No-Fault Case Law

The court considered the relevant facts involving an action in which the respondent brought suit to avoid payment of certain no-fault claims submitted by the appellant based on the appellant's failure to follow conditions precedent to coverage or to verify its claims. The issue before the court was whether the defaulting appellant, which did not answer or appear in response to the suit after being served through the Secretary of State, could vacate the default judgment and defend the action, and whether the appellant demonstrated a reasonable excuse for the default and a potentially meritorious defense to the action. The court held that the defaulting appellant, having failed to substantiate that it did not have actual notice of the action in time to defend, did not have a reasonable excuse for the default pursuant to CPLR 5015 (a) (1), and the motion pursuant to CPLR 5015 (a) (1) was untimely. Thus, the court affirmed the lower court's denial of the appellant's motion to vacate the judgment.

The main issue before the court was whether to vacate an order of administrative dismissal under CPLR 3215(c) and enter a default judgment against Defendant for failure to respond to an action seeking reimbursement for medical services provided under the No-Fault system. Plaintiff had failed to serve the summons and complaint on Defendant until over two years after the statutory 120-day service period had expired, and also failed to move for an extension of time to effectuate service. Plaintiff argued that the court's failure to give notice of the impending administrative dismissal deprived them of an opportunity to be heard. The court held that the dismissal was proper under CPLR 3215(c) as the case lay dormant in the court system without a default judgment against Defendant for over three years, and that Plaintiff's vague excuses for the procedural defects, including law office failure due to a new case management and computer system, were not valid reasons to vacate the dismissal. The holding of the case was that Plaintiff's motion to vacate the order of administrative dismissal pursuant to CPLR 3215(c) was denied, and the complaint was dismissed with prejudice.

The court considered the denial of a motion by the defendant to dismiss the complaint, or in the alternative, to compel the plaintiff to produce its owner for an examination before trial, and the granting of the plaintiff's cross motion for summary judgment. The main issue decided was whether the defendant's argument for dismissal based on plaintiff's reimbursement pursuant to a fee schedule of a practitioner provider option (PPO) agreement, and the failure to name Multiplan as a necessary party, was valid. The holding was that the branch of the defendant's motion seeking to compel the plaintiff to produce its owner for an examination before trial was granted, and the plaintiff's cross motion for summary judgment was denied. The court also found that the plaintiff failed to establish its prima facie entitlement to summary judgment, as the evidence did not prove that the claims in question had not been timely denied, or that the defendant had issued timely denial of claim forms that were without merit as a matter of law.

The main issue in this case was whether the Civil Court properly granted defendant's motion to vacate a judgment entered upon their failure to appear or answer the complaint, and to compel the plaintiff to accept defendant's late answer. The court considered the reasons stated in a similar case and affirmed the order, holding that the judgment was properly vacated and the plaintiff was compelled to accept the defendant's late answer. The relevant facts considered by the court were not explicitly mentioned in the summary, but it can be inferred that the plaintiff had initially been granted a judgment upon the defendant's failure to respond, and the defendant later sought to vacate this judgment and submit a late answer. Ultimately, the court held in favor of the defendant, granting their motion and compelling the plaintiff to accept their late answer.

The Court considered the case of Prompt Medical Supply, Inc. as the assignee of Gladstone Lawrence against State Farm Mutual Auto Ins. Co. The main issue decided was whether the defendant had established a reasonable excuse for not timely answering the complaint and the existence of a potentially meritorious defense to the action. The holding was that the Civil Court did not improvidently exercise its discretion in finding that the defendant had established a reasonable excuse for not timely answering the complaint, as the defendant had reasonably believed that the plaintiff might withdraw the action and had failed to provide requested verification. Therefore, the order was affirmed.

The court considered an appeal from an order of the Civil Court in Kings County denying the defendant's motion to dismiss the complaint on the ground that the court lacked personal jurisdiction over the defendant in a case involving a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the Civil Court had personal jurisdiction over the defendant, American Independent Insurance Co., in the case. The holding of the court was that the order denying the defendant's motion to dismiss the complaint was reversed, and the defendant's motion to dismiss the complaint was granted based on the reasons outlined in Pavlova v American Ind. Ins. Co. and previous relevant cases. Therefore, the defendant's motion to dismiss the complaint was ultimately granted.

The court considered the motion to dismiss the complaint pursuant to CPLR 3216 in the case of Pro Health Acupuncