No-Fault Case Law

The court considered an order from the District Court of Suffolk County which denied the defendant's motion to dismiss 17 of 21 claims for first-party no-fault benefits, and granted the plaintiff's cross motion for summary judgment. The main issue decided was whether the letters scheduling examinations under oath (EUOs) of the plaintiff were defective. The court held that the EUO scheduling letters were not defective, as they properly identified the assignor, the date of the accident, and the defendant's file number. The court also found that the defendant had timely mailed denial of claim forms and that the plaintiff had failed to appear for the scheduled EUOs. As a result, the court modified the order to grant the defendant's motion to dismiss 17 of the claims and denied the plaintiff's cross motion for summary judgment on those 17 claims.

The court considered the no-fault benefits claim for medical expenses filed by the plaintiff after being struck by a motor vehicle owned by George W. Nellen, whose insurance carrier was the defendant. The defendant denied the plaintiff's application for benefits on the grounds that the injuries were not related to the motor vehicle accident. The defendant moved to dismiss the complaint on the basis that the plaintiff had assigned his right to receive no-fault benefits to various medical providers and thus had no standing to bring the action. The main issue decided was whether the defendant was entitled to summary judgment dismissing the complaint, and the court held that the defendant was entitled to judgment as a matter of law because the plaintiff failed to raise a triable issue of fact. Therefore, the court reversed the order denying the defendant's motion and granted the motion for summary judgment dismissing the complaint.

The relevant facts in the case involved a no-fault insurance carrier commencing an action seeking a judgment declaring it was not obligated to pay a claim for no-fault insurance benefits submitted by the defendant on behalf of its assignor John Thomas. The defendant had been awarded more than $5,000 against the plaintiff as a result of a master arbitration award. The plaintiff moved for leave to enter a default judgment against the defendant based upon the defendant's failure to answer the complaint or appear in this action. The Supreme Court denied the plaintiff's motion on the basis that the master arbitration award was supported by evidence in the record and was not arbitrary or capricious. The main issue decided was whether the plaintiff's motion for leave to enter a default judgment against the defendant should have been granted, and whether a judgment should be declared that the plaintiff is not obligated to pay a claim for no-fault insurance benefits submitted by the defendant on behalf of its assignor John Thomas. The holding of the court was that the plaintiff's motion for leave to enter a default judgment against the defendant should have been granted, and since it was a declaratory judgment action, the matter must be remitted to the Supreme Court for the entry of a judgment declaring that the plaintiff is not obligated to pay a claim for no-fault insurance benefits submitted by the defendant on behalf of its assignor John Thomas.

The main issue in this case was whether the plaintiff, RX Warehouse Pharmacy Inc., was entitled to recover assigned first-party no-fault benefits for breach of contract from the defendant, Erie Insurance Exchange. The court considered the defendant's motion to dismiss the action on the grounds of failure to join a necessary party, specifically the insurance carrier for the plaintiff's assignor, Mikhail Soldatov. The defendant argued that it was not the insurer of Soldatov's vehicle and therefore had no duty to provide him with no-fault coverage. The plaintiff, however, claimed that the court lacked subject matter jurisdiction to hear the defense that another insurance carrier was responsible for the plaintiff's claims and argued that the issue must be resolved through arbitration. The court ultimately found in favor of the defendant, granting their motion to interpose an answer within 30 days due to the lack of evidence that Soldatov was an "eligible injured person" under defendant's policy.

The court considered the fact that the provider was seeking to recover assigned first-party no-fault benefits in the amount of $342.01. The main issue decided was whether the defendant had established the proper mailing of the independent medical examination (IME) scheduling letters and whether the plaintiff's assignor had failed to appear for the IMEs. The holding of the court was that the proof submitted by the defendant was sufficient to establish the proper mailing of the IME scheduling letters and that the plaintiff's assignor had failed to appear for the IMEs. The court also found that there was an issue of fact as to whether the defendant had received the claim seeking reimbursement in the amount of $342.01, and as a result, neither party was entitled to summary judgment upon that claim. Therefore, the court modified the order by denying the branch of the defendant's motion seeking summary judgment dismissing the claim in the amount of $342.01.

The court considered the fact that the plaintiff, Bronx Chiropractic Care, P.C., had failed to appear for scheduled examinations under oath (EUOs) as demanded by the defendant, State Farm Insurance. The main issue decided in this case was whether the defendant's motion for summary judgment dismissing the complaint should have been denied because the plaintiff objected to the EUO demands and the defendant failed to establish that the demands were reasonable. The holding of the case is that the order granting the defendant's motion for summary judgment was affirmed, with the court concluding that the plaintiff's objection to the EUO demands and the defendant's failure to establish the reasonableness of the demands were not sufficient to deny the motion. Therefore, the plaintiff failed to provide a valid defense to the motion for summary judgment.

The court was presented with the issue of whether the defendant's motion for summary judgement dismissing the complaint was valid. The plaintiff argued that the defendant's motion should have been denied because the plaintiff objected to the defendant's examinations under oath (EUOs) demands and the defendant failed to establish that the demands were reasonable. However, the court held that the defendant was not required to provide a reason for its demand for an EUO in response to an objection from the plaintiff, as it was not specified in the regulation. Since the plaintiff's sole argument was based on this ground and the court found no basis to disturb the order, it affirmed the order granting the defendant's motion for summary judgement.

The court considered the facts that the plaintiff, Actual Chiropractic, P.C., was seeking to recover first-party no-fault benefits from State Farm Insurance and that State Farm had requested the plaintiff to appear for examinations under oath (EUOs) but the plaintiff failed to do so. State Farm issued a timely denial of the claims on the ground that the plaintiff failed to appear for the EUOs. The main issue decided was whether State Farm was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to appear for the scheduled EUOs. The court held that State Farm had established its prima facie entitlement to summary judgment by demonstrating that it twice duly demanded an EUO from the plaintiff, that the plaintiff failed to appear, and that State Farm issued a timely denial of the claims. Therefore, the court reversed the order of the trial court and granted State Farm's motion for summary judgment dismissing the complaint.

The main issues in this case were whether the action by the provider to recover assigned first-party no-fault benefits should be held in abeyance pending a determination by the Workers' Compensation Board of the parties' rights under the Workers' Compensation Law, and whether there is an issue of fact as to whether the plaintiff's assignor had been acting in the course of his employment at the time of the accident and that, therefore, workers' compensation benefits might be available. The Civil Court of the City of New York, Kings County granted the branch of defendant's cross motion seeking to hold the action in abeyance. The court determined that the issue of eligibility for workers' compensation benefits must be resolved in the first instance by the Workers' Compensation Board before the court considers whether the plaintiff is entitled to recover first-party no-fault benefits. Therefore, the order was affirmed.

The relevant facts of the case involve a dispute between Global Liberty Insurance Company and Medco Tech, Inc. regarding a claim for no-fault insurance benefits for medical equipment provided to an individual involved in a motor vehicle accident. Global Liberty Insurance Company relied on a peer review report that concluded the individual's condition was degenerative and not post-traumatic, and therefore the surgery undergone was not medically necessary in relation to the accident. The main issue decided by the court was whether the need for the medical equipment was causally related to the accident. The holding of the court was that the arbitral award must be vacated and a de novo hearing held because, based on the record before them, it would be irrational to conclude that the need for the medical equipment was causally related to the accident. Therefore, the court reversed the judgment against Global Liberty Insurance Company and granted their motion to vacate the award, while denying Medco Tech, Inc.'s motion to confirm the award.