No-Fault Case Law

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.

The court considered whether Unitrin Advantage Insurance Company was required to pay approximately $12,000 in no-fault insurance benefits to Dr. Andrew J. Dowd for two surgeries he performed in 2011. Unitrin was skeptical that the injuries were legitimate and requested Dr. Dowd to appear for an examination under oath (EUO) to answer questions about the medical necessity of the surgeries. Dr. Dowd failed to appear for the EUOs and Unitrin denied his benefits claims based on this. Dr. Dowd argued that he had submitted the claims properly and that Unitrin failed to issue a timely denial of those claims. The court decided that Unitrin's EUO request upon receipt of the first claim was untimely and therefore, Unitrin may not deny Dr. Dowd's claim for benefits from the first surgery. However, the court held that Dr. Dowd failed to comply with a requirement of the applicable no-fault insurance policy in the case of the second surgery, and therefore, owed him $6,106.56 in benefits.

The court considered the fact that Wave Medical Services, P.C. (Wave) had moved for summary judgment to recover assigned first-party no-fault benefits, while defendant Farmers New Century Insurance Co. (Farmers) had cross-moved for summary judgment to dismiss the complaint, based on an order from a Supreme Court declaratory judgment action granting a default judgment against Wave. The main issue decided was whether Farmers had a duty to pay no-fault benefits to Wave, and the court held that they did not, based on a Supreme Court judgment declaring that Wave was ineligible to collect such benefits. The holding of the case was that the Civil Court properly denied Wave's motion for summary judgment and granted Farmers' cross motion for summary judgment dismissing the complaint, based on the Supreme Court's declaration and judgment that Farmers had no obligation to pay no-fault benefits to Wave. Therefore, the order was affirmed.

The court considered the defendant's failure to cooperate with the plaintiff's investigation into the claim for supplemental uninsured/underinsured motorist coverage related to an accident in which the defendant was a passenger. The main issue decided was whether the court had personal jurisdiction to render a default judgment against the defendant, and if the plaintiff's motion for a default judgment should have been granted. The holding of the court was that the service was proper and the court did have jurisdiction over the defendant. However, the court also held that the motion for a default judgment should have been denied, as the delay in serving the answer was short, and the defendant provided a meritorious defense and there was no indication that the default was willful or that the plaintiff was prejudiced as a result of the late answer. The court also found that the defendant's cross motion to renew and vacate the November 2018 order should have been granted.

The relevant facts that the court considered in this case were that American Transit Insurance Company requested a declaratory judgment that it was not required to pay no-fault benefits to various medical-provider defendants. The main issue decided by the court was whether American Transit was entitled to summary judgment against certain answering defendants and default judgment against remaining defendants. The court held that the motion was not properly before the court as American Transit's action had already been dismissed due to their failure to appear at scheduled preliminary conferences and they had not moved to vacate that default dismissal. Additionally, the court found that American Transit's motion was not based on admissible evidence and therefore denied the motion.

The court considered the case of Nationwide Affinity Insurance Company of America against multiple defendants, including Jamaica Wellness Medical, P.C., LVOV Acupuncture, P.C., and United Wellness Chiropractic, P.C. The main issue decided was whether the plaintiff is obligated to pay claims for no-fault insurance benefits submitted by the defendants on behalf of injured parties after the injured parties failed to appear for two scheduled examinations under oath (EUOs). The holding was that the plaintiff is not obligated to pay these claims because the injured parties failed to appear for the scheduled EUOs and the plaintiff issued a timely and proper denial of the claims. The court determined that the medical provider defendants failed to raise a triable issue of fact in opposition to the plaintiff's motion for summary judgment.

The court considered the defendant's motion for summary judgment to dismiss the complaint, which was based on the plaintiff's assignor failing to appear for scheduled examinations under oath and independent medical examinations. The plaintiff cross-moved for summary judgment, which was granted by the Civil Court. However, the Appellate Term reversed the decision, as the proof submitted by the plaintiff did not establish that the claim had not been timely denied or that the denial of the claim form was without merit. Additionally, the court considered arguments made by the defendant based on a declaratory judgment action in favor of the defendant from a separate case. The court decided to take judicial notice of the judgment from the other case and awarded the defendant summary judgment, dismissing the complaint. The portion of the order denying the defendant's motion for summary judgment was also dismissed as academic. In summary, the main issue decided in this case was whether the plaintiff's assignor had met the necessary requirements to receive no-fault benefits, and whether the defendant was entitled to summary judgment based on a judgment from a separate declaratory judgment action. The holding of the court was to reverse the decision to grant the plaintiff's cross motion for summary judgment, award summary judgment in favor of the defendant, and dismiss the portion of the order denying the defendant's motion for summary judgment as academic.

The court considered the potential obligation of American Transit Insurance Company to pay no-fault insurance benefits to medical providers who had applied for benefits on behalf of Tynise Watson, a passenger in a vehicle allegedly involved in a collision. American Transit sought a declaratory judgment that it was not required to pay these benefits, based on its belief that the collision giving rise to Watson's need for medical treatment was staged. The court held that the evidence provided by American Transit, including a police accident report and an examination under oath transcript, was largely inadmissible hearsay and not sufficient to support a motion for summary judgment or default judgment. Therefore, the court denied both branches of American Transit's motion and ordered the parties to prepare a request for a preliminary conference.