No-Fault Case Law

The relevant facts in this case involved a dispute between Chapa Products Corp., as Assignee of Isabel Corniel, and 21st Century Insurance Company. Chapa Products Corp. sought to recover assigned first-party no-fault benefits, but the defendant argued that the plaintiff had not timely submitted the claim underlying the first cause of action and had failed to provide requested verification as to the claim underlying the second cause of action. The main issue decided by the court was whether the plaintiff had timely submitted the claims and verification as required, and whether the defendant had received the verification at issue. The holding of the court was that while the defendant had demonstrated that the claim underlying the first cause of action had not been timely submitted and that the defendant had not received the verification at issue, the proof submitted by the plaintiff was sufficient to give rise to a presumption that the claim form and verification had been timely mailed. Therefore, on this record, neither party was entitled to summary judgment.

The relevant facts the court considered in this case were that Solution Bridge, Inc. was seeking to recover assigned first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. State Farm moved for summary judgment dismissing the first cause of action on the grounds that Solution Bridge failed to provide requested verification. The main issue decided was whether Solution Bridge provided sufficient evidence to show that the requested verification had been mailed to, and received by, State Farm. The holding of the case was that the affidavit submitted by Solution Bridge was sufficient to give rise to a presumption that the verification had been provided, creating a triable issue of fact. Therefore, the court reversed the order and denied State Farm's motion for summary judgment.

The court considered the circumstances underlying the action, in which the plaintiff sought to recover a balance of $10,906.14, which was claimed due as a loss of earnings for attendance at an examination under oath in the context of a first-party no-fault insurance claim. The issue decided was whether the additional $2,604,942 claimed by the plaintiff could be rightfully considered in the formula for calculation of lost earnings pursuant to 11 NYCRR 65-3.5 (e). The court held that while there is no disagreement about the formula used to determine the loss of earnings incurred as a result of the plaintiff's appearance at the examination under oath, the focus should be on the actual monetary loss incurred, and the parties failed to provide evidence of why the plaintiff's unavailability for an undisclosed number of hours on that date caused earnings loss. Therefore, both the defendant's motion and plaintiff's cross motion for summary judgment were denied.

The court considered a case in which Global Liberty Insurance Co. sought to vacate an award in favor of Dr. Mark S. McMahon, who was an assignee of Rudy Corniel. Global had only partially approved a payment for arthroscopic surgery performed on its insured, and McMahon sought payment for the balance. The lower arbitrator awarded the balance to McMahon, but did not consider a reference to the American Medical Association's CPT Assistant newsletter that Global relied on. The master arbitrator affirmed this decision, and the Supreme Court also denied Global's petition to vacate the award. The Appellate Division reversed this decision, holding that CPT Assistant, which is referenced in the Official New York Workers' Compensation Medical Fee Schedule, should have been considered in the arbitration process. Consequently, the matter was remanded for a new arbitration.

The court in this case considered whether defendant Sloan Tyrell failed to appear at properly noticed medical examinations, which would constitute a failure of a condition precedent to receiving insurance benefits for a motor vehicle accident. Plaintiff sought a declaration of noncoverage and an amendment to add additional defendants who allegedly provided the same claimant with services in connection with the same accident. The main issue decided was whether plaintiff provided the insured with proper notice of the location of the scheduled examinations. The court determined that plaintiff did not proffer sufficient evidence to establish prima facie that proper notice was provided and denied plaintiff's motion for summary judgment against defendants-respondents and a default judgment against the remaining defendants. However, the court granted the motion for leave to amend the complaint to add the proposed additional defendants, finding that permissive joinder was appropriate and leave to amend should have been freely granted.

The court considered the issue of whether the defendant insurance company was entitled to summary judgment dismissing the complaint filed by the plaintiff chiropractic care provider to recover assigned first-party no-fault benefits. The main issue decided was whether the insurance company was required to set forth objective reasons for requesting examinations under oath (EUOs) in order to establish its prima facie entitlement to summary judgment. The court held that the insurance company was not required to set forth objective reasons for requesting EUOs, as it only needed to demonstrate that it had duly demanded an EUO from the provider, that the provider failed to appear, and that 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 court considered a case in which Zen Acupuncture P.C. was appealing the denial of their cross-motion for summary judgment in a dispute with Allstate Insurance Company. The main issue decided was whether the proof submitted by Zen Acupuncture P.C. established that the claim had not been timely denied or that the denial of the claim was conclusory, vague, or without merit as a matter of law. The holding of the Court was that the denial of the cross-motion for summary judgment should be affirmed because the proof submitted failed to establish that the claim had not been timely denied or that the denial of the claim was without merit. Therefore, the order was affirmed and costs of $25 were imposed on the appellant.

The court considered a case in which a provider sought to recover assigned first-party no-fault benefits from an insurance company. The insurance company had moved for summary judgment, arguing that the provider had failed to appear for scheduled examinations under oath. The court also considered the provider's cross motion for summary judgment. The main issue decided was whether the provider's failure to appear for scheduled examinations under oath was a valid reason for the insurance company to deny the claim for no-fault benefits. The holding of the case was that the court affirmed the order granting the insurance company's motion for summary judgment and denying the provider's cross motion for summary judgment.

In this case, LMS Acupuncture, P.C. was appealing an order from the Civil Court of the City of New York, which granted State Farm Mutual Automotive Ins. Co.'s motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue in this case was whether plaintiff failed to appear for duly scheduled examinations under oath (EUOs). The court found that the proof submitted by the defendant was sufficient to demonstrate that the plaintiff had indeed failed to appear for the EUOs. The court also held that the defendant was not required to set forth objective reasons for requesting the EUOs in order to establish their entitlement to summary judgment. Therefore, the court affirmed the order granting the defendant's motion for summary judgment and denying the plaintiff's cross motion for summary judgment.

The court considered the fact that the plaintiff, Ksenia Pavlova, as the assignee of Murray, Eldica, was seeking to recover first-party no-fault benefits from Hartford Insurance Company. The main issue decided was whether the plaintiff had failed to appear for duly scheduled examinations under oath, and if so, whether this justified the granting of the defendant's motion for summary judgment dismissing the complaint. The holding of the case was that the order granting the defendant's motion for summary judgment was affirmed, as the plaintiff had indeed failed to appear for the scheduled examinations under oath, as required. Therefore, the plaintiff's appeal was denied, and the order of the Civil Court was affirmed.