No-Fault Case Law

The relevant facts of the case include an action by a provider to recover assigned first-party no-fault benefits, resulting in a judgment entered in April 2016 due to the defendant's failure to appear or answer the complaint. The defendant then moved to vacate the default judgment citing an excusable default and a meritorious defense. The issue before the court was whether the defendant demonstrated a reasonable excuse for its default and a potentially meritorious defense to the action, as required by CPLR 5015 (a) (1). The court considered that the process server's affidavit provided evidence of proper service of process upon the defendant and ultimately denied the branch of the defendant's motion seeking to vacate the default judgment pursuant to CPLR 5015 (a) (1) due to the defendant's failure to establish a reasonable excuse for its default.

The court considered a proceeding brought by Kanter Physical Medicine & Rehab, P.C., as the assignee of an individual, to vacate a master arbitrator's award which upheld the award of an arbitrator, denying the petitioner's claims to recover assigned first-party no-fault benefits. The main issue was whether there was a rational basis for the determination of the master arbitrator upholding the arbitrator's award. The holding of the case was that the court found a rational basis for the determination of the master arbitrator upholding the arbitrator's award, and therefore the Civil Court properly denied the petition to vacate the master arbitrator's award. The order was modified to add a provision confirming the master arbitrator's award, as a special proceeding should terminate in a judgment, not an order.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the plaintiff's motion for leave to reargue its opposition to the defendant's prior motion to dismiss the complaint. The defendant's motion to dismiss the complaint pursuant to CPLR 3216 was granted based on the plaintiff's failure to comply with a 90-day notice. The main issue decided was whether the plaintiff should be granted leave to reargue its opposition to the defendant's motion to dismiss, and whether the defendant's motion to dismiss the complaint should be denied upon reargument. The holding of the court was that the order granting the defendant's motion to dismiss the complaint pursuant to CPLR 3216 was adhered to, affirming the order with modification, without costs.

The court considered a motion to dismiss a complaint by defendant GEICO Insurance, based on the plaintiff Faith Acupuncture, P.C.'s failure to comply with a 90-day notice in a no-fault benefits case. The Civil Court initially granted defendant's motion to dismiss, finding that plaintiff's claim of law office failure did not constitute a justifiable excuse. Plaintiff then moved for reargument, which was granted, resulting in an order denying defendant's motion to dismiss. The main issue decided was whether plaintiff's failure to comply with the 90-day notice warranted dismissal of the complaint. The holding of the case was that the order granting defendant's motion to dismiss the complaint pursuant to CPLR 3216 was adhered to, thereby affirming the decision to dismiss the complaint.

The relevant facts considered by the court were that the plaintiff, a medical provider, filed a summons and complaint to recover first-party no-fault benefits, but did not serve these documents on the defendant within the 120-day time period allotted by CPLR 306-b. The defendant moved to dismiss the complaint pursuant to CPLR 3211 (a) (8), and the plaintiff "cross-moved," pursuant to CPLR 306-b, for an extension of time to serve the summons and complaint upon the defendant and to deem the service on December 31, 2015 timely. The main issue decided by the court was whether the plaintiff's delayed service of the summons and complaint warranted dismissal of the complaint. The holding of the court was that the order granting the defendant's motion to dismiss the complaint and denying the plaintiff's "cross" motion for an extension of time to serve the documents was affirmed.

The relevant fact considered by the court was that the plaintiff did not serve the summons and complaint to the defendant until 47 days after the expiration of the 120-day time period allotted by CPLR 306-b. The main issue was whether the court should dismiss the complaint pursuant to CPLR 3211 (a) (8) due to the late service of the summons and complaint, or extend the time for service based on "good cause shown or in the interest of justice." The holding of the case was that since plaintiff's law office failure argument did not amount to a showing of good cause, the court properly granted defendant's motion to dismiss the complaint and denied plaintiff's "cross" motion. Therefore, the order was affirmed.

The main issues decided in this case were whether verification requested by the defendant remained outstanding and whether the testimony proffered by the defendant's witness was credible. The court considered the evidence presented at a nonjury trial and the determination made by the trial court. The court held that the determination of a trier of fact as to issues of credibility is given substantial deference, and as the record supported the Civil Court's determination, the judgment was affirmed. The Appellate Term, Second Department found no basis to disturb the Civil Court's finding and affirmed the judgment.

The relevant facts the court considered in the case of Maria S. Masigla, P.T., as Assignee of Jackson, Vicki, v. Windhaven Insurance Company, included the plaintiff's attempt to recover assigned first-party no-fault benefits in the amount of $2,738.52. The main issues decided in the case were whether the Civil Court had subject matter jurisdiction, personal jurisdiction, and whether the defendant's policy provided no-fault coverage as required by Insurance Law § 5107. The holding of the case was that the order denying the defendant's motion for summary judgment dismissing the complaint was affirmed. The court determined that the action fell within the subject matter jurisdiction of the Civil Court, and that the defendant had waived all personal jurisdiction defenses by failing to raise them in a timely manner. Additionally, the defendant did not demonstrate that its policy did not provide no-fault coverage, and therefore did not demonstrate its entitlement to judgment as a matter of law.

The court considered a provider's attempt to recover assigned first-party no-fault benefits from an insurance company. The main issues decided were whether the provider had failed to provide requested verification, and if there was a triable issue of fact as to whether the verification had been provided. The holding of the case was that the provider's affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to and received by the insurance company, creating a triable issue of fact. As a result, the court modified the order by denying the insurance company's motion for summary judgment dismissing the complaint.

The court considered an action by a medical supply provider to recover assigned first-party no-fault benefits, in which the defendant moved for summary judgment dismissing the complaint based on lack of medical necessity. The Civil Court granted the defendant's motion, leading to an appeal by the plaintiff. The defendant's proof was found to be sufficient to establish a presumption that the denial of claim form had been properly mailed, and the peer review report submitted by the defendant provided a factual basis and medical rationale for the determination of a lack of medical necessity for the supplies at issue. The plaintiff failed to submit any medical evidence to rebut the conclusions of the peer review report. As a result, the judgment granting the defendant's motion for summary judgment was affirmed.