No-Fault Case Law

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.

The main issues in this case were whether the defendant, Stacey Kapeleris, had standing to pursue her claims for no-fault insurance benefits from Allstate, and if so, whether her assignments to medical providers were still valid. The court considered the fact that Kapeleris had assigned her right to no-fault insurance benefits for medical expenses to Winthrop and to Nancy E. Epstein, and that she had also been billed directly by Winthrop and Long Island Neurosurgical Associates after Allstate denied the claims and subsequently settled the bills from these providers directly. The court held that Kapeleris had standing to pursue her claims for no-fault benefits based on her direct payments to the medical providers and the invalidation of the assignments. Based on these findings, the court affirmed the denial of Allstate's motion, and granted Kapeleris's cross motion for summary judgment, allowing her to seek recovery of no-fault insurance benefits from Allstate.

The court considered the case of Liberty Mutual Insurance Company and LM General Insurance Company seeking a declaratory judgment that they are not required to pay no-fault benefits to Trevohn Martin, Dwayne Bailey, and Damell Jackson, as well as various medical provider defendants. Liberty Mutual denied the claims for no-fault benefits and sought default judgment against the defendants. The main issues decided were whether Liberty Mutual had the right to deny coverage based on defendants' failure to appear for a scheduled examination under oath and whether the collision that gave rise to the need for medical treatment was staged, justifying a denial of coverage. The court held that Liberty Mutual had failed to provide sufficient evidence to establish a prima facie case for these grounds, and therefore their motion for default judgment was denied. Defendants were granted an extension to answer the complaint.

The main issue in the case was whether the plaintiff was entitled to renew its opposition to the defendant's motion seeking to toll the accrual of no-fault statutory interest, based on a change in the law. The relevant facts considered by the court were that the plaintiff commenced the action in 2002 to recover assigned first-party no-fault benefits for services allegedly rendered in 2001. The defendant moved to strike the notice of trial and to dismiss the complaint or, in the alternative, to toll the accrual of no-fault statutory interest. The Civil Court denied the plaintiff's motion for leave to renew, in effect, its opposition to the branch of the defendant's motion seeking to toll the no-fault interest, arguing for a change in the law. The holding of the court was that the plaintiff's motion for leave to renew was properly denied, as the case cited by the plaintiff, Eagle Surgical Supply, Inc., did not represent a change in the law. Therefore, the order was affirmed.