No-Fault Case Law

The court considered the issue of whether an insurance company was entitled to summary judgment in a case where a healthcare provider sought to recover unpaid no-fault benefits. The healthcare provider argued that it had established its entitlement to recovery, while the insurance company argued that the provider's assignor had failed to appear for scheduled Examinations Under Oath (EUOs) and that the accident was an intentional loss and therefore not covered. The court held that the insurance company's denials were untimely, as they were issued after the deadline, and that the evidence of a purposeful collision was insufficient to support the insurance company's defense. Therefore, the insurance company's motion for summary judgment was denied, and the healthcare provider's cross-motion for summary judgment was granted. The provider was entitled to recover the unpaid amount, along with statutory interest, attorneys' fees, and costs.

The relevant facts in this case were that the defendant-insurer, Global Liberty Insurance Company, attempted to invoke the primary jurisdiction of the Workers' Compensation Board (WCB) in two first-party no-fault actions nearly seven years after the issue was raised as an affirmative defense and during the trial. The main issue decided was whether the trial court properly denied the defendant's belated attempt to invoke the primary jurisdiction of the WCB. The holding of the case was that the trial court's decision to deny the defendant's attempt was affirmed, as the defendant's belated invocation of the primary jurisdiction of the WCB was seen as an attempt to further delay the litigation, and therefore was not allowed under these particular circumstances.

The court considered the date of entry of the judgment, the period for which postjudgment interest was sought, and the actions of both the plaintiff and defendant in making payment. The main issues decided were whether the defendant was entitled to stop the accrual of postjudgment interest and if the plaintiff's delay had caused the interest to accrue. The holding of the court was that the defendant was not entitled to stop the accrual of all postjudgment interest and that the matter was remitted to the Civil Court for a new determination of the branch of the defendant's motion seeking an order directing the clerk to enter a satisfaction of judgment. The court also emphasized that the plaintiff is only entitled to receive simple interest at the statutory rate of nine percent per year from the date of the entry of the judgment through the date of the payment of the judgment.

The relevant facts of the case involved a provider suing to recover assigned first-party no-fault benefits. The only issues for trial were whether the services rendered were medically necessary and whether the plaintiff had properly billed in accordance with the workers' compensation fee schedule. At a nonjury trial, the plaintiff's attorney moved to preclude the defendant's expert witnesses on the grounds of untimely disclosure and that disclosure had been made by facsimile transmission, a method of notice which the plaintiff's counsel had previously rejected. The defense argued that there would be no prejudice to the plaintiff as a result of the testimony, and counsel advised the court that his witnesses were present to testify. The Civil Court granted the plaintiff's motion to preclude the witnesses and denied the defendant's motion, pursuant to CPLR 4404 (b), to set aside the decision. The main issue decided was whether the decision of the Civil Court should be set aside, and the matter should be remitted for a new trial limited to the issues of medical necessity and billing pursuant to the workers' compensation fee schedule. The holding of the case was that the order was reversed, defendant's motion to set aside the decision of the Civil Court was granted, and the matter was remitted to the Civil Court for a new trial limited to the issues of medical necessity and billing pursuant to the workers' compensation fee schedule.

The main issues decided in this case were whether the services rendered were medically necessary and whether the plaintiff had properly billed in accordance with the workers' compensation fee schedule. During a nonjury trial, the plaintiff's attorney moved to preclude the defendant's expert witnesses on the grounds of untimely disclosure and that it had been made by facsimile transmission, a method of notice which the plaintiff's counsel had previously rejected. The Civil Court granted the plaintiff's motion to preclude the witnesses, and later denied the defendant's motion, pursuant to CPLR 4404 (b), to set aside the decision. The Appellate Court reversed the order and held that the defendant's motion should have been granted. The matter was remitted to the Civil Court for a new trial limited to the issues of medical necessity and billing pursuant to the workers' compensation fee schedule.

The main issues considered in this case were whether the services rendered were medically necessary and if the plaintiff had properly billed in accordance with the workers' compensation fee schedule. The court found that defendant's service of expert witness notices at issue should have been more prompt, but there was no intentional or willful failure to disclose by the defendant, and there was no showing of prejudice by the opposing party. As a result, the Civil Court erred in precluding defendant's expert witnesses. The holding of the court was to reverse the order, grant defendant's motion to set aside the decision of the Civil Court, and remit the matter to the Civil Court for a new trial limited to the issues of medical necessity and billing pursuant to the workers' compensation fee schedule.

Plaintiff commenced an action to recover no-fault medical benefits on November 10, 2009, and defendant served plaintiff's attorney with a 90-day written demand pursuant to CPLR 3216 (b) (3) on August 5, 2016. On January 13, 2017, 158 days after receiving the demand, plaintiff filed a notice of trial. Defendant moved to dismiss the plaintiff's complaint pursuant to CPLR 3216, and plaintiff did not oppose the motion. The issue was whether the plaintiff had demonstrated a justifiable excuse for its delay and the existence of a meritorious cause of action. The holding was that since plaintiff failed to oppose defendant's motion and demonstrate any ground to deny it, defendant's motion to dismiss the complaint pursuant to CPLR 3216 was granted.

The court considered whether the complaint should have been dismissed pursuant to CPLR 3216 after the defendant filed a notice of trial 94 days following a 90-day demand. The main issue was whether plaintiff's delay was justifiable and whether there was a meritorious cause of action. The court reversed the lower court's order and granted the defendant's motion to dismiss, finding that the plaintiff had not taken any action within 90 days of receiving the demand and had not demonstrated any grounds to deny the motion. The failure to oppose the plaintiff's motion rendered the delay inexcusable. Thus, the court held that the plaintiff's complaint should be dismissed.

The court considered a case in which Charles Deng Acupuncture, P.C. was appealing the denial of their motion for summary judgment and the granting of the defendant's cross motion for summary judgment dismissing the complaint. The main issue decided was whether the defendant had established with admissible evidence that Florida law applied to the case, limiting the amount available for no-fault reimbursement to $10,000, and whether the defendant had paid the full monetary limits of the policy at issue. The holding of the case was that the defendant failed to establish with admissible evidence that Florida law applied and that the payment log provided by the defendant did not constitute evidence in admissible form. This led to the denial of the defendant's cross motion for summary judgment, and the order was modified to reflect this decision. The court also determined that plaintiff's motion for summary judgment was properly denied, as the proof submitted by plaintiff failed to establish that the claims had not been timely denied.

The court considered the fact that the defendant failed to send a delay letter to the plaintiff as required by 11 NYCRR 65-3.6 (b) after sending a second examination under oath (EUO) scheduling letter to the plaintiff's assignor. As a result, the defendant failed to properly toll the time to pay or deny the plaintiff's claims, and was precluded from raising its defense that the plaintiff's assignor had failed to appear for scheduled EUOs. The main issue decided was whether the defendant had properly sent a delay letter to the plaintiff in accordance with the regulations. The holding of the case was that the judgment in favor of the plaintiff was affirmed, as the defendant failed to comply with the regulations regarding the sending of the delay letter.