No-Fault Case Law

The court in the present case considered a special proceeding pursuant to CPLR 7502 and 7510 for confirmation of a No-Fault Insurance master arbitration award in favor of John T. Mather Memorial Hospital, a medical provider, against American Transit Insurance Company. The main issues decided were whether the master arbitration award should be confirmed, whether an attorney's fee should be awarded to the petitioner, and whether the respondent was entitled to costs and disbursements. The court held that the master arbitration award in favor of the hospital was confirmed, and the hospital was awarded the principal amount, interest, attorney's fees, and return of the filing fee as determined in the arbitration hearing. The court denied the hospital's request for an attorney's fee in connection with the petition to confirm, and awarded costs and disbursements to the respondent. The court also clarified that the purpose of the Article 75 proceeding was to obtain a judgment for the hospital to levy upon the respondent's assets to enforce the award, rather than being in the nature of an appeal.

The court considered an appeal from an order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint on the grounds that the policy limits had been exhausted and denying the plaintiff's cross-motion for summary judgment. The main issue was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the order was modified to deny the defendant's motion for summary judgment dismissing the complaint. Therefore, the order was affirmed without costs.

The court considered an action by a medical provider to recover first-party no-fault benefits, where the defendant's motion for summary judgment dismissing the complaint was granted on the ground that the policy limits had been exhausted. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted, and whether the plaintiff's cross-motion for summary judgment should be denied. The holding of the case was that the order was modified by providing that the defendant's motion for summary judgment dismissing the complaint is denied, and as so modified, the order is affirmed without costs.

The relevant facts the court considered were that Pain Medical, PLLC, as an assignee of a patient, was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue was whether State Farm had paid the policy limits in accordance with the law, and if it had, whether Pain Medical could prove that the claim at issue had not been timely denied. The court held that State Farm failed to prove that it had made any payments under the policy, as it did not lay a sufficient foundation for the payment log to be accepted as proof of payment. Therefore, the court denied State Farm's motion for summary judgment dismissing the complaint. It also denied Pain Medical's cross-motion for summary judgment, as it failed to establish that the claim at issue had not been timely denied or that State Farm had issued a timely denial of the claim form.

The court considered the fact that Stark Medical Supply Inc. was seeking to recover first-party no-fault benefits from Foremost Property and Casualty Insurance for medical services provided to Emmanuel Dorvil following a motor vehicle accident. The main issue decided was whether the defendant had successfully proven that the insurance policy was exhausted at the time of the claim. The court held that the defendant failed to prove policy exhaustion as the incorrect dates in the log substantially affected the rights of the plaintiff, and the log entries did not prove that the policy was exhausted when the claims at issue were deemed complete. Therefore, the court entered judgement in favor of the plaintiff in the sum of $1,281.32 plus filing fees and interest from July 24, 2018.

The court considered the motion for summary judgment brought by the plaintiffs, Nationwide General Insurance Company, to determine whether they were obligated to pay no-fault benefits to the defendants, ARS Medical Equipment Corp., Ideal Care Pharmacy, Inc., and Rosar Medical Equipment Corp. The main issue decided by the court was whether the plaintiffs had a valid basis to deny coverage based on the investigation undertaken by their investigator and the examination under oath testimony of the driver of the vehicle involved in the accident. The court held that the plaintiffs demonstrated a "founded belief" that the accident was not covered by no-fault insurance and that they were entitled to deny coverage pursuant to regulations and provisions of the policy voiding coverage based on fraud. Additionally, the court found that the claimants' failure to appear for two properly noticed and scheduled EUOs was a violation of a condition precedent to coverage and a valid basis to deny the defendants' claims. In conclusion, the court reversed the lower court's decision, granted the plaintiffs' motion for summary judgment, and declared that the plaintiffs were not obligated to pay no-fault benefits to the defendants.

The relevant facts the court considered were that a judgment had been entered on May 3, 2022 upon the defendant's failure to answer the complaint, and the defendant subsequently moved to vacate the default judgment and compel the plaintiff to accept its answer. The main issue decided was whether the defendant had a reasonable excuse for its default and whether it had a potentially meritorious defense to the action. The holding of the case was that the defendant's claim of not receiving the summons and complaint, as well as a COVID-19-related staff reduction, were insufficient to constitute a reasonable excuse for the default, and therefore, the motion to vacate the default judgment and compel the plaintiff to accept defendant's answer was denied.

The court considered the denial of respondent WJW Medical Products, Inc.'s motion for attorney's fees in connection with a no-fault insurance arbitration award. The main issue was whether WJW should be granted attorney's fees under 11 NYCRR 65-4.6(d). The holding of the case was that the Supreme Court's denial of WJW's motion for attorney's fees was reversed, and the matter was remanded for a recalculation of fees in accordance with the statute. Additionally, the court declined to award interest for the three-month period of WJW's delay in filing a notice of entry, as it exceeded the allotted time and was deemed unreasonable. The court also decided that WJW was not entitled to attorney's fees for prosecuting the appeal, as a party is not entitled to "fees on fees" when applying for attorney's fees.

The court considered a dispute between American Transit Insurance Company and Trinity Pain Management of Staten Island, PLLC regarding the determination of a No-Fault insurance master arbitrator. The main issue decided was the proper standard of review for a No-Fault insurance master arbitrator and the Article 75 court scrutiny of a master arbitrator's review. The holding was that the master arbitrator's determination was not arbitrary, capricious, irrational, without a plausible basis, or incorrect as a matter of law, and that the grounds for vacating the arbitration award as specified in CPLR 7511 (b) had not been established. As a result, the court denied the petition of American Transit Insurance Company, dismissed the special proceeding, and confirmed the master arbitration award in its entirety. Respondent was awarded the principal amount, interest, attorney's fees, and return of filing fee as determined in the arbitration. Additionally, Petitioner was ordered to pay Respondent an attorney's fee, and Respondent was awarded the costs and disbursements to be taxed by the Clerk.

The court considered an appeal from two orders of the District Court of Suffolk County, one entered in June 2021 and the other in October 2022, both related to a motion for summary judgment by the defendant to dismiss the complaint. The main issue decided was whether the unpaid portion of first-party no-fault benefits sought to be recovered exceeded the amount permitted by the workers' compensation fee schedule, and whether the only issue at trial shall be whether the defendant properly paid the claim to the fee schedule. The holding of the court was that the branch of the defendant's motion seeking summary judgment dismissing the complaint was granted, as the defendant's affidavits established prima facie that the amount sought to be recovered exceeded the fee schedule, and the plaintiff failed to present evidence to raise a triable issue of fact.