No-Fault Case Law

The case involved New Age Acupuncture, P.C. and Global Liberty Insurance Company, with New Age Acupuncture, P.C. seeking to recover assigned first-party no-fault benefits following an accident. Global Liberty Insurance Company had defaulted in appearing for a scheduled court date and moved to open its default and dismiss the complaint based on an order and judgment from the Supreme Court, Bronx County, declaring that the company had no obligation to pay the plaintiff for claims arising from the accident in question. The main issue in the case was whether the Civil Court had correctly denied the defendant's motion to open its default, and the Appellate Term, Second Department held that the Civil Court had improvidently exercised its discretion in denying the motion. The Appellate Term reversed the order and granted the defendant's motion to open its default and, upon opening the default, dismiss the complaint, stating that this was necessary "for sufficient reason and in the interests of substantial justice." In summary, the relevant facts considered by the court included the default of Global Liberty Insurance Company and the order and judgment from the Supreme Court regarding the company's obligation to pay the plaintiff. The main issue decided by the court was whether the defendant's motion to open its default and dismiss the complaint should have been granted, and the holding of the case was that the motion should have been granted for sufficient reason and in the interests of substantial justice.

The court considered the issue of whether American Transit Insurance Company had an obligation to pay no-fault insurance benefits to defendant Juan Romero-Richiez, who was involved in a vehicle collision covered by American Transit's policy. Romero-Richiez assigned the right to collect benefits to various medical providers, and American Transit denied his application for benefits. The court granted a default judgment in favor of American Transit, declaring that Romero-Richiez and the medical providers were not entitled to no-fault benefits due to his failure to appear for scheduled independent medical examinations. However, American Transit's motion for summary judgment against one of the medical providers, Right Choice, was denied. The court held that American Transit failed to establish its entitlement to summary judgment as it did not provide evidence of meeting the timeliness requirements or show that the specific IME requested was necessary to determine if the claim should be paid. The court also rejected American Transit's argument that the failure to appear for IMEs is a breach of a condition precedent to coverage and found that the 15-business-day deadline for requesting an IME applies to all IME requests, regardless of the reason for the request. Therefore, the motion for summary judgment was denied.

The case involved a motor vehicle accident in which petitioner's vehicle was struck by another vehicle that failed to stop for a red light. Petitioner recovered damages from the driver of the other vehicle and submitted a supplemental uninsured/underinsured motorist (SUM) coverage claim to State Farm. The matter went to compulsory arbitration and the arbitrator awarded petitioner $2,250,000. State Farm appealed, contending that the award was arbitrary, capricious, and unsupported by evidence. The court affirmed the arbitration award, finding that the findings of the arbitrator were rational, had evidentiary support, and were not arbitrary and capricious. The court also concluded that there was evidentiary support for the arbitrator's decision that petitioner was entitled to collect the SUM benefits from State Farm. The judgment of the Supreme Court, which awarded petitioner money damages upon the arbitration award, was unanimously affirmed without costs.

The court considered that the plaintiff, Precise Physical Therapy Solutions, as assignee of Tazaya P., had submitted a medical bill to the defendant, State Farm Mutual Auto. Ins. Co., for treatment received by Tazaya P. after a car accident in an insured vehicle. The defendant denied the claim based on a belief that the alleged injury did not arise from an insured incident and because the assignor failed to sign the transcript of an examination under oath. The main issue decided was whether the defendant's motion for summary judgment to dismiss the plaintiff's complaint should be granted. The court held that the defendant's motion for summary judgment was denied in its entirety without opposition and without prejudice as it failed to provide sufficient evidence to rebut the presumption of coverage and that the motion to dismiss due to the assignor's failure to subscribe the transcript was premature and lacked evidence of an insurance contract term requiring the same.

The court considered a case where Longevity Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits from Nationwide Ins. The main issue was whether the plaintiff's assignor had failed to appear for duly scheduled examinations under oath, and whether the claims had been timely denied on that ground. The court found that defendant had established that the EUO scheduling letters had been timely mailed, that the assignor had failed to appear for the scheduled EUOs, and that the claims had been timely denied on that ground. Plaintiff failed to raise a triable issue of fact in opposition, and the court ultimately held in favor of the defendant, granting their motion for summary judgment dismissing the complaint.

The relevant facts considered by the court were that the plaintiff filed a lawsuit against the New York State Insurance Fund for failure to pay first party No-Fault benefits as a result of medical services rendered to an injured party. The main issue decided was whether the court had jurisdiction to hear the case, as the defendant argued that it should have been brought in the New York State Court of Claims. The holding of the case was that the court did not have jurisdiction, and therefore the plaintiff's motion for leave to reargue and renew the decision was denied. The court found that the new fact brought by the plaintiff, that the case was time-barred in the Court of Claims, did not change the outcome of the prior decision and therefore did not establish a basis for leave to renew.

The main issue in this case was whether the defendant had paid the limits of the policy in accordance with 11 NYCRR 65-3.15 in order to assert a defense of policy exhaustion. The court considered whether the defendant had made any payments under the policy and if the proof submitted was sufficient to establish the timely denial of claims. The court held that the defendant failed to demonstrate, as a matter of law, that it had made any payments under the policy, and therefore, its motion for summary judgment dismissing the complaint was denied. Additionally, the court held that the plaintiff's motion for summary judgment was properly denied, as the proof submitted by the plaintiff failed to establish that the claims had not been timely denied or that the defendant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law.

The main issue in this case was whether a provider could recover assigned first-party no-fault benefits when service of the summons was completed by mail, but there was no proof of acknowledgment of receipt of the summons and complaint by the defendant, thus failing to establish personal jurisdiction. The court held that when service of the summons in a Civil Court action is other than by personal delivery, service is complete upon the filing of proof of service. This involves an acknowledgment of receipt of the summons and complaint, as provided for in the CPLR 312-a. The record in this case failed to show that a signed acknowledgment of receipt was returned to the plaintiff, leading to a failure to acquire personal jurisdiction over the defendant. As a result, the court affirmed the order granting the defendant's motion to dismiss the complaint.

The relevant facts considered by the court included a dispute over whether the plaintiff obtained personal jurisdiction over the defendants in an action to recover assigned first-party no-fault benefits. The plaintiff alleged that the summons and complaint were served by mail pursuant to CPLR 312-a, but there was no acknowledgment of service in their papers. The defendants moved to dismiss the complaint on the ground that the plaintiff had failed to obtain personal jurisdiction over them, and the Civil Court denied the motion. The main issue decided was whether the plaintiff had acquired personal jurisdiction over the defendants, and the holding of the court was that the record failed to demonstrate that a signed acknowledgment of receipt was returned to the plaintiff, and thus they had failed to acquire personal jurisdiction over the defendants, resulting in the reversal of the lower court's decision and the granting of the defendants' motion to dismiss the complaint.

The court considered the fact that the defendant had moved for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs) and that the amounts plaintiff sought to recover upon the remaining claims exceeded the amount permitted by the workers' compensation fee schedule. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint on these grounds. The holding of the court was that the defendant's motion for summary judgment should have been granted, as they had sufficiently established that the IME scheduling letters had been timely mailed, the assignor had failed to appear for the scheduled IMEs, and the claim at issue was timely denied. Therefore, the branch of defendant's motion seeking summary judgment to dismiss the claim was granted.