No-Fault Case Law

In the case of MUA Chiropractic Healthcare, PLLC v State Farm Mut. Auto. Ins. Co., the main issue before the court was whether 11 NYCRR 65-3.8 (g) (1) (ii) was inconsistent with the express dictates of the Insurance Law and therefore constitutionally void. The court held that the regulation was inconsistent with the legislative statute which establishes the legal doctrine that defenses to claims not raised within 30 days after receipt of a no-fault claim are precluded. The court found that the regulation, which removed the fee schedule defense from the statutory preclusion rule, was an unconstitutional overreach and deemed it invalid. As a result, the defendant's fee schedule defense became nonviable 30 days after the claim was received without denial or demand for further verification. Thus, the defendant's motion to dismiss was denied as moot, and the plaintiff's cross motion seeking summary judgment was granted.

The court considered a motion by the defendant to reargue a previous decision denying the defendant's motion for summary judgment. The defendant argued that the court had misapplied the law when it denied the motion based on the plaintiff's failure to attend scheduled Examinations Under Oath (EUO). The defendant asserted that a previous Supreme Court Order had made a final determination on this issue, precluding the plaintiff's cause of action to recover no-fault benefits. The court granted the defendant's motion to reargue, vacated its previous decision, and issued a new decision in its place. The court acknowledged that it had erred in finding that the Supreme Court Order did not have a preclusive effect and held that the doctrine of res judicata bars the plaintiff's action to recover no-fault benefits. The main issue decided by the court was whether the previous Supreme Court Order made a final determination with res judicata effect, precluding the plaintiff's action to recover no-fault benefits. The court held that the Supreme Court Order did have a preclusive effect and that the doctrine of res judicata applied, barring the plaintiff's action. Therefore, the court vacated its previous decision and issued a new decision in favor of the defendant.

The court considered various verification requests and responses between Taira RX Corp., HKP Physical Therapy, P.C. and Government Employees Insurance Company (Geico). Geico argued that plaintiffs' actions were premature due to unresolved verification requests, denial justifications, and plaintiffs' failure to respond to reasonable verification requests. The main issues decided by the court were whether Geico's requests were appropriate and justified and whether plaintiffs had substantially complied with the requests. The court granted Geico's motions in some actions, dismissed some complaints without prejudice as premature, granted some complaints with prejudice, and denied some, while also granting summary judgment in favor of plaintiffs.

The relevant facts of this case include that the plaintiff commenced this action to recover assigned first-party no-fault benefits pertaining to an accident that occurred on November 16, 2013. The defendant failed to answer the complaint or appear in the action, and the Civil Court granted plaintiff's motion for the entry of a default judgment. After a motion by the defendant to vacate the default, the parties entered into a stipulation that the default judgment was vacated and the case was ready to proceed to trial. The insurer then commenced a declaratory judgment action in Supreme Court, New York County, involving the same accident, and the Civil Court denied defendant's application to stay the action pending resolution of the declaratory judgment action. The main issue in this case was whether the Civil Court improvidently exercised its discretion in denying defendant's application to adjourn the trial, and the holding was that the judgment, awarding the plaintiff the principal sum of $923.20, was affirmed.

The relevant facts considered in this case were that the plaintiff, Longevity Medical Supply, Inc., was seeking to recover assigned first-party no-fault benefits from the defendant, Travelers Property & Casualty Insurance Company. Plaintiff appealed from an order of the Civil Court of the City of New York that 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 in this case was whether the defendant's motion for summary judgment dismissing the complaint should have been considered by the Civil Court due to it being filed more than 120 days after the notice of trial had been filed. The holding of this case was that the Civil Court properly granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The court found that the defendant's motion for summary judgment was timely filed, and the plaintiff's remaining contentions lacked merit or were unpreserved for appellate review. Therefore, the order of the Civil Court was affirmed with $25 costs.

The relevant facts the court considered was that plaintiff was seeking to recover assigned first-party no-fault benefits related to an accident that occurred on November 16, 2013. Defendant failed to answer the complaint or appear in the action, resulting in a default judgment. The parties then entered into a stipulation agreeing to establish their respective prima facie cases and proceed to trial with no further motion practice. Despite this, the insurer commenced a declaratory judgment action in Supreme Court, New York County, involving the same accident, and sought to stay the action in the Civil Court pending resolution of the declaratory judgment action. The main issue decided was whether the trial court improperly exercised its discretion in denying defendant's request for an adjournment of the trial pending a determination by the Supreme Court of the insurer's motion for the entry of a declaratory judgment. The holding was that, considering all the surrounding facts and the parties' agreement by stipulation, it was not an improvident exercise of discretion for the trial court to deny defendant's request for an adjournment. Therefore, the judgment awarding plaintiff the principal sum of $2,484.68 was affirmed.

The main issues in the case involved a provider seeking to recover assigned first-party no-fault benefits, and a defendant appealing from an order denying their motion to vacate a judgment based on their failure to appear or answer the complaint. The court considered the affidavit of service, which indicated that the defendant was properly served by delivery of the summons and complaint to an individual at the defendant's offices who was authorized to accept service on its behalf. The court held that the defendant had failed to establish a reasonable excuse for its default and that the affidavit submitted by the defendant's employee in support of the motion was insufficient to establish an excusable default. Therefore, the order denying the defendant's motion was affirmed.

In the case of Quality Health Product, Inc. v American Transit Insurance Company the main issue was whether or not the action to recover assigned first-party no-fault benefits should be held in abeyance pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law. Defendant moved for an order staying the action pending a determination by the Workers' Compensation Board and granting summary judgment dismissing the complaint if proof of such an application was not filed with the court within 90 days. The court found that there was an issue as to whether plaintiff's assignor had been acting in the course of his employment at the time of the accident and that workers' compensation benefits might be available, and therefore held the action in abeyance pending a determination by the Workers' Compensation Board. The decision was affirmed by the court.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which denied the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to appear for three scheduled examinations under oath (EUOs). The court held that the defendant's papers failed to establish, as a matter of law, that the denial of the claim form had been timely mailed, and as a result, the defendant did not demonstrate that it is not precluded from asserting its proffered defense. The court also found that the doctrine of collateral estoppel asserted by the defendant would not apply to the denial of the claim at issue, as that claim was not at issue in the prior action. Therefore, the court affirmed the order, stating that the defendant was not entitled to summary judgment dismissing the complaint.

The court considered the case of Ksenia Pavlova, D.O. as assignee of Cazeau, Rene, against American Transit Ins. Co. In this case, the plaintiff moved for summary judgment to recover assigned first-party no-fault benefits, while the defendant cross-moved for summary judgment to dismiss the complaint or to hold the action in abeyance pending a determination by the Workers' Compensation Board. The main issue decided was whether the action should be held in abeyance pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law based upon the plaintiff's assignor's alleged eligibility for workers' compensation benefits. The holding was that the order denying the plaintiff's motion for summary judgment and granting the branch of the defendant's cross motion seeking to hold the proceeding in abeyance was affirmed, with the court awarding $25 in costs.