No-Fault Case Law
Adirondack Ins. Exch. v Rodriguez (2023 NY Slip Op 02095)
April 26, 2023
The main issue in this case was whether the collisions involving insured motor vehicles were intentional acts, and whether the insurance carriers had a duty to pay no-fault claims relating to those collisions. The trial court had declared that the collisions were intentional acts, and that the insurance carriers were not obligated to pay related no-fault claims. The appellate court affirmed the trial court's decision, holding that the insurance carriers demonstrated their prima facie entitlement to judgment as a matter of law by providing evidence that the collisions were intentional, including evidence that the insured individuals procured the insurance policies fraudulently and that the collisions occurred under similar circumstances. The appellate court also found that the appellants failed to raise a triable issue of fact or to establish that the plaintiffs' evidence was inadmissible, and therefore the trial court properly granted the summary judgment in favor of the insurance carriers.
Horizon P.T. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50442(U))
April 14, 2023
The court considered a case where plaintiff Horizon P.T. Care, P.C. was seeking to recover assigned first-party no-fault benefits from defendant State Farm Mutual Automobile Ins. Co. for services rendered to an assignor injured in a motor vehicle accident. State Farm claimed that Horizon had failed to appear for scheduled examinations under oath and that certain causes of action were barred by a previous declaratory judgment. The main issue was whether Horizon was entitled to recover the benefits and if the causes of action were barred by res judicata. The court held that Horizon's failure to appear for examinations under oath barred certain causes of action, and that the remaining causes of action were also properly dismissed as State Farm's employees' affidavits gave rise to a presumption that the necessary documents had been timely mailed. Therefore, the order denying Horizon's motion for summary judgment and granting State Farm's cross motion for summary judgment dismissing the complaint was affirmed.
Glispy v Ameriprise Ins. Co. (2023 NY Slip Op 50338(U))
April 13, 2023
The court considered a motion for summary judgment related to a claim for assigned first-party no fault benefits resulting from medical treatment provided to an individual after a motor vehicle accident. The main issue decided was whether the defendant was entitled to summary judgment and dismissal of the complaint based on the plaintiff's failure to attend scheduled Examinations Under Oath (EUOs). The holding of the court was that the defendant's motion for summary judgment was granted, as the plaintiff failed to rebut the presumption of the mailing of the EUO scheduling letters and non-appearance at the EUOs. The plaintiff's cross-motions for summary judgment were denied, and the matter was dismissed. The court found that the defendant had established timely mailing of EUO scheduling letters and the non-appearance of the assignor at scheduled EUOs, and the plaintiff had failed to raise an issue of fact for trial.
Allstate Chiropractic, P.C. v Nationwide Affinity Ins. Co. of Am. (2023 NY Slip Op 50299(U))
March 24, 2023
The court considered a motion for summary judgment by the defendant, who sought to dismiss the complaint on the grounds that the plaintiff failed to appear for scheduled examinations under oath (EUOs). The main issue was determining whether the defendant's denials of the claims for services rendered were timely based on the plaintiff's nonappearance at the duly scheduled EUOs. The court held that there was an issue of fact as to whether an EUO scheduled between certain dates was mutually rescheduled, and therefore, the defendant's entitlement to summary judgment was dependent upon whether the plaintiff's nonappearance at a scheduled EUO occurred on a specific date. The court ultimately affirmed the order, insofar as appealed from, and held that the branch of the defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services rendered was properly denied.
MT Physical Therapy v Lancer Ins. (2023 NY Slip Op 50297(U))
March 24, 2023
The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, granting the defendant's motion for summary judgment dismissing the complaint in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff's assignor's failure to appear for a scheduled examination under oath (EUO) constituted a failure to appear under the no-fault regulations. The court held that the defendant made a prima facie showing that the assignor's failure to appear for the scheduled EUOs constituted a failure to appear under the no-fault regulations, and also established that the assignor had failed to appear for a second scheduled EUO. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.
