 1002, and denied the motion for summary judgment, but gave the plaintiff leave to move to sever the plaintiffs and to renew the motion for summary judgment as to those plaintiffs.

The claimant was injured in a car crash and was denied no-fault benefits by her insurance company. This claimant was seeking supplementary uninsured motorist (SUM) benefits from their insurance company. After a lengthy series of doctor consultations, she eventually discovered she had severe injuries and pursued the SUM claim. The Supreme Court ruled in favor of the insurance company, determining the claimant did not provide timely notice of her claim. The appellate court disagreed, stating that the claimant acted with due diligence in ascertaining her claim, and the delay was reasonable. As a result, the court reversed the decision in favor of the insurance company, granting the application for a permanent stay of arbitration.

The court considered the plaintiff’s motion to strike the defendant’s seventh, eighth, and tenth affirmative defenses on the ground that they were not pleaded with the specificity required by CPLR 3016(b) in an action to recover first-party no-fault benefits under Insurance Law § 5101. The defendant State Farm Mutual Automobile Insurance Company denied a claim for first-party no-fault benefits in the amount of $757.00 for medical supplies provided to its assignor Edme Aenor in connection with injuries arising out of a September 2, 2002 motor vehicle accident. Defendant’s affirmative defenses asserted fraudulent conduct, fraudulently misrepresented costs, and that the medical supplies for which reimbursement is sought were not related to the accident. The court granted in part and denied in part plaintiff’s motion to strike, specifically striking defendant’s seventh and eighth affirmative defenses and that portion of defendant’s tenth affirmative defense alleging that "the medical supplies for which reimbursement is sought were never actually provided". The court held that these defenses were being stricken because of defendant’s admitted failure to pay or reject the claims within 30 days of receipt, but declined to strike the portion of defendant’s tenth affirmative defense alleging that "the medical supplies for which reimbursement is sought were not related to the accident."

The court considered a case where health care providers were seeking assigned no-fault benefits from an insurance company, State Farm Mutual Automobile Insurance Company. The main issue was whether the health care providers were entitled to summary judgment for assigned no-fault benefits, as well as whether the insurance company was precluded from asserting the defense of an insurance fraud scheme due to an untimely denial of the claims. The court held that the health care providers established their entitlement to summary judgment for assigned no-fault benefits, as the insurance company failed to pay or deny the claims within the prescribed 30-day period. However, the insurance company was not precluded from asserting the defense of an insurance fraud scheme, as the affidavit submitted by their special investigator demonstrated a "founded belief that the alleged injuries do not arise out of an insured incident." Therefore, the plaintiffs' motion for summary judgment was properly denied.

The main issue in this case was whether the plaintiff was entitled to summary judgment in its favor. The court considered the evidence presented by the plaintiff, which consisted of an affirmation of counsel, an unverified complaint, and an affidavit from "Ernest Horowitz MD," who stated that the assertions in his counsel's affirmation were true and correct. However, the court did not accept the attempted incorporation by reference of the factual allegations contained in the counsel's affirmation. The court also noted that the No-Fault Verification of Treatment furnished by the plaintiff's counsel to the court differed from what was apparently sent to the defendant upon submission of the claim. As a result, the court denied the plaintiff's motion seeking summary judgment and awarded costs to the defendant. The holding of the case was that the plaintiff's motion for summary judgment was denied, and costs were awarded to the defendant.