No-Fault Case Law

The case involved Ultimate Health Products, Inc., as the assignee of Zenaida Solero, suing Travelers Insurance Company to recover first-party no-fault benefits. The main issue in the case was whether plaintiff had failed to appear for scheduled examinations under oath (EUOs). At the nonjury trial, the Civil Court dismissed the complaint after finding that the defendant had established that plaintiff had failed to appear for the EUOs. The appellate court reviewed the determination made after the nonjury trial and affirmed the judgment, stating that the trial court's opportunity to observe and evaluate the testimony and demeanor of the witnesses affords it a better perspective from which to assess their credibility. Therefore, the holding of the case was that the judgment of the Civil Court, which dismissed the complaint on the grounds that the plaintiff had failed to appear for scheduled EUOs, was affirmed by the appellate court.

The court considered a case where AOM Medical Supply, Inc., as the assignee of Tiana Addison, sought to recover first-party no-fault benefits from Hereford Insurance Co. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The court held that the defendant's motion for summary judgment dismissing the complaint was affirmed, as the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The court's decision was affirmed based on the reasons stated in a similar case, Allay Med. Servs., P.C., as Assignee of Mills, Keith A. v Metropolitan Gen. Ins. Co., which was decided concurrently.

The court considered the fact that defendant sought summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). Defendant established that the letters scheduling the EUOs had been timely mailed, that the plaintiff's assignor had failed to appear on either date, and that the claims had been timely denied on those grounds. The main issue decided was whether defendant's cross motion for summary judgement should be granted. The holding of the case was that the order denying defendant's cross motion for summary judgement was reversed, and defendant's cross motion for summary judgment was granted.

The main facts the court considered in this case were that the plaintiff, Active Care Medical Supply Corp., was seeking to recover first-party no-fault benefits from the defendant, American Transit Insurance Company. The defendant had moved for summary judgment to dismiss the complaint on the basis that the plaintiff had failed to appear for scheduled examinations under oath. The plaintiff also cross-moved for summary judgment. The main issue decided by the court was whether the plaintiff's failure to attend scheduled examinations under oath justified the dismissal of the complaint. The court held that the plaintiff's failure to appear for duly scheduled examinations under oath was sufficient grounds for granting the defendant's motion for summary judgment and dismissing the complaint. The court affirmed the order of the Civil Court, with costs of $25. The decision was based on similar reasoning to another case considered simultaneously.

The court considered the facts surrounding a provider's attempts to recover first-party no-fault benefits and a motion filed by the defendant for summary judgment dismissing the complaint. The defendant had argued that there was no coverage for the accident in question. The main issue decided was whether the defendant's motion for summary judgment was untimely under CPLR 3212(a). The holding of the case was that the defendant's motion for summary judgment was not untimely, and the motion to dismiss the complaint was denied. The court also found that the affidavit provided by the defendant was not enough to establish, as a matter of law, that the insured's vehicle was not involved in the accident at issue. As a result, the plaintiff's remaining arguments were found to lack merit or were not preserved for appellate review.

The court considered the fact that the plaintiff, Bento Ortho, Inc., was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted, and whether the plaintiff's cross motion for summary judgment should be denied. The court held that there was an issue of fact as to whether the plaintiff's claims were timely denied, due to a significant discrepancy between the date the bills were sent and the date they were received by the defendant. As a result, the court modified the order by denying the defendant's motion for summary judgment dismissing the complaint.

The case involved a dispute between V.S. Care Acupuncture, P.C. (V.S.) and Country-Wide Ins. Co. regarding a claim for no-fault benefits for treatment rendered to Morris Collins. Country-Wide denied the claim on the grounds that Collins did not appear for independent medical examinations and that V.S. failed to appear at scheduled examinations under oath. Country-Wide also contended that V.S. was fraudulently incorporated. The original arbitration ruled in favor of V.S., finding that Country-Wide had not met its burden of proof regarding the fraudulent incorporation defense. On appeal to a master arbitrator, the master arbitrator found that the original arbitrator had committed an error of law in rejecting the fraudulent incorporation defense. The court held that the master arbitrator's determination was without a rational basis and vacated the master arbitrator's award, confirming the original arbitrator's award in favor of V.S. The court also remitted the matter back to the Supreme Court for a determination of the amount of an additional attorney's fee to be awarded to V.S.

The Supreme Court vacated a master arbitrator’s award in favor of V.S. Care Acupuncture, P.C. in the amount of $3,650, plus statutory interest, attorney's fees, and costs and disbursements. Country-Wide Ins. Co. then appealed this decision. V.S. Care Acupuncture, P.C. had filed a claim for no-fault benefits for treatment it provided, that the carrier Country-Wide Ins. Co. denied. The arbitrator denied V.S.'s claim, finding that the evidence established that V.S. was fraudulently incorporated in violation of (State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]). The Supreme Court granted the petition, vacated the master arbitrator's award, and entered a judgment in favor of V.S. in the amount of the claim for no-fault benefits plus statutory interest, attorneys' fees, and costs and disbursements. Upon appeal, the judgment was reversed, the original award was reinstated, and V.S. failed to demonstrate any grounds for vacating the master arbitrator's award.

The case involves Bay Needle Care Acupuncture, an assignee of a claim for no-fault benefits for treatment rendered to Kareem Edgar, and Country-Wide Ins. Co. Country-Wide denied the claim, leading to the arbitration. The original arbitrator found in favor of Bay Needle and Country-Wide appealed, resulting in the master arbitrator vacating the award and remitting the matter for a new hearing. Bay Needle petitioned to vacate the master arbitrator's award and the Supreme Court granted the petition, vacated the master arbitrator's award, confirmed the original arbitrator's award in favor of Bay Needle, and entered judgment accordingly. The main issue was whether the master arbitrator exceeded their power in vacating the original arbitrator's award. The holding was that the master arbitrator did exceed his power in vacating the original arbitrator's award, and the original arbitrator's award was confirmed in favor of Bay Needle. Additionally, Bay Needle was entitled to an attorney's fee for this appeal and the matter was to be remitted to the Supreme Court for that purpose.

The main issue in this case was whether a matter was entitled to preclusive effect, and if the prior determination involving the same parties was sufficient for this. The court found that Acuhealth failed to establish that the issue for collateral estoppel was identical to an issue decided in the prior proceeding. Additionally, Acuhealth failed to demonstrate any additional ground for vacating the master arbitrator's award. The court also held that an arbitrator's rulings are largely unreviewable, and that courts have a limited ability to vacate an arbitrator's award unless the error claimed is so irrational as to require vacatur. The court found that the petition to vacate the arbitrator's award should have been denied, and the award should have been confirmed, thus reversed the original judgment in favor of the petitioner and awarded in favor of Country-Wide Ins. Co.