No-Fault Case Law

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.

The relevant facts in this case involved True-Align Chiropractic Care, P.C. seeking to recover assigned first-party no-fault benefits from GEICO Ins. Co. The issue decided by the court was whether the Civil Court's granting of defendant's motion to dismiss the complaint pursuant to CPLR 3216 was proper. The main holding of the case was that the plaintiff did not provide a justifiable excuse for their delay in responding to defendant's 90-day notice and did not demonstrate a potentially meritorious cause of action. Therefore, the appellate term affirmed the order granting defendant's motion to dismiss the complaint, as it was properly granted.

The relevant facts the court considered were that a professional chiropractic corporation was seeking to recover no-fault benefits for services provided to its assignor in 2009. Defendant moved for summary judgment to dismiss the complaint, arguing that the corporation could not enforce its claims because its sole shareholder had lost his chiropractic license, leaving a question of whether the corporation had the authority to act without the shareholder in effect practicing illegally, because the professional service corporation failed to comply with the Business Corporation Law. The main issue decided was that despite the revocation of the shareholder's professional license, the chiropractic corporation continued to exist and was entitled to seek recovery of no-fault benefits for services rendered to its assignor prior to the date of the revocation of the shareholder's license. The holding was that the appellate term court decided in favor of the chiropractic corporation, reversing the lower court's decision and denying the defendant's motion for summary judgment dismissing the complaint. The court ruled that the corporation was entitled to pursue reimbursement for services rendered to its assignor, despite the fact that the corporation did not comply with the Business Corporation Law requirements.

The court considered the claim by a medical provider seeking reimbursement for medical services from an insurance company in a no-fault action. The medical provider sought summary judgment, asserting that they had timely and properly mailed claim forms to the insurance company. The insurance company claimed that the medical provider's case must be dismissed as premature, as they had failed to provide requested verification within 120 days of the initial request. The court found that the medical provider had established its entitlement to summary judgment, as they had submitted admissible evidence that the claim forms had been timely and properly mailed to the insurance company. The insurance company failed to raise a triable issue of fact in opposition to the medical provider's motion and also failed to establish their own entitlement to summary judgment. As a result, the court granted the medical provider's motion for summary judgment and denied the insurance company's motion to dismiss the case as premature.

The court considered that the plaintiff, Kemper Independence Insurance Company, was seeking summary judgment to declare that it was not obligated to reimburse the defendants for no-fault claims submitted in connection with a motor vehicle accident. Kemper Independence Insurance Company failed to provide the injured claimant's assignees with specific objective justification for its request that the injured claimant submit to an examination under oath (EUO) to establish proof of claim. The main issue decided was that the plaintiff's motion for summary judgment was denied as premature as they did not provide the necessary justification for the request for an EUO. The holding of the case was that the motion for summary judgment was denied, and the appellate division affirmed the decision of the lower court.

The relevant facts were that the plaintiff medical provider sought to recover no-fault benefits from the defendant insurance company, but the defendant moved for dismissal of the complaint on the grounds that the plaintiff's claims are barred by a declaratory judgment in Supreme Court. The plaintiff argued that the Supreme Court declaratory judgment did not apply to or otherwise bar this action under the doctrine of res judicata or collateral estoppel because the defendant herein is not the same entity that was named in the declaratory judgment. However, the defendant proffered evidence that the proper insurer was a different entity than the one named in the complaint, and the court found that the plaintiff's action was barred by the doctrine of res judicata. The main issue decided was whether the plaintiff's claims were barred by the declaratory judgment in a Supreme Court case, and the holding of the court was that the plaintiff's action is dismissed with prejudice pursuant to the declaratory judgment.

The main issue in the case was whether the accident claimed by the defendants was actually staged, therefore invalidating their claim for benefits from the plaintiff's insurance under a no-fault endorsement. The court considered the evidence pertaining to the nature of the accident, including a videotaped confession from one of the passengers, and statements made to the police and the Department of Financial Services. The court ultimately held that the motion for renewal should have been granted in the interest of justice and substantive fairness, as the additional evidence submitted by the plaintiff would change the prior determination. Additionally, the court found that the evidence provided by the plaintiff proved that the motor vehicle accident was staged, and was properly authenticated for purposes of summary judgment. Therefore, the plaintiff owed no coverage to the defendants.

The case involved Quality Health Supply Corp., seeking to recover assigned first-party no-fault benefits from Nationwide Ins. Defendant moved for summary judgment, claiming that it had timely denied the claims because the plaintiff failed to appear for duly scheduled examinations under oath (EUOs). The Civil Court denied defendant's motion and granted plaintiff's cross motion for summary judgment. The court held that the 30-day period for an insurer to pay or deny a claim based upon a failure to appear for an EUO begins to run on the date of the second EUO nonappearance. Since the defendant did not deny the claims until more than 30 days after the second failure to appear, the defendant was not entitled to summary judgment dismissing the complaint. The court affirmed the order, stating that the defendant did not demonstrate that it is not precluded from raising its proffered defense, and raised no issue with respect to plaintiff's establishment of its prima facie entitlement to summary judgment.