No-Fault Case Law

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.

The court considered a motion filed by the defendant to dismiss the complaint on the ground of laches, based on the delay in prosecuting the action by the plaintiff, PDG Psychological, P.C., as assignee of Jose Alba, seeking to recover assigned first-party no-fault benefits from State Farm Mutual Insurance Co. The Civil Court granted the defendant's motion to dismiss the complaint on the ground of laches, finding the remaining branches of the motion moot. However, on appeal, the Appellate Term, Second Department reversed the order, denied the branch of defendant's motion seeking to dismiss the complaint on the ground of laches, and remitted the matter to the Civil Court for a determination of the remaining branches of the defendant's motion. The relevant issue decided was the dismissal of the complaint on the ground of laches, and the holding of the appellate court was to reverse the order and remit the matter for further determination.

The relevant facts in this case involved an action by a provider to recover assigned first-party no-fault benefits, where defendant moved to dismiss the complaint on the ground of laches, based on plaintiff's delay in prosecuting the action. The Civil Court granted this branch of defendant's motion and found that the remaining branches of the motion were moot. The main issue decided by the court was whether the complaint should be dismissed on the ground of laches due to the plaintiff's delay in prosecuting the action. The holding of the court was that the branch of defendant's motion seeking to dismiss the complaint on the ground of laches was denied, and the matter was remitted to the Civil Court for a determination of the remaining branches of defendant's motion.

The court considered that A.M. Medical Services, P.C. commenced an action in 2002 to recover assigned first-party no-fault benefits for services allegedly rendered in 2001. 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 granted the branch of defendant's motion seeking to toll the accrual of no-fault interest to the extent of tolling the interest from March 24, 2003 to July 13, 2017. The main issue decided was whether statutory interest should accumulate when a provider unreasonably delays the court proceeding in a no-fault action, and the holding of the case was that the Civil Court's decision to toll the no-fault interest was affirmed by the Supreme Court. The court determined that the plaintiff failed to support their argument that it was the defendant who unreasonably delayed the action, and therefore the defendant's motion to toll the accrual of no-fault interest was granted.

The court considered the fact that the defendant had allegedly cancelled the subject insurance policy on August 28, 2013, and that the motor vehicle accident in question occurred on September 4, 2013. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted based on the alleged cancellation. The court held that the defendant had not demonstrated the effectiveness of the policy cancellation with respect to the plaintiff's assignor, and therefore, the motion for summary judgment should have been denied. The court also found that the plaintiff's cross-moving papers failed to establish that the defendant had failed to deny the claim within the requisite 30-day period. As a result, the Civil Court properly denied the plaintiff's cross motion for summary judgment.

The court considered whether American Transit Insurance Company was obligated to pay no-fault insurance benefits to Albert Hayes, who was a passenger in a vehicle involved in a collision covered by American Transit's insurance policy. Hayes applied for benefits, which American Transit denied, and the company sought a declaratory judgment that it was not required to pay benefits to Hayes or the medical providers that were his assignees. American Transit sought summary judgment against the answering defendants and default judgment against the non-appearing defendants, but the motion was denied. The court held that American Transit failed to demonstrate compliance with the procedural and timeliness requirements related to the handling of no-fault claims and was therefore not entitled to summary or default judgment in its favor.

The court considered the fact that the plaintiff was awarded no-fault benefits in the amount of $4,590.72, and that the defendant's independent medical examination (IME) no-show defense was not established. The main issue was whether the plaintiff was entitled to attorneys' fees pursuant to the standard fee provision or the hourly rate fee provision contained in Insurance Department Regulations. The court held that the standard fee provision contained in the regulations applies in this case, as the specifically enumerated policy issues on the denial of claim form did not include the assignor's failure to attend an IME. The court also ruled that the opinion letters issued by the Department of Financial Services did not interpret the counsel fees regulation at issue, and did not explicitly state that the failure of the assignor to appear for an IME constitutes a "policy violation" triggering additional attorneys' fees under the regulations. Therefore, the court affirmed the order granting the defendant's motion to vacate so much of the judgment as awarded plaintiff attorneys' fees pursuant to the regulations.

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, in which the order granted the defendant's motion to dismiss the complaint on the ground of laches. The main issue decided was whether the delay in prosecuting the action by the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, warranted the dismissal of the complaint on the ground of laches. The holding of the court was that the order was reversed, the branch of defendant's motion seeking to dismiss the complaint on the ground of laches was denied, and the matter was remitted to the Civil Court for a determination of the remaining branches of defendant's motion. The court's decision was based on the reasons stated in a similar case, Rockaway Med. & Diagnostic, P.C., as Assignee of Ramon Ortiz v State Farm Mut. Ins. Co., and the justices all concurred with the decision.