No-Fault Case Law

The relevant facts from the case involve a dispute between Acuhealth Acupuncture, P.C. and Country-Wide Ins. Co. over a denied claim for no-fault benefits. The original arbitrator found in favor of Acuhealth, but the master arbitrator vacated the award and issued a new award in favor of Country-Wide based on a defense that Acuhealth was fraudulently incorporated. Acuhealth then petitioned the Supreme Court pursuant to CPLR article 75 to vacate the master arbitrator's award. The main issue decided was whether the master arbitrator acted within his discretionary authority and correctly vacated the original arbitrator's award. The holding of the case was that the master arbitrator exceeded his power by rejecting the original arbitrator's discretionary authority and passing upon factual questions concerning the validity of the defense, and thus the Supreme Court's determination to vacate the master arbitrator's award and confirm the original arbitrator's award in favor of Acuhealth was affirmed. Additionally, the court remitted the case for the determination of an additional attorney's fee to be awarded to Acuhealth.

The appellate term affirmed the denial of Allstate Insurance Company's petition to vacate a master arbitration award in favor of Victoria Brown. Allstate failed to demonstrate the existence of any statutory grounds for vacating the award, as the master arbitrator found that the decision was rational and not arbitrary or capricious. The arbitrator's rejection of Allstate's IME no show defense was based on evidence, including proof of mailing the IME notices and the claimant's previous appearances at IMEs. Additionally, Allstate did not dispute that the parties had agreed to limit the issue before the arbitrator to the IME no show defense. Therefore, the court held that there were no grounds for vacating the award, and affirmed the judgment in favor of Victoria Brown.

The petitioner's assignor underwent acupuncture treatments and initiated a no-fault arbitration proceeding against the respondent insurer. An arbitrator decided in favor of the petitioner, awarding them a sum of money. The petitioner contested the attorney's fee award to a master arbitrator. The court decided that the master arbitrator's decision to affirm the award was not arbitrary and capricious. This is because the award had a rational basis. The master arbitrator decided that the petitioner's attorney failed to submit proper documentation to establish an hourly rate, thus justifying the affirmation of the attorney's fee. The court agreed with the Supreme Court's denial of the petition. The petitioner failed to demonstrate their entitlement to an attorney's fee.

The court considered the fact that the plaintiff, Actual Chiropractic, P.C., as Assignee of Wilson Santiago, had failed to appear for duly scheduled examinations under oath (EUOs) after the defendant, State Farm Insurance, had requested them. The main issue decided was whether the defendant was required to set forth objective reasons for requesting the EUOs in order to establish its entitlement to summary judgment. The holding of the case was that the defendant was not required to set forth objective reasons for requesting the EUOs in order to establish its entitlement to summary judgment. This was because an insurer only needs to demonstrate, as a matter of law, that it twice duly demanded an EUO from the provider, the provider twice failed to appear, and the insurer issued a timely denial of the claim. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the defendant-insurer's motion for summary judgment dismissing the underlying first-party no-fault action should be granted. The court considered whether the defendant had submitted competent evidence of the assignor's nonappearance at scheduled independent medical examinations (IMEs). The holding of the court was that the defendant's motion for summary judgment was properly denied, as the evidence submitted by the defendant, including a conclusory affirmation of the IME doctor and an affidavit from the IME scheduling vendor, lacked probative value and did not establish personal knowledge of the assignor's nonappearance. Therefore, the court affirmed the order of the Civil Court of the City of New York, denying the defendant's motion for summary judgment.

The court considered a case where a medical provider was seeking to recover assigned first-party no-fault benefits for treatment provided to an individual who was injured by a vehicle. The insurance company argued that the injuries were the result of an intentional assault and therefore not covered under the insurance policy. The main issue was whether the injuries were the result of an accident or an intentional act. The court held that the injuries were not the result of an accident and were in fact the result of an intentional act, based on substantial documentary evidence including a police accident report, a criminal complaint, an arrest report, and an affidavit from the insurance company's Special Investigation Unit investigator. Therefore, the court denied the medical provider's motion for summary judgment and granted the insurance company's cross motion to dismiss.

The relevant facts the court considered in the case of Matter of Global Liberty Ins. Co. of N.Y. v Top Q. Inc. included the denial of a petition to vacate a master arbitrator's award. The main issue decided by the court was whether the master arbitrator's award was arbitrary due to its irrational disregard of controlling law related to a no-fault insurance policy. The holding of the court was that the master arbitrator's award was indeed arbitrary because it irrationally ignored the controlling law that the no-fault policy issued by the petitioner was void ab initio. Therefore, the petition to vacate the master arbitrator's award was granted.

The court considered a motion for summary judgment by the defendant, which was granted due to the plaintiff's failure to submit opposition papers in a timely manner. The plaintiff then moved to vacate the order based on CPLR 5015(a)(1), providing excuses for the late submission. The main issue decided was whether the plaintiff's reasons for the late submission constituted a reasonable excuse for the default and if the opposition to the defendant's motion was potentially meritorious. The holding of the case was that the plaintiff failed to demonstrate a reasonable excuse for the default, and therefore the order denying the motion to vacate was affirmed.

The relevant facts considered by the court were that the plaintiff, Right Aid Medical Supply Corp., had failed to serve their opposition papers and cross motion for summary judgment on time, as required by a stipulation signed by both parties. The main issue decided was whether the plaintiff should be granted relief from the consequences of their failure to serve their opposition papers and cross motion on time, and whether they had a potentially meritorious opposition to the defendant's motion for summary judgment. The holding of the court was that the plaintiff did not provide any excuse for their default in their motion papers and that they failed to demonstrate a potentially meritorious opposition to the defendant's motion. Therefore, the court affirmed the order entered on September 28, 2017, which denied the plaintiff's motion to vacate the prior order and grant the plaintiff's cross motion.

The relevant facts considered by the court in this case involved an action by a provider to recover assigned first-party no-fault benefits. The plaintiff appealed from an order of the Civil Court that granted the defendant's motion to vacate a judgment of that court entered upon the defendant's failure to appear or answer the complaint, and to compel the plaintiff to accept the defendant's answer. The main issue decided by the court was whether the defendant had provided a reasonable excuse for its default in failing to appear or answer the complaint. The holding of the court was that the defendant did not demonstrate a reasonable excuse for the default and therefore, the branches of the defendant's motion seeking to vacate the default judgment and to compel the plaintiff to accept the defendant's answer were denied.