No-Fault Case Law

The case involved an appeal from an order of the Civil Court of the City of New York, in which the court denied the defendant's cross motion for summary judgment dismissing the complaint and granted implicit findings in favor of the plaintiff. Specifically, the issues concerned a provider seeking to recover first-party no-fault benefits and the defendant claiming not to have received the claims at issue, creating a dispute over the mailing of claim forms. The main legal issue considered was whether the plaintiff had established its prima facie case, and the court found the order to be internally inconsistent. The holding was that the implicit findings in plaintiff's favor were vacated and the order was affirmed without additional costs.

The relevant facts of the case included the plaintiff seeking to recover assigned first-party no-fault benefits, with the defendant moving for summary judgment on the grounds of a valid rescission of the insurance policy under Florida law. The main issue at hand was whether the insurance policy had been properly rescinded in accordance with Florida law. The court held that the defendant failed to demonstrate the proper rescission of the policy, as it did not provide notice of the rescission to the insured and did not return all of the paid premiums. Additionally, the court found that the plaintiff was not named or served in a previous declaratory judgment action in Florida and did not have a full and fair opportunity to defend its interests, thus the orders from the Circuit Court of Florida could not be given res judicata effect. Therefore, the court reversed the order and denied the defendant's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court in this case were that the defendant, Auto One Insurance Company, failed to appear for trial in an action brought by Diagnostic Medicine, P.C. The plaintiff sought to recover assigned first-party no-fault benefits. The Civil Court granted the defendant's motion to vacate the judgment based on excusable default and a potentially meritorious defense to the action. The main issues decided were whether the plaintiff had provided proper notice of the judgment and whether the defendant had a reasonable excuse for its default and a potentially meritorious defense. The holding of the case was that while the defendant was entitled to notice of the judgment, they were relieved of the underlying default based on a jurisdictional defect and the existence of a potentially meritorious defense. However, the court found that the defendant's unsupported denial of receiving relevant notices from the plaintiff was insufficient to establish an excusable default, and therefore struck the provisions for the filing of a new notice of trial and restoration of the matter to the trial calendar.

The court considered the fact that the defendant filed a motion for summary judgment to dismiss the complaint brought by providers to recover assigned first-party no-fault benefits. The main issue was that the defendant's motion for summary judgment was filed over 120 days after the notice of trial was filed by the plaintiffs, making it untimely unless good cause was shown. The court held that the defendant's motion for summary judgment to dismiss the complaint was untimely and was therefore denied, and that the Civil Court improvidently exercised its discretion in considering the defendant's argument for good cause, as it was raised for the first time in the reply papers. The plaintiffs' cross motion for summary judgment was also deemed untimely for the same reasons and therefore should not have been considered by the Civil Court. The court modified the previous order to deny the defendant's motion for summary judgment dismissing the complaint.

The relevant facts considered by the court were that the plaintiff, Ultra Ortho Products, Inc., as the assignee of Zacharie Elaine, had moved for summary judgment to recover assigned first-party no-fault benefits, and the defendant, GEICO Ins. Co., cross-moved for summary judgment dismissing the complaint on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). The main issue decided by the court was whether the plaintiff had failed to appear for the scheduled EUOs. The holding of the court was that the defendant's proof was sufficient to demonstrate that the plaintiff had failed to appear for the EUOs and that the EUO scheduling letters and denial of claim forms had been timely mailed. Therefore, the court reversed the order and granted the defendant's cross motion for summary judgment dismissing the complaint.

The court considered the case of Excel Surgery Center, LLC seeking to recover unpaid first-party no-fault benefits from Metropolitan Property and Casualty Insurance Co. The main issue decided was whether the disputed medical services had been rendered in New Jersey and if defendant had fully paid the claim in accordance with the New Jersey Automobile Medical Fee Schedule. The holding of the case was that defendant had fully paid the claim submitted by the New Jersey provider in accordance with the New Jersey medical fee schedule, and plaintiff failed to raise a triable issue of fact in opposition to the motion for summary judgment. Therefore, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint.

The fact considered in this case was that Bronx Medical Diagnostic, P.C. sought to recover first-party no-fault benefits for medical services it had provided to an assignor as a result of a motor vehicle accident. Bronx Medical had originally moved for summary judgment, which was granted by the Civil Court. However, defendant Global Liberty then sought to vacate the judgment and dismiss the complaint based on a declaratory judgment action it had initiated seeking a declaration that there was no coverage as a result of the accident. The Supreme Court subsequently issued an order restraining the prosecution of any pending actions and vacating any judgments related to the accident. The main issue decided in this case was whether Global Liberty's motion to vacate the Civil Court's judgment based on the Supreme Court's order was valid. The holding was that the Supreme Court's order did not provide a basis for Global Liberty to vacate the judgment, and thus the motion to vacate the judgment and dismiss the complaint was denied.

The court considered an action for first-party no-fault benefits stemming from a motor vehicle accident in 2014, and treatment provided by the plaintiff. The defendant, an insurance company, sought summary judgment to dismiss the complaint on the basis that the accident was not a covered event, was staged, and misrepresentations were made. They also alleged that the plaintiff failed to appear for scheduled examinations under oath. In response, the plaintiff argued that the defendant's denials were late and invalid, and that no authority allows the defendant to assert new defenses or verification requests beyond the statutory deadline. The court held that the motion for summary judgment was denied, and the plaintiff's cross motion was granted, finding that the defendant had failed to make a prima facie showing and that the defense of examination under oath no-show was precluded. The court stated that this is a case of first impression, and found that the defendant's unilateral "review" of the previously denied claims was untimely and frustrated the purpose of the No-Fault Law, and that the remaining contentions of the parties were denied as moot.

The court considered the facts of a provider seeking to recover first-party no-fault benefits and their failure to appear for scheduled examinations under oath. The main issue decided was whether the provider's failure to appear for examinations under oath was grounds for summary judgment dismissing the complaint. The holding of the court was that the order granting the defendant's motion for summary judgment was affirmed, as the provider's failure to appear for scheduled examinations under oath justified the dismissal of the complaint.

The relevant facts considered by the court were that the plaintiff, Medical Records Retrieval, Inc., doing business as Kamara Supplies, as assignee of Rosa McCabe, was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant insurance company was entitled to summary judgment dismissing the complaint on the basis that the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations. The holding of the case was that the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The court's decision was based on the same reasons as another related case, Allay Med. Servs., P.C., as assignee of Harrison, Henry v Travelers Ins. Co. The decision was entered on November 8, 2019.