No-Fault Case Law

The court considered the affidavits of an employee of a company retained to schedule independent medical examinations (IMEs), as well as an affidavit from the medical provider who was to perform the IMEs, and an affidavit executed by defendant's claims examiner. The main issue was whether the IME scheduling letters had been timely mailed, and whether the plaintiff's assignor had failed to appear for the duly scheduled IMEs. The court held that the affidavits established that the IME scheduling letters had been timely mailed, and that the plaintiff's assignor had failed to appear for those IMEs. As a result, the court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint.

The relevant facts that the court considered were that Domny Medical Services, P.C. was seeking to recover assigned first-party no-fault benefits, and the defendant, Travelers Insurance Company, had moved for summary judgment to dismiss the complaint, which was granted. The court also considered that plaintiff's cross motion for summary judgment was denied. The main issue decided was whether the record was sufficient to establish the proper mailing of the examination under oath scheduling letters to plaintiff's assignor and the denial of claim forms to plaintiff. The holding of the case was that the order granting defendant's motion for summary judgment and dismissing the complaint, while denying plaintiff's cross motion for summary judgment, was affirmed.

The relevant facts considered by the court in First Care Med. Equip., LLC v. Kemper Ins. Co. involved a medical equipment provider seeking to recover assigned first-party no-fault benefits. The main issue was whether the provider was entitled to summary judgment upon the first cause of action, as defendant insurance company argued that the supplies furnished were not medically necessary. The court ultimately held that the provider failed to establish its entitlement to summary judgment, as it did not prove that the defendant failed to timely deny the claim or that the denial of claim form was conclusory, vague, or without merit as a matter of law. The judgment awarding the provider the principal sum of $2,523.37 was reversed, and the branch of the provider's motion seeking summary judgment upon the first cause of action was denied. Thus, the defendant insurance company was not required to pay the requested benefits.

The court considered a case involving a motion for leave to enter a judgment upon defendant's failure to appear or answer the complaint, and a cross motion to open the default and compel the plaintiff to accept the late answer. The main issue decided was whether the defendant had a reasonable excuse for the default and the existence of a potentially meritorious defense to the action. The holding of the case was that the defendant failed to meet its burden of demonstrating a reasonable excuse for its default, and therefore, the motion for leave to enter a default judgment was granted and the cross motion to open its default in answering and to compel plaintiff to accept the late answer was denied.

The court considered a case where ESA Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits from Nationwide Affinity Ins. Co. of America. The main issue decided was whether the defendant had sufficient proof to establish that the initial and follow-up letters scheduling an examination under oath (EUO) had been timely mailed to plaintiff's assignor and whether the plaintiff's assignor had failed to appear for the scheduled EUOs. The court held that the proof submitted by the defendant was sufficient to establish that the letters had been timely mailed to the plaintiff's assignor and that the assignor had failed to appear for the scheduled EUOs. The court also rejected the plaintiff's argument that the affidavit submitted by the defendant did not comply with Alabama law, as it had an embossed notarial seal affixed to it. Therefore, the court affirmed the order, granting the defendant's motion for summary judgment and dismissing the complaint, while denying the plaintiff's cross motion for summary judgment.

The relevant facts the court considered were that the defendant had not received the claim forms underlying certain causes of action and that the plaintiff had failed to appear for duly scheduled examinations under oath. The main issues decided were whether there was a triable issue of fact as to whether the claims were timely submitted to the defendant, and whether the defendant was entitled to summary judgment dismissing the fourth and fifth causes of action based on the plaintiff's failure to appear for the examinations under oath. The holding of the case was that there was a triable issue of fact as to whether the claims were timely submitted to the defendant, and that the defendant was not entitled to summary judgment dismissing the fourth through ninth causes of action. Therefore, the order was modified to deny the branches of the defendant's motion seeking summary judgment dismissing the second through ninth causes of action.

The court considered that the defendant insurance company had sent letters scheduling examinations under oath (EUOs) to the plaintiff's assignor, which the plaintiff's assignor had failed to appear at. The insurance company had also timely denied the claims on these grounds. The main issue decided was whether the insurance company was entitled to summary judgment dismissing the complaint due to the assignor's failure to appear for the scheduled EUOs. The holding of the court was that the insurance company had established that the EUOs had been scheduled and that the assignor had failed to appear, and as the plaintiff had failed to raise a triable issue of fact in opposition, the insurance company was entitled to summary judgment dismissing the complaint. Therefore, the judgment was reversed, the order from 2018 was vacated, the insurance company's motion for summary judgment was granted, and the plaintiff's cross-motion was denied.

The relevant facts considered in this case were that State Farm Mutual Automobile Insurance Company sought to vacate an arbitration award issued in favor of Hereford Insurance Company, which dismissed State Farm's claim for intercompany reimbursement of no-fault benefits paid to its insured. State Farm had paid the benefits as a result of a motor vehicle accident and had initially claimed the other driver was uninsured. However, the arbitration panel ruled in favor of Hereford, determining that most of State Farm's claims were untimely and that there was insurance coverage for the other driver, which State Farm knew or should have known about. The main issue decided by the court was whether the arbitration award was supported by evidentiary support and not arbitrary and capricious, as mandatory arbitration awards must satisfy an additional layer of judicial scrutiny. The holding of the case was that the order denying State Farm's petition to vacate the arbitration award and granting Hereford's cross petition to confirm the arbitration award was affirmed, as the arbitrators' determination was not found to be arbitrary or capricious.

The court considered the fact that the provider had moved for summary judgment to recover assigned first-party no-fault benefits, and the insurer had served a cross-motion for summary judgment to dismiss the complaint, claiming material misrepresentation in the procurement of the insurance policy. The insurer had also commenced a declaratory judgment action in another court, resulting in a judgment that it had no duty to provide coverage for specified collisions. The main issue was whether the insurer's papers served in 2016 should be treated as a motion or cross-motion, and whether the lower court should have granted the insurer's motion for summary judgment based on the doctrine of res judicata. The holding of the court was that the judgment and order of the lower court were reversed, the provider's motion for summary judgment was denied, and the insurer's "cross" motion for summary judgment dismissing the complaint was granted.

The court considered the plaintiff's motion to recover first-party no-fault benefits and the defendant's motion for summary judgment based on the plaintiff's failure to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the defendant had timely denied the claims and if the plaintiff had failed to appear for the EUOs. The holding of the case was that the defendant's attorney was present at the scheduled EUOs and that the plaintiff had failed to appear, therefore the defendant was entitled to summary judgment dismissing the claims for services provided to Pia Daniels and James Stokely. The plaintiff had failed to demonstrate the existence of a triable issue of fact, and the order was modified to grant the defendant's motion for summary judgment.