No-Fault Case Law

This case involved Liberty Mutual Insurance Company's denial of no-fault-benefits claims for a person injured in an accident on the grounds that the injured person had materially misrepresented the insured vehicle's garaging address and the identity of the vehicle's operators. The plaintiffs moved for a default judgment under CPLR 3215 against non-answering defendants but it was ultimately denied. The main issue was whether Liberty Mutual's denials of the no-fault claims were timely, as it is required by law that these claims be paid or denied within 30 days after proof of the claim is received. Liberty Mutual failed to establish that its denials were timely and therefore, the court ruled in favor of denying the motion for default judgment, stating that the action would be dismissed if a renewed default-judgment motion was not filed within 30 days.

The court considered whether the defendant's motion for summary judgment and to dismiss the plaintiff's complaint on the basis that the plaintiff's assignor failed to appear for four scheduled examinations under oath (EUO) should be granted. The main issue decided was whether the denial of the claim by the defendant was timely, even though it exceeded the 30-day time period from the second EUO no-show. The court held that the defendant's motion for summary judgment was granted in its entirety, and the plaintiff's cross motion was denied. The court found that the defendant demonstrated its prima facie entitlement to judgment as a matter of law by showing that the scheduling letters were timely and properly mailed, and that the assignor failed to appear on each of the four scheduled dates. Therefore, the plaintiff's complaint was dismissed.

The plaintiff initiated legal action against the defendant insurance company in order to recover no-fault insurance benefits for lost wages. The defendant sought to disqualify the plaintiff's counsel, as the principal of the plaintiff's legal representation had previously represented the defendant in hundreds of no-fault actions. The Supreme Court granted the defendant's motion to disqualify counsel for the plaintiff based on the existence of a prior attorney-client relationship, the substantially related issues involved in both representations, and the materially adverse interests of the present client and former client. The plaintiff appealed this decision, however, the appellate court affirmed the decision to disqualify counsel for the plaintiff. The court held that the disqualification of an attorney is at the discretion of the court, and in this case, the Supreme Court properly exercised its discretion in granting the defendant's motion to disqualify the plaintiff's attorney.

The relevant facts the court considered were that the plaintiff had served discovery demands on the defendant in an action to recover no-fault insurance benefits for lost wages arising from a 2016 motor vehicle accident. The defendant provided responses, and the plaintiff then moved to compel the defendant to respond to the discovery demands. The main issue decided was whether the Supreme Court properly denied the plaintiff's motion to compel discovery, and the holding was that the court did not improvidently exercise its discretion in denying the motion without prejudice to renew. The court determined that the motion papers were missing copies of the discovery demands served on the defendant and details about what discovery remained outstanding, and therefore the denial was proper.

The relevant facts of the case included a provider seeking to recover assigned first-party no-fault benefits, with the defendant appealing from an order granting the plaintiff's motion to vacate the dismissal of the action and to restore the action to the trial calendar. The main issue decided was whether the plaintiff demonstrated a reasonable excuse for its default and had a meritorious cause of action. The holding of the case was that the Civil Court did not improvidently exercise its discretion in finding that the plaintiff had demonstrated a reasonable excuse for its default, as the plaintiff's witness was out of the country at the time of the trial. Additionally, the plaintiff demonstrated that it has a meritorious cause of action. Therefore, the order to vacate the dismissal of the action was affirmed.

The court considered the circumstances under which plaintiff was denied motion for medical expenses. The plaintiff was involved in an accident resulting in multiple injuries, and was insured by the defendant up to $50,000 for no-fault coverage and up to $50,000 for additional personal injury protection (APIP) coverage. She settled with the responsible parties' insurance carriers for $100,000 each due to the injuries sustained, but the defendant refused to pay out any additional money under the APIP coverage and placed a lien on the $7,292.85 already paid to the plaintiff. The main issue decided was whether the defendant was required to pay the remainder of the APIP coverage for the plaintiff's medical expenses and if the defendant had the right to a lien on the amount already paid to the plaintiff. The holding of the case was that the denial of plaintiff's motion was not warranted and the basis should have been that the motion was premature, therefore the complaint must be reinstated.

The court considered the insurance company's petition to vacate an arbitration award in favor of the medical company. The insurance company demonstrated that the claimant failed to appear for an independent medical examination, which constituted a breach of a condition precedent vitiating coverage. The court held that the insurance company was entitled to judgment as a matter of law based on evidence of the claimant's failure to appear and established case law. Therefore, the arbitration award was vacated, and the medical company's request for attorney fees was denied, as their claim was deemed invalid as a matter of law.

The main issue decided in this case was whether a health service provider seeking No-Fault insurance compensation for providing post-surgery services had to establish that a prior arbitration award was affirmed by a master arbitrator, confirmed by a court, and not subject to de novo review as a prerequisite to arguing that the award constituted collateral estoppel on the issue of medical necessity for the surgery. The court held that the health service provider did not have to establish that the prior arbitration award was affirmed by a master arbitrator and confirmed by a court in order to argue that the award constituted collateral estoppel on the issue of medical necessity for the surgery. Following the arbitration award of Richard B. Ancowitz, Esq., the court granted Respondent U.S. Med Supply Corp.'s claim for No-Fault insurance compensation for post-surgery medical supplies provided or rented, and the judgment was in favor of the respondent. U.S. Med was awarded $4,000.00 for the services provided to Mahendra Singh, who claimed to have been injured in a motor vehicle accident and assigned his No-Fault insurance benefits to U.S. Med.

The court considered the facts surrounding a No-Fault insurance dispute, where an arbitrator awarded the respondent $2,450.73 for health service expenses following a motor vehicle accident. The petitioner insurance company originally denied the claim on the grounds that the injured party was acting within the course of employment and should have submitted the bills to a Workers' Compensation insurer. However, a Workers' Compensation Board later found that the injured party was not working at the time of the accident. The primary issue was whether the insurer could assert a defense of lack of medical necessity in a subsequent denial after the initial denial on different grounds had been overturned. The court decided whether the defense of lack of medical necessity, asserted after the initial denial based on employment status, should be considered in the arbitration process. The petitioner sought to vacate the arbitration award, arguing the defense of medical necessity had not been adequately addressed. The respondent cross-petitioned for confirmation of the arbitration award and sought additional costs and fees. The holding of the court was that the initial defense regarding the injured party's employment status did not preclude the insurer from later asserting a defense of lack of medical necessity. The court investigated whether the second defense was raised timely and whether it was considered during the arbitration process. Ultimately, the court denied the petition to vacate the master arbitration award, and granted additional attorney fees to respondent.

The main issues in this case were whether the court should review a verified petition to determine if it makes out a prima facie case when submitted by an insurance company to vacate awards of a No-Fault insurance hearing arbitrator and a master arbitrator in favor of a health service provider, and whether a No-Fault insurer makes out a prima facie case to vacate an arbitration award when no defense of lack of medical necessity was asserted in its denials of claim. The background of the case involved American Transit Insurance Company seeking to vacate a No-Fault Insurance master arbitration award in favor of Ortho City Services Inc.'s claim for No-Fault insurance compensation for medical supplies following a motor vehicle accident. The court found that the insurance company made out a prima facie case in support of vacatur of the arbitration award, and that the arbitrator erred with respect to an issue of medical necessity. Therefore, it was held that the petition to vacate the arbitration award should be granted.