No-Fault Case Law

In the case Longevity Med. Supply, Inc. v Progressive Ins. Co., the court considered the fact whether Progressive Insurance Company was liable to pay no-fault benefits to Longevity Medical Supply, Inc. which was the assignee of Saddiq Waiters, who was involved in a motor vehicle accident. The main issue in the case was the failure of Saddiq Waiters to appear for an independent medical examination (IME) scheduled on two occasions as required by Progressive Insurance Company to process the claim. The court held that Progressive Insurance Company met its prima facie burden to establish that it properly mailed scheduling letters for IMEs, but failed to establish that the claimant failed to appear for the IMEs. Therefore, the court denied the defendant's motion for summary judgment. The court found that both affidavits submitted by the defendant were insufficient and the defendant had not met its burden to establish that the claimant failed to appear for the IME.

The court considered the fact that the plaintiff filed an action against the defendant seeking to recover $5,503.90 in assigned no-fault insurance benefits. The main issues decided were whether the plaintiff had standing to receive the reimbursement, the medical necessity of the treatment, and the proper payment under the fee schedule. The court held that the plaintiff did have standing to receive reimbursement, denied the defendant's motion on the Mallela defense, found a material issue of fact exists as to the medical necessity of the treatment, and denied the defendant's motion for summary judgment as to the proper payment under the fee schedule. The plaintiff's cross motion for summary judgment was also denied in its entirety.

The case involved an appeal from a judgment entered in a Civil Court of New York, in which the court granted the plaintiff's motion for a default judgment and denied the defendant's cross-motion for summary judgment dismissing the complaint. The plaintiff, a provider seeking to recover assigned first-party no-fault benefits, alleged that the summons and complaint were served by mail, but failed to provide proof of proper service. The defendant argued that the complaint should be dismissed due to the plaintiff's failure to serve the summons and complaint within 120 days of commencing the action. The Appellate Court reversed the judgment, vacated the order, and granted the defendant's cross-motion for summary judgment, remitting the matter to the Civil Court for the entry of a judgment in favor of the defendant dismissing the complaint without prejudice. The court emphasized that proof of proper service was a prerequisite to the entry of a default judgment, and plaintiff's failure to provide evidence of service led to the reversal of the judgment.

The court considered the plaintiff's delay in prosecuting the action as a basis for dismissal. The main issue decided was whether laches was a proper basis to dismiss the complaint in this action to recover assigned first-party no-fault benefits. The holding was that laches was not a proper basis to dismiss the complaint in this action, and therefore the branch of the defendant's motion seeking dismissal on the ground of laches was denied. The matter was remitted to the Civil Court for a determination of the remaining branches of the defendant's motion.

The relevant facts considered by the court were that TAM Medical Supply Corp. sought to recover first-party no-fault benefits from Republic Western Insurance Company, but Republic argued that the action was barred by the doctrine of res judicata due to a previous order granting a default judgment against TAM and its assignor. TAM submitted late opposition papers to Republic's motion for summary judgment, and the Civil Court granted Republic's motion without considering TAM's late opposition. TAM then moved to vacate the order, claiming a reasonable excuse for submitting the opposition papers late and a meritorious claim of breach of contract. The court determined that TAM's explanation of law office failure was insufficient, and therefore denied TAM's motion to vacate the order. The holding of the case was that the order denying TAM's motion was affirmed.

The main issue in this case was whether the supplies at issue were medically necessary. The court considered the fact that the defendant's expert witness was precluded from testifying at the non-jury trial because of untimely disclosure, and the plaintiff was awarded $12,182.91 after the trial. The appellate court decided that precluding the defendant's expert from testifying was in error, as there was no evidence of intentional or willful failure to disclose and no showing of prejudice by the opposing party. The court held that the matter needed to be remitted to the Civil Court for a new trial limited to the issue of medical necessity, and that the defendant's expert should not have been precluded from testifying.

The main issue in this case was the entry of a default judgment in favor of the plaintiff, Freedom Chiropractic, P.C., for no-fault benefits for services provided to Ludmilla Dejean, who was injured in a motor vehicle accident. The defendant, 21st Century Insurance Company, argued that it did not receive proper notice of the motion for the entry of the default judgment, and therefore the judgment was null and void. The Supreme Court had previously issued a declaratory judgment, determining that 21st Century was not obligated to reimburse Freedom Chiropractic and Dejean for claims arising from the accident, and that the insurance policy was null and void with respect to that accident. The court ultimately held that the defendant demonstrated an excusable default and a meritorious defense to the action, and therefore granted summary judgment dismissing the complaint. The order granting summary judgment to the defendant was affirmed by the Appellate Term.

Reported in New York Official Reports at New Chiropractic Care, P.C. v Nationwide Ins. Co. of N.Y. (2020 NY Slip Op 50652(U)) New Chiropractic Care, P.C. a/a/o Selena Figueroa, New Chiropractic Care, P.C. a/a/o Jason Dorvllier, Plaintiff, againstNationwide Insurance Company of New York, Defendant.CV-746259-17/KI Zara Javakov Esq., P.C. (Koenig Pierre and Zachary Albright Whiting of […]

The relevant fact in this case was that defendant Elvina Bookman was a passenger in a vehicle involved in a collision, covered by a no-fault insurance policy issued by plaintiff American Transit Insurance Company. American Transit denied Bookman's application for no-fault benefits and sought a declaratory judgment that it was not required to pay no-fault benefits to Bookman or to the medical providers acting as Bookman's assignees. The main issue decided was whether American Transit complied with the procedural and timeliness requirements of 11 NYCRR § 65-3.5 governing the handling of no-fault claims. The holding of the case was that American Transit did not demonstrate compliance with the requirements and was therefore not entitled to summary judgment against the answering defendants or default judgment against the non-appearing defendants. Therefore, the motion seeking summary judgment and default judgment was denied.

The New York State Civil Court of the City of New York, Bronx County, considered the defendant's motion to strike a Notice of Trial on the grounds that the plaintiff failed to provide information requested and failed to appear for a deposition. The defendant also sought to strike the complaint for failure to provide requested discovery. The action was brought by Sanford Chiropractic, P.C. A/A/O Martel Paterson, for medical benefits pursuant to Article 51 of the New York State Insurance Law. The defendant's motion to strike the Notice of Trial was granted in part because the affidavit in support of the motion specified reasons the action was not entitled to be on the calendar, and the Notice of Trial misrepresented that discovery was complete. The Court determined that a false certificate of readiness could strike a Notice of Trial, and a delayed motion to vacate an error on a note of issue should be denied.