No-Fault Case Law

The court considered an appeal from an order in a case where a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The main issue in the case was whether the provider had failed to appear for scheduled examinations under oath (EUOs) and whether the insurance company was entitled to summary judgment dismissing the complaint based on this failure. The court held that the insurance company had established that the EUO had been scheduled and the provider had failed to appear, and that the claims had been timely denied on that basis. As the provider failed to raise a triable issue of fact in opposition to the insurance company's motion, the court granted the insurance company's cross motion for summary judgment dismissing the complaint. Therefore, the court reversed the lower court's order, denied the provider's motion for summary judgment, and granted the insurance company's cross motion for summary judgment dismissing the complaint.

The court considered the matter of personal jurisdiction over an out-of-state defendant in a lawsuit to recover assigned first-party no-fault benefits. The main issue decided was whether the Civil Court had personal jurisdiction over the defendant insurance company. The holding of the case was that the defendant's motion to dismiss the complaint pursuant to CPLR 3211 (a) (8) was granted, as the court lacked personal jurisdiction over the defendant. The decision was based on the earlier case of Domny Med. Servs., P.C., as Assignee of Garcia, Lionel v First Acceptance Ins. Co., Inc., which influenced the decision to reverse the previous order and grant the defendant's motion to dismiss the complaint.

The relevant facts of this case were that Domny Medical Services filed a motion to recover first-party no-fault benefits by mailing a copy of the summons and complaint to an out-of-state insurance company. First Acceptance Insurance Company, Inc. (First Acceptance) moved to dismiss the complaint, arguing that the Civil Court lacked personal jurisdiction. The main issue decided in this case was whether personal jurisdiction had been obtained over First Acceptance. The holding of the case was that the Civil Court did not have personal jurisdiction over First Acceptance, as the plaintiff failed to show that service of process pursuant to CPLR 312-a was properly effectuated. Therefore, the order denying First Acceptance's motion to dismiss the complaint pursuant to CPLR 3211 (a) (8) was reversed, and First Acceptance's motion was granted.

The case involved an appeal from an order of the Civil Court of Queens County that granted the plaintiff's motion to recalculate an award of statutory no-fault interest from a simple rate to a compound rate in a judgment entered on January 31, 2017. The plaintiff, a provider of assigned first-party no-fault benefits, had submitted claims to the defendant in March 2001, stemming from an accident in December 2000, which was settled in January 2015. The defendant did not pay the settlement amount, resulting in a judgment entered in 2017 that awarded statutory no-fault interest at a simple rate. The plaintiff moved to have the interest recalculated again based on pre-2002 regulations that required interest to be calculated at a compound rate. The court affirmed the order, stating that the interest should be recalculated at a compound rate, and also found that the defendant's remaining contention was not properly before the court.

The relevant facts considered in this case involved a dispute over first-party no-fault benefits arising from a motor vehicle accident. American Independent Ins. Co. (AIIC) sought summary judgment based on the doctrine of collateral estoppel, citing two previous determinations by the Supreme Court. The first determination, entered in 2014, held that AIIC was not obligated to pay first-party benefits to certain parties due to the accident being staged, but did not name Gentlecare Ambulatory Anesthesia Services as one of the parties. The second determination, in 2016, directed a judgment to be settled on notice, and a judgment was signed and entered in 2016 barring Gentlecare from seeking reimbursement for claims pertaining to the accident. The main issue decided was whether AIIC had established its defense of collateral estoppel based on the previous determinations, and whether Gentlecare had a full and fair opportunity to litigate the issue in the earlier action. The court held that AIIC failed to establish that it was not obligated to pay first-party benefits to Gentlecare based on the 2014 order, and that the 2016 judgment barred Gentlecare from seeking reimbursement for claims pertaining to the accident. The court affirmed the order granting AIIC's motion for summary judgment.

The court considered that the defendant had moved for summary judgment to dismiss the complaint on the ground that the action was barred under collateral estoppel due to two determinations in the Supreme Court, Kings County. The first determination, from May 13, 2014, stated that the defendant was not obligated to pay first-party benefits based on a staged accident, but did not name the appellant as one of the parties affected. The second determination, from March 8, 2016, resulted in a judgment being settled and entered on August 23, 2016, which barred the appellant from seeking reimbursement for claims pertaining to the accident in question. The main issue decided was whether the defendant established its collateral estoppel defense based on the two determinations from the Supreme Court. The holding was that the defendant had not established that it was not obligated to pay first-party benefits to the appellant based on the May 13, 2014 determination, but that the judgment entered on August 23, 2016 clearly barred the appellant from seeking reimbursement for claims pertaining to the accident in question, so the order granting the defendant's motion for summary judgment was affirmed.

The court considered an action by a provider to recover assigned first-party no-fault benefits. The defendant moved to dismiss the complaint on the ground that the action should have been commenced in New Jersey, where the accident had occurred. The plaintiff opposed this motion on the ground that the defendant had failed to establish where the accident had occurred and cross-moved for summary judgment. The court found that the defendant failed to demonstrate any potential hardship to proposed witnesses if the action is heard in New York and failed to otherwise establish with admissible evidence that "in the interest of substantial justice the action should be heard in another forum". The court also found that the plaintiff failed to demonstrate its entitlement to judgment as a matter of law. The holding of the court was that the branch of defendant's motion seeking to dismiss the complaint on the ground of forum non conveniens should have been denied and the matter was remitted to the Civil Court to determine the remainder of defendant's motion.

The court considered a motion by the defendant to dismiss the complaint on the ground of forum non conveniens, arguing that the action should have been commenced in New Jersey, where the accident had occurred. The defendant relied on a New Jersey police crash investigation report to establish that the accident had occurred in New Jersey and that the plaintiff's assignor lived in Texas. The court held that the police report was inadmissible hearsay and defendant had failed to demonstrate the location of the underlying accident or the assignor's residence. The court found that the Civil Court erred in determining that defendant's evidence had sufficiently demonstrated a lack of significant contacts to New York. The court also held that the plaintiff had failed to demonstrate its prima facie entitlement to summary judgment, as the proof submitted failed to establish that the claim at issue had not been timely denied or that the defendant had issued a timely denial of claim form that was conclusory, vague, or without merit as a matter of law. Therefore, the order was modified to deny the defendant's motion to dismiss the complaint on the ground of forum non conveniens, and the matter was remitted to the Civil Court to determine the remainder of defendant's motion.

The relevant facts considered by the court were that a provider sought to recover assigned first-party no-fault benefits that were settled in April 2008, but which the defendant did not pay. A judgment was subsequently entered on January 30, 2017, and the plaintiff moved to correct the judgment by recalculating the interest. The Civil Court granted the motion but, sua sponte, stayed the accrual of statutory no-fault interest from April 9, 2008 through February 22, 2017. The main issue decided by the court was whether the portion of the order which tolled the accrual of interest was appealable, as it did not address a demand for relief made on notice and was, therefore, sua sponte. The holding of the case was that the portion of the order which tolled the accrual of interest did not address a demand for relief made on notice and was, therefore, sua sponte, and was not appealable as of right, so the appeal was dismissed.

The court considered whether a provider could recover assigned first-party no-fault benefits. The insurance company moved for summary judgment, claiming that it had timely denied the claims and that the amounts sought exceeded the workers' compensation fee schedule. The court found that the insurance company demonstrated it had timely mailed initial and follow-up requests for verification but had not received the requested verification. However, the provider's affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the insurance company. Therefore, there was a triable issue of fact as to whether the provider provided the requested verification. Additionally, the court found a triable issue of fact regarding the insurance company's fee schedule defense. As a result, the judgment was reversed, the part of the order granting summary judgment to the plaintiff was vacated, and plaintiff's cross motion for summary judgment was denied.