No-Fault Case Law

The case involved a dispute over first-party no-fault benefits for acupuncture services provided after a motor vehicle accident. The plaintiff was granted summary judgment in the Civil Court, but the defendant later obtained a declaratory judgment in Supreme Court denying the plaintiff's right to no-fault benefits. The defendant then moved to vacate the judgment in Civil Court based on the Supreme Court's ruling, and the Civil Court granted the motion. However, the Appellate Term of the Supreme Court reversed the decision, ruling that the Supreme Court did not have the authority to vacate the judgment issued by the Civil Court. Therefore, the decision to vacate the judgment in Civil Court was in error, and the defendant's motion was denied.

The relevant facts of the case included a provider seeking to recover first-party no-fault benefits, with a default judgment entered against the defendant for failing to appear or answer the complaint. The defendant moved to vacate the default judgment, claiming it had not received the summons and complaint and had a potentially meritorious defense. The court considered whether the defendant had a reasonable excuse for the default and a potentially meritorious defense. The court held that the defendant failed to demonstrate a reasonable excuse for the default and therefore denied the defendant's motion to vacate the default judgment. Additionally, the court held that the plaintiff's cross motion seeking costs and sanctions was improperly granted, as the defendant's behavior was not found to be frivolous. The judgment awarding costs to the plaintiff was reversed, while the remainder of the order was affirmed.

The relevant facts the court considered in this case were that the master arbitrator's award was challenged by Global Liberty Insurance Company of New York due to the respondent's assignor's failure to attend scheduled independent medical exams. The main issue decided by the court was whether the master arbitrator's award was arbitrary and ignored established precedent that the petitioner's no-fault policy was void ab initio due to the assignor's failure to attend medical exams. The holding of the case was that the master arbitrator's award was indeed arbitrary and that it irrationally ignored the well-established precedent, and as a result, the court unanimously reversed the order and granted the petition to vacate the master arbitrator's award.

The court considered the fact that the plaintiff had served the summons and complaint on the defendant on October 31, 2016, and a default judgment was entered on March 13, 2017 based on defendant's failure to answer the complaint. The defendant moved to vacate the default judgment in December 2017, arguing that it had timely answered the complaint with the wrong index number. Defendant contended that it had potentially meritorious defenses to the action, as the provided services lacked medical necessity and the limits of the insurance policy had been exhausted. However, the plaintiff rejected the defendant's answer because it contained the wrong index number, and the defendant did not submit a new answer with the corrected index number until December 13, 2017. The main issue decided by the court was whether the defendant had a reasonable excuse for its default, as well as a potentially meritorious defense. The court held that a defendant seeking to vacate a default judgment must demonstrate both a reasonable excuse for the default and a potentially meritorious defense to the action. The court found that the defendant failed to demonstrate a reasonable excuse for its default, as it had waited a year after its initial answer was rejected before serving a new answer bearing the correct index number. Therefore, the court affirmed the order denying the defendant's motion to vacate the default judgment.

The court considered the evidence presented by both the plaintiff and the defendant in a first-party no-fault action. The defendant, an insurance company, submitted a peer review report from its physician, which concluded that the medical supplies provided to the plaintiff's assignor were not medically necessary. The report stated that the assignor was already receiving other therapies for her injuries and that the equipment in question was either unnecessary or redundant. The plaintiff's opposition, which consisted of an attorney's affirmation, prescription, and claim forms, did not include medical evidence or other competent proof of medical necessity. The main issue decided by the court was whether the defendant insurer was entitled to judgment as a matter of law dismissing the complaint. The court held that the defendant had made a prima facie showing of entitlement to judgment as a matter of law based on the evidence presented. As a result, the court reversed the lower court's order and granted the defendant's motion for summary judgment, ultimately dismissing the complaint. In summary, the court considered the evidence of medical necessity presented by both parties, ultimately holding that the defendant had made a prima facie showing of entitlement to judgment as a matter of law, and therefore dismissing the complaint.

The court considered the case of Medcare Supply, Inc. v. Global Liberty Insurance, in which Medcare Supply was seeking to recover first-party no-fault benefits from Global Liberty Insurance. The main issue decided was whether Global Liberty Insurance had properly scheduled independent medical examinations (IMEs) and whether Medcare's assignor had failed to appear for these examinations. The court held that defendant's moving papers demonstrated timely mailing of the IME scheduling letters and denial of claim form, as well as the assignor's failure to appear for the scheduled IMEs. In contrast, Medcare failed to raise a triable issue of fact in opposition to defendant's motion, and consequently, the order was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court were that this was an action by a provider to recover assigned first-party no-fault benefits, and the defendant moved to dismiss the complaint for lack of personal jurisdiction, stating that it does not conduct business in the State of New York. Plaintiff's opposition papers consisted only of an affidavit of its owner attesting to mailing policies and procedures and the affirmation of its counsel, who had no personal knowledge of the underlying facts. The main issue decided was whether the plaintiff had established a jurisdictional basis for the service, as the burden shifted to plaintiff to establish this after the defendant's prima facie showing that the court lacked personal jurisdiction. The court held that plaintiff failed to meet its burden and did not produce evidence showing a jurisdictional basis for the service, and accordingly, the order to dismiss the complaint for lack of personal jurisdiction was affirmed.

The court considered the fact that the defendant moved to dismiss the complaint on the ground of laches, based on the plaintiff's delay in prosecuting the action. The Civil Court granted this branch of the defendant's motion and found that the remaining branches of the motion were moot. However, the court held that it has no power to dismiss an action for gross laches or failure to prosecute in the absence of a 90-day demand to serve and file a notice of trial. The doctrine of laches does not provide an alternate basis to dismiss a complaint where there has been no service of a 90-day demand pursuant to CPLR 3216. Since the defendant did not claim to have served a demand pursuant to CPLR 3216, it was an error to dismiss the complaint based on laches. The court reversed the order, denied the branch of the 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 court considered the facts of the case, where medical professional corporations submitted bills and assignment of benefit forms to insurance carrier plaintiffs seeking reimbursement under the No-Fault Law. The defendants failed to appear at requested examinations under oath. The main issue decided was whether the insurance carrier plaintiffs were obligated to pay or reimburse any of the claims after the defendants failed to appear at the EUOs. The holding of the case was that the insurance carrier plaintiffs were not obligated to pay or reimburse any of the subject claims, as the defendants failed to raise a triable issue of fact, and the insurance carrier plaintiffs established that they issued timely and proper denials for the claims due to the nonappearance at the EUOs. The court reversed the order denying the plaintiffs' motions for leave to renew their motions seeking summary judgment and granted the motions for summary judgment.

The main issue in this case was whether the defendant's breach of a material condition precedent to coverage by failing to appear at scheduled examinations under oath allowed the plaintiff to deny all of the claims retroactively to the date of loss. The main holding of the case was that the plaintiff was not under any obligation to pay or reimburse any of the subject claims due to the defendant's failure to appear at the scheduled examinations under oath. The court determined that the plaintiff's prima facie entitlement to judgment was established on the issue of their timely and proper denial of coverage, and dismissed the defendant's cross motion to compel discovery as moot. The court reversed the motion, dismissed the cross motion, and granted judgment in favor of the plaintiff declaring that they are under no obligation to pay or reimburse any of the subject claims.