Horizon P.T. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50295(U))
March 24, 2023
The relevant facts the court considered in this case were the action brought by plaintiff Horizon P.T. Care, P.C. to recover assigned first-party no-fault benefits for injuries sustained in a motor vehicle accident in 2015, and a declaratory judgment issued by the Supreme Court in a prior action commenced by State Farm against Horizon regarding the same accident. The main issue decided was whether the Civil Court action was barred by the declaratory judgment. The holding of the court was that under the doctrine of res judicata, the Civil Court action was barred by the prior declaratory judgment and the decision to grant defendant's motion for summary judgment dismissing the complaint and to deny plaintiff's cross motion for summary judgment was affirmed.
Integrated Pain Mgt., PLLC v Empire Fire & Mar. Ins. Co. (2023 NY Slip Op 50219(U))
March 22, 2023
The relevant facts included Integrated Pain Management, PLLC seeking no-fault insurance benefits for medical services it rendered to an assignor, Mikwam Murphy, due to an automobile accident. Defendant Empire Fire & Marine Insurance Company moved for summary judgment dismissing the complaint, arguing that the plaintiff was barred from relitigating the issue of coverage due to the doctrines of res judicata, collateral estoppel, and law of the case. In 2019, Empire Fire had commenced a declaratory judgment action in Kings County Supreme Court against Integrated Pain Management and Murphy, among others. The main issue the court decided was whether the plaintiff was barred from relitigating the issue of coverage. The holding of the case went in favor of the defendant, Empire Fire, dismissing the plaintiff's complaint and ruling that the plaintiff was indeed barred from relitigating the issue of coverage due to the aforementioned legal doctrines.
Country-Wide Ins. Co. v Alicea (2023 NY Slip Op 01474)
March 21, 2023
The relevant facts in this case involved Country-Wide Insurance Company's motion for summary judgment declaring that they had no duty to pay no-fault claims to the defendants based on the injured party's failure to appear for examinations under oath (EUO). The main issue in this case was whether Country-Wide Insurance Company had a specific objective justification for requesting the EUO, as required by 11 NYCRR 65-3.5 (e). The court ultimately held that the motion to grant summary judgment was premature under CPLR 3212, as the insurer had failed to provide a medical provider with its objective justification for requesting the EUO. The Court also explained that the insurer's reason for the EUO was essential for medical providers to oppose an insurer's summary judgment motion, and that information was in the exclusive knowledge and control of the insurer. Therefore, the motion court's decision was reversed, the motion was denied, and the declaration and stay were vacated.
Kalitenko v Integon Natl. Ins. Co. (2023 NY Slip Op 50218(U))
March 20, 2023
The court considered the Defendant's motion for summary judgment due to the Assignor's failure to appear for independent medical examinations and examinations under oath. There was a procedural issue with the Defendant's answer being filed more than the 30-day statutory period after the affidavit of service was filed with the Court, and the Plaintiff rejected the Defendant's answer. The main issue decided was whether the Defendant's motion for summary judgment was proper and if issue had been joined. The holding of the case was that since issue had not been joined, the Defendant's motion for summary judgment was denied without prejudice. The Court also stated that before the Defendant's motion for summary judgment could be decided, issue must be joined by the acceptance of the Defendant's untimely answer.
American Tr. Ins. Co. v North Shore Family Chiropractic PC (2023 NY Slip Op 50208(U))
March 20, 2023
The main issue in this case was whether it was arbitrary and capricious for a No-Fault insurance arbitrator to reject a course-of-employment defense and not defer resolution of it to the Workers' Compensation Board where the only evidence provided was a police report establishing that the driver was operating a vehicle which bore "TC" plates and lacked passengers. American Transit Insurance Company ("ATIC") sought to vacate a No-Fault Insurance master arbitration award affirming the award of compensation to North Shore Family Chiropractic PC ("North Shore") for health service expenses. North Shore had filed a claim for No-Fault insurance compensation for treating its assignor, Alberto Carpinteyro, who was injured in a motor vehicle accident. The Supreme Court, Kings County ultimately granted ATIC's petition and vacated the arbitration awards, thereby denying North Shore's cross-petition to confirm the awards.