No-Fault Case Law

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.

The relevant facts considered by the court in this case were that a medical provider, the appellant, was seeking to recover first-party no-fault benefits from the respondent insurance company. The main issue decided by the court was whether the appellant was entitled to summary judgment in their favor or if the respondent's cross motion for summary judgment dismissing the complaint should be granted. The court ultimately held that the order denying the appellant's motion for summary judgment and granting the respondent's cross motion for summary judgment was affirmed. This decision was based on the fact that the appellant's assignor had failed to appear for scheduled examinations under oath, which was a requirement for recovery of the no-fault benefits. As a result, the complaint was dismissed.

The main issues that were decided in this case were whether the plaintiff had failed to appear for scheduled examinations under oath and whether this failure justified the granting of the defendant's cross motion for summary judgment dismissing the complaint. The court considered the fact that the plaintiff, Lenex Services, Inc., had failed to appear for the scheduled examinations under oath, which was a requirement for the claim for first-party no-fault benefits. As a result, the court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The court's holding was that the plaintiff's failure to appear for the scheduled examinations justified the dismissal of the complaint, and the order was affirmed.

The court considered the fact that Lvov Acupuncture, P.C. had filed a complaint seeking to recover first-party no-fault benefits, but defendant Hereford Insurance Co. had granted a motion for summary judgment dismissing the complaint on the basis that Lvov Acupuncture had failed to appear for scheduled examinations under oath. The main issue decided was whether the provider had failed to appear for duly scheduled examinations under oath, and therefore was not entitled to recover first-party no-fault benefits. The holding of the court was that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed. The court cited a similar case, Allay Med. Servs., P.C., as Assignee of Harrison, Henry v Travelers Ins. Co., and found that the reasons stated in that case applied to the present case as well. Therefore, the order was affirmed.

The court considered the facts that the plaintiff commenced an action to recover assigned first-party no-fault benefits in 2010, and over five years later, the defendant served a 90-day written demand pursuant to CPLR 3216 (b) (3). The plaintiff failed to comply with the demand by filing a notice of trial within 90 days or move to vacate the demand or extend the 90-day period. The main issue decided was whether the plaintiff had a justifiable excuse for its delay and the existence of a meritorious cause of action. The holding of the case was that the defendant's motion to dismiss was properly granted as the plaintiff made no attempt to demonstrate an excuse for its failure to comply with the 90-day notice, and therefore, the order was affirmed.

The court considered the fact that the plaintiff, Allay Medical Services, P.C., was seeking to recover first-party no-fault benefits as an assignee of Henry Harrison. The main issue in the case was whether the defendant, Travelers Insurance Company, was entitled to summary judgment dismissing the complaint on the basis that the assignor had failed to appear for duly scheduled examinations under oath (EUOs). The court held that the defendant had established that the EUO scheduling letters and denial of claim form had been timely mailed and that the plaintiff had failed to appear for the scheduled EUOs. As a result, the court affirmed the order granting the defendant's motion for summary judgment and dismissing the complaint. Any remaining arguments raised by the plaintiff for the first time on appeal were not considered by the court.

The court considered a prior action in which defendant had been granted summary judgment dismissing the same claims related to the same accident and assignor, Valdez Vallon, as the claims at issue. Defendant moved for summary judgment dismissing the complaint, arguing that plaintiffs' present action was barred by the doctrine of res judicata. The main issue decided was whether the doctrine of res judicata precluded plaintiffs from asserting the same causes of action in the present case as in the prior action. The holding of the court was that plaintiffs were precluded from asserting the same causes of action in this case under the doctrine of res judicata, and therefore, defendant's motion for summary judgment dismissing the complaint was granted.

The court considered a case in which a surgeon performed surgery on a patient who had been injured in a bicycle accident. The patient assigned his no-fault insurance claims to the surgeon, who submitted the claims for arbitration after the insurance carrier denied the claims. An initial arbitrator ruled in favor of the surgeon, but a master arbitrator vacated that award and issued a new award in favor of the insurance carrier. The main issue decided was whether the master arbitrator exceeded his powers by conducting a de novo review of the medical evidence. The holding of the court was that the master arbitrator did exceed his authority by impermissibly performing a de novo review of the medical evidence, and, therefore, the order granting the petition to vacate the award of the master arbitrator and confirming the award of the initial arbitrator was affirmed.