No-Fault Case Law

The main issue in the case was whether the Civil Court properly denied the defendant's motion to vacate a default order, which granted the plaintiff's motion for summary judgment. The parties had entered into a stipulation setting a briefing schedule for the motion, and the defendant failed to serve its opposing papers and cross motion in a timely manner, leading to the default order being granted in favor of the plaintiff. The Court considered whether the stipulation setting the briefing schedule was necessary for the consideration of the questions involved and whether the defendant had a reasonable excuse for its default. The holding of the case was that the Civil Court properly denied the defendant's motion to vacate the default order, as the stipulation was necessary for the consideration of the questions involved, and the defendant failed to establish a reasonable excuse for its default. Therefore, the order denying the defendant's motion to vacate was affirmed.

The court considered the provider's action to recover assigned first-party no-fault benefits in the amount of $2,738.52. The main issue decided was whether the Civil Court had jurisdiction over the case and whether the defendant's policy provided for no-fault coverage. The holding of the case was that the Civil Court did have jurisdiction over the matter because the action sought to recover a sum of less than $25,000. Additionally, the defendant failed to demonstrate that its policy did not provide for such coverage, so they did not demonstrate their entitlement to judgment as a matter of law. Therefore, the order denying the defendant's motion for summary judgment dismissing the complaint was affirmed.

The court considered a master arbitrator's award issued by the Civil Court and determined that it should be set aside because the arbitrator had exceeded his power by issuing an award that was beyond the policy limits. Respondent argued that its claims were complete before the policy issued by petitioner was exhausted, but the court found that the claims were never verified as the healthcare provider failed to appear for an examination under oath as requested by the insurer. The court also concluded that the Appellate Term had the power to remand to Civil Court for a framed issue hearing, after which the respondent was not entitled to the attorneys' fees it requested. Therefore, the Appellate Division affirmed the order of the Appellate Term without costs.

The relevant facts that the court considered in Montvale Surgical Center, LLC. v State Farm Mut. Auto. Ins. Co. included the plaintiff seeking reimbursement of No-Fault benefits for medical and surgical services rendered to a New York claimant at its New Jersey surgical center. The defendant moved to dismiss the complaint on the ground that the plaintiff lacks legal capacity to sue in New York, and alternatively moved to compel discovery and a deposition of the plaintiff. The main issues decided by the court were whether the plaintiff was a foreign corporation doing business in New York, and whether the plaintiff had failed to demonstrate a prima facie case in support of summary judgment. The holding of the case was that the defendant's motion to dismiss the complaint was denied, with prejudice, as the court found that the defendant failed to prove that the plaintiff was doing business in New York. Additionally, the court denied the defendant's alternative motion to compel discovery and a deposition of the plaintiff, and denied the plaintiff's cross-motion for summary judgment.

The main issue in this case was whether the Civil Court should have vacated a default order and granted summary judgment to the defendant in a dispute over first-party no-fault benefits. The defendant argued that the default order should be vacated due to a potentially meritorious defense to the action, as evidenced by a prior order granting summary judgment to the defendant. The court held that the prior order should not have been relied upon to grant summary judgment to the defendant, as it had already been conclusively determined by the prior grant of summary judgment to the plaintiff. The court reversed the prior order and remitted the case back to the Civil Court for a new determination regarding the defendant's motion to vacate the default order.

The court considered a case in which a provider's claims for assigned first-party no-fault benefits had been denied based on allegations of "improper kickbacks," "improper fee splitting," "improper fee scheduling" and "billing for services not rendered." The provider submitted the claims to arbitration pursuant to Insurance Law § 5106 (b) and the arbitrator found in favor of the provider. The insurer appealed the award to the master arbitrator, who vacated the arbitrator's award and remitted the matter for a new hearing. The provider then commenced a proceeding to vacate the master arbitrator's award, and the District Court found that there was a rational basis for the original arbitrator's award and vacated the master arbitrator's award. The main issue was whether the master arbitrator exceeded his power in vacating the original award, and the court held that there was a rational basis for the original arbitrator's award and thus the master arbitrator had exceeded his authority. The court affirmed the order to vacate the master arbitrator's award and remit the matter for further proceedings, and also remitted the matter to the District Court to determine the provider's reasonable attorney's fees for the appeal.

The case involved a dispute between Country-Wide Insurance Company and TC Acupuncture P.C., as the assignee of Corey Crichlow, over attorney's fees in connection with a no-fault arbitration award. The main issue considered by the court was whether TC Acupuncture was entitled to attorney's fees in the article 75 proceeding reviewing the arbitration award in its favor. The court held that TC Acupuncture was indeed entitled to additional attorney's fees for its motion to modify the order and its opposition to Countrywide's motion to reargue that order. The court also found that TC Acupuncture was entitled to the attorney's fees incurred in the appeal to this Court of the order issued in the article 75 proceeding. The judgment of Supreme Court was therefore modified to remand the matter for a determination of TC Acupuncture's reasonable attorney's fees incurred in the proceeding and its appeal.

The court considered the facts of a case in which a provider had settled a claim for first-party no-fault benefits in February 2003, but the defendant did not pay the settlement amount, resulting in a judgment entered on January 30, 2017. The main issue decided by the court was whether a sua sponte stay of the accrual of no-fault interest was appropriate. The holding of the court was that the order of the Civil Court was reversed, and the portion of the order which stayed the accrual of statutory no-fault interest from February 3, 2003 to February 14, 2017 was vacated. The court found that once the case was settled, the defendant was obligated to pay the agreed-upon amount to the plaintiff, and there was no evidence that the plaintiff had prevented the defendant from doing so, so the Civil Court was in error in tolling the accrual of interest.

The court considered the fact that a settlement for first-party no-fault benefits was reached in February 2008, but the defendant did not pay the settlement amount. A judgment was entered in January 2017 pursuant to CPLR 5003-a. The main issue decided was whether the Civil Court erred in staying the accrual of no-fault statutory interest from February 20, 2008 through February 22, 2017. The holding of the court was that the Civil Court erred in tolling the accrual of interest, and therefore, the order was reversed, and the portion of the order that stayed the accrual of statutory no-fault interest from February 20, 2008 to February 22, 2017 was vacated. The appeal was dismissed.

The court considered an action for certain declaratory relief to determine whether Repwest Insurance Company had a duty to provide insurance coverage for a collision between a livery vehicle insured by Hereford Insurance Company and a vehicle driven by Nazim Hanif and insured by Repwest. Hereford Insurance Company filed a counterclaim against Repwest for loss transfer pursuant to Insurance Law § 5105 (a). The main issue in this case was whether or not the supreme court had subject matter jurisdiction over the counterclaim. The holding was that the counterclaim for loss transfer was subject to mandatory arbitration and therefore, the supreme court had no subject matter jurisdiction over the counterclaim. The counterclaim of the nominal defendant Hereford Insurance Company was dismissed for lack of subject matter jurisdiction. Therefore, the order of the supreme court was reversed.