No-Fault Case Law

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.

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.