No-Fault Case Law
Actual Chiropractic, P.C. v State Farm Ins. (2019 NY Slip Op 51552(U))
September 27, 2019
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.
Satya Drug Corp. v Global Liberty Ins. Co. of N.Y. (2019 NY Slip Op 51505(U))
September 20, 2019
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.
ACH Chiropractic P.C. v Geico Ins. Co. (2019 NY Slip Op 51439(U))
September 4, 2019
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.
Matter of Global Liberty Ins. Co. of N.Y. v Top Q. Inc. (2019 NY Slip Op 06445)
September 3, 2019
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.
Right Aid Med. Supply Corp. v Travelers Ins. Co. (2019 NY Slip Op 51415(U))
August 23, 2019
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.
Right Aid Med. Supply Corp. v Travelers Ins. Co. (2019 NY Slip Op 51414(U))
August 23, 2019
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.
Santomauro v Allstate Ins. Co. (2019 NY Slip Op 51413(U))
August 23, 2019
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.
Right Aid Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51409(U))
August 23, 2019
The relevant facts considered in this case are that Right Aid Medical Supply Corp. was seeking to recover assigned first-party no-fault benefits, and State Farm Mutual Automobile Insurance Co. moved for summary judgment dismissing the complaint on the ground that the action was premature. The main issue decided was whether plaintiff had provided the requested verification to defendant. The holding of the court was that the judgment is reversed and the matter is remitted to the Civil Court for a new trial on the issue of whether the requested verification remains outstanding. The court held that the burden was on plaintiff to provide the requested verification, and since no testimony was presented, the Civil Court found for the defendant.
McCulloch v New York Cent. Mut. Ins. Co. (2019 NY Slip Op 06254)
August 22, 2019
The relevant facts in this case involved a plaintiff who sought uninsured/underinsured motorist benefits based on injuries sustained in a motor vehicle accident, but the jury found that the accident was not a substantial factor in causing an injury to the plaintiff. The main issues dealt with the court's decision to preclude the plaintiff from calling her insurer's representatives as witnesses and to enter evidence of insurance at trial, as well as whether the court properly rejected the plaintiff's request to charge the jury regarding the aggravation of a preexisting injury. The holding of the court was that the judgment dismissing the complaint and awarding the defendant costs and disbursements was affirmed without costs.
Medical Care of W. N.Y. v Allstate Ins. Co. (2019 NY Slip Op 06243)
August 22, 2019
The court considered the plaintiff's allegations that the defendant, an insurance company, violated no-fault regulations by requesting verifications and examinations under oath and delaying payment of claims for treatment rendered by the plaintiff. The main issues decided were whether the amended complaint sufficiently alleged causes of action for breach of contract, negligent hiring, supervision, or retention, and prima facie tort. The holding of the court was that the amended complaint failed to state a cause of action for breach of contract, negligent hiring, supervision, or retention, and prima facie tort, and thus the order of the Supreme Court denying the defendant's motion to dismiss the amended complaint was reversed and the amended complaint was dismissed. The court found that the allegations in the amended complaint were vague and conclusory and failed to sufficiently allege facts to support the causes of action.