No-Fault Case Law

The court considered a motion for summary judgment by the defendant, who argued that the plaintiff failed to appear for scheduled examinations under oath (EUOs) and therefore should be denied first-party no-fault benefits. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to appear for the EUOs. The holding of the case was that the order denying the defendant's motion for summary judgment was reversed, with the court granting the defendant's motion for summary judgment dismissing the complaint. The court found that the defendant had established the timely and proper mailing of the EUO scheduling letters and denial of claim forms, as well as the plaintiff's failure to appear for the EUOs, and therefore was entitled to summary judgment in their favor.

The court considered the disagreement between Charles Deng Acupuncture, P.C. and State Farm Mutual Automobile Insurance Co. over the amount of payment for acupuncture services provided by Charles Deng. State Farm had paid based on the workers' compensation fee schedule for acupuncture services rendered by chiropractors, which Charles Deng argued was improper. The main issue decided was whether State Farm's fee reductions were proper under the workers' compensation fee schedule for acupuncture services performed by chiropractors. The holding of the court was that while the insurer could use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount a licensed acupuncturist is entitled to receive, State Farm was not entitled to summary judgment dismissing so much of Charles Deng's complaint as sought to recover $54.73 for an initial visit on February 5, 2014 and an additional $.63 for services rendered on February 27, 2014. The order was modified to deny the branches of the defendant's motion seeking summary judgment dismissing those parts of the complaint.

The relevant facts the court considered were that Bronx Chiropractic Care, P.C. was seeking to recover assigned first-party no-fault benefits from State Farm insurance. State Farm moved for summary judgment to dismiss the complaint on the grounds that Bronx Chiropractic Care had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether State Farm was entitled to summary judgment dismissing the complaint. The holding of the case was that the court reversed the order and granted State Farm's motion for summary judgment dismissing the complaint, as it was determined that State Farm had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, as well as the plaintiff's failure to appear for the EUOs. Therefore, the court found that Bronx Chiropractic Care had failed to meet its obligations and State Farm was entitled to summary judgment.

The court considered the fact that the plaintiff, Island Life Chiropractic, P.C., was seeking to recover assigned first-party no-fault benefits and that the defendant, State Farm Mutual Automobile Ins. Co., had moved for summary judgment dismissing the complaint on the basis that the plaintiff had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether the defendant demonstrated its entitlement to summary judgment, and the court held that the defendant had failed to do so. The court found that there was an issue of fact as to whether the plaintiff had contacted the defendant to reschedule the EUOs and whether the defendant had responded to the messages left by the plaintiff. The court also found that the defendant's mere reliance on an affirmation from its counsel was not sufficient to establish its entitlement to summary judgment, and therefore affirmed the order denying the defendant's motion for summary judgment.

The main issues in this case were whether the plaintiff was entitled to turn over monies from its bank account outside of New York State to satisfy a judgment, and what interest rate should accrue on first party no-fault benefits after the entry of judgment. The court considered the history of the case, including a prior judgment in favor of the plaintiff, a motion to modify the judgment, and an appeal by the defendant. The court ultimately held that the plaintiff was not entitled to turn over monies from its bank account, as the bank was not a party to the action, and that interest on first party no-fault benefits should accrue at a rate of two percent per month, in accordance with 11 NYCRR 65-3.9(a), and not at the rate of nine percent per year. The court also denied the defendant's cross-petition seeking dismissal and sanctions for filing a frivolous action.

The case involved a dispute between Preferred Ortho Products, Inc., as the assignee of Reid, Ramone, and 21st Century Insurance Company. The main issue in this case was whether plaintiff could recover assigned first-party no-fault benefits when the assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The court considered the argument presented by the plaintiff that the address used on the IME scheduling letters improperly included an apartment number that did not appear on plaintiff's claim forms. However, the court ruled that this argument could not be considered as it was being raised for the first time on appeal. Ultimately, the court affirmed the order granting defendant's motion for summary judgment dismissing the complaint and denying the plaintiff's cross motion for summary judgment.

In this case, Country-Wide Insurance Company filed a no-fault insurance claim seeking a de novo adjudication following a master arbitrator's award in excess of $5,000. The defendant, Yao Jian Ping, appealed from the Civil Court of New York's order denying his motion to dismiss the action. The main issue in the case was whether the action was properly commenced in the Civil Court, given that the amount in dispute did not exceed $25,000. The court held that the action was properly commenced in Civil Court, as the amount in dispute did not exceed $25,000, based on Insurance Law § 5106(c) and CCA 212-a. As a result, the court affirmed the order, with costs awarded to Country-Wide Insurance Company.

The court considered whether the insurer should be allowed to amend its answer to include the affirmative defense of res judicata and to seek summary judgment dismissing the complaint on the ground that the plaintiff's action was barred based on that doctrine. The main issue decided was whether the insurer had waived its res judicata defense by submitting its answer in the Civil Court after it had commenced the declaratory judgment action. The holding of the court was that the order denying the insurer's motion was reversed, and the insurer's motion for leave to amend its answer to include the res judicata defense and to deem the answer served nunc pro tunc was granted. The court also held that, under the doctrine of res judicata, the plaintiff's action was barred based on the previous declaratory judgment entered by the Supreme Court.

The court considered the motion for summary judgment filed by defendant in an action to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant had established the timely and proper mailing of the examinations under oath (EUO) scheduling letters and the denial of claim forms, as well as the plaintiff's failure to appear for the EUOs. The holding of the court was that to establish its entitlement to summary judgment dismissing the complaint, the defendant insurer had demonstrated, as a matter of law, that it had twice duly demanded an EUO from the provider, that the provider had twice failed to appear, and that the insurer had issued a timely denial of the claims. The court further found that the plaintiff's argument that the defendant's EUO requests were unreasonable lacked any basis and that defendant's motion for summary judgment dismissing the complaint was granted.

The court considered a case in which Lotus Acupuncture, P.C. as the assignee of Jose Corsino sued Country-Wide Ins. Co. for first-party no-fault benefits. The judgment awarded the plaintiff $7,755 after a non-jury trial. The main issue decided was that the judgment must be reversed, as no testimony was taken as to the specific action, and a new trial should be held. The holding of the court was that the judgment was reversed and the matter was remitted to the Civil Court for a new trial. The court found that as no testimony was taken specifically for this action, a new trial must be held in order to make a fair and just ruling.