No-Fault Case Law

The court considered a case in which a petitioner sought to vacate an arbitration award issued in relation to an insurance claim being denied. It was determined that the petitioner was not able to establish that the assignor of the respondents was injured in the course of his employment, therefore the claim had been properly denied by the petitioner. The petitioner had failed to provide evidence that the assignor was on duty or carrying a paying passenger at the time of the incident. The Supreme Court was found to have the authority to award attorneys' fees in connection with a "court appeal from a master arbitration award and any further appeals." The matter was remanded for a determination of the amount of fees to which the respondents were entitled. The decision of the Supreme Court was unanimously modified on the law, to remand for a determination of respondents' attorneys' fees pursuant to 11 NYCRR 65-4.10 (j) (4), and otherwise affirmed, without costs.

In the court case, the main issue was that plaintiff no-fault insurers wanted to resolve the question of the fee schedule applicable to reimbursement of licensed acupuncturists who provide services to eligible individuals injured in motor vehicle accidents. Under relevant Insurance Law and regulations, the permissible charge for such services renders the superintended to have not adopted a fee schedule applicable to licensed acupuncturists, requiring consideration of "charges permissible for similar procedures under schedules already adopted or established". The plaintiffs failed to provide admissible evidence to make a prima facie showing of entitlement to judgment on the issue as a matter of law. Additionally, a previously submitted informal opinion letter of the former Insurance Department was considered but did not sufficiently resolve the issue. As a response, the court denied plaintiff's order, concluding that since the superintendent has not adopted a fee schedule, the remaining option would be to pay the provider the prevailing fee in the geographic location of the provider, subject to review by the insurer.

The court considered the facts that a default judgment was taken against the defendant for failing to appear at trial, and that the defendant had attempted to effect a substitution of counsel prior to the trial date. The main issue decided was whether the defendant's failure to comply with the procedural requirements for changing or withdrawing an attorney justified the entry of a default judgment. The court held that the defendant's failure to strictly comply with the procedural requirements did not justify the entry of a default judgment, and that the default judgment was therefore reversed and the defendant's motion to open its default was granted.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue decided was whether the proof submitted by the defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim forms had been properly mailed. The holding of the court was that the proof submitted by the defendant was indeed sufficient to give rise to such a presumption, and therefore the order granting the defendant's motion for summary judgment was affirmed.

The main issue decided in this case was whether or not the defendant, GEICO Ins. Co., was entitled to summary judgment dismissing the complaint brought by Omphil Care, Inc. as assignee of Rivera, Eugenio. The lower court had denied GEICO's cross motion for summary judgment, but the Appellate Term, Second Department reversed that decision and granted GEICO's cross motion for summary judgment dismissing the complaint. The relevant facts considered by the court were that Omphil Care had failed to appear for scheduled examinations under oath (EUOs). The court found that GEICO had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, and as a result, they were entitled to summary judgment dismissing the complaint.

The court considered an appeal from an order denying the defendant's motion to sever the first cause of action, seeking to recover services rendered to Hajar Abada, from the remaining causes of action and granting the plaintiff's cross-motion for summary judgment. The main issue decided was whether the defendant's motion to sever the first cause of action should have been granted. The holding of the court was that the defendant's appeal did not present any argument with respect to the portion of the order granting summary judgment upon the first cause of action, and therefore failed to establish a basis to disturb that portion of the order. As a result, the court affirmed the order insofar as it was appealed from.

The court considered a motion by the defendant to sever the first cause of action, seeking to recover upon a claim for services rendered to Hajar Abada, from the remaining causes of action, and a cross motion by the plaintiff for summary judgment. The main issue decided was whether the defendant's motion to sever the first cause of action should be granted. The court's holding was that the motion to sever the first cause of action from the remaining causes of action should be denied, and the branch of plaintiff's cross motion for summary judgment upon the first cause of action should be granted. The plaintiff's contention that its motion should have been granted was deemed moot. The court affirmed the order, with costs.

The main issue in this case was whether the Civil Court erred in failing to decide the branch of defendant's motion seeking summary judgment dismissing the complaint on the ground that the coverage limits of the insurance policy had been exhausted. In the underlying action, the provider was seeking to recover assigned first-party no-fault benefits, while the insurance company moved for summary judgment on the grounds that it never received the claims at issue and that the coverage limits available under the insurance policy had already been exhausted. The Civil Court denied both the branch of defendant's motion seeking summary judgment on the ground that defendant had never received the claims at issue, and plaintiff's cross motion, stating that there was an issue of fact with respect to defendant's defense that it had not received the claims at issue. The Appellate Term, Second Department dismissed the appeal, noting that no appeal lies from an order or portion thereof which fails to determine a motion or branch thereof. The holding of the case was that the appeal was dismissed and the branch of defendant's motion seeking summary judgment dismissing the complaint on the ground that the coverage limits available under the subject insurance policy had already been exhausted remained pending and undecided.

The court considered the fact that Milky Way Acupuncture, P.C. had filed a lawsuit in 2015 to recover first-party no-fault benefits that had been assigned to them. Nationwide Ins. had moved for summary judgment to dismiss the complaint on the basis that Milky Way Acupuncture, P.C. had failed to submit the bills at issue to them. The main issue decided was whether or not Milky Way Acupuncture, P.C. had properly submitted the claims to Nationwide Ins. The holding of the case was that the order of the Civil Court, which had granted defendant's motion for summary judgment dismissing the complaint, was affirmed. The court determined that Milky Way Acupuncture, P.C. had failed to demonstrate that the claim forms had been mailed to Nationwide Ins., and the affidavit submitted in support of their motion for leave to renew failed to establish the identity of the insurance carrier to whom the claim forms had been resubmitted. Therefore, the appeal was dismissed and the order was affirmed.

The relevant facts considered by the court in this case were that Pro-Align Chiropractic, P.C. was seeking to recover first-party no-fault benefits as an assignee of Kethelyne Jean-Louis. The main issue decided was whether the defendant, Integon National Ins. Co., had timely mailed the IME scheduling letters and denial of claim forms, and whether the plaintiff's assignor had failed to appear for the scheduled IMEs. The holding of the court was that the defendant's proof sufficiently established that they had timely mailed the IME scheduling letters and denial of claim forms, and that the plaintiff's assignor had indeed failed to appear for the scheduled IMEs. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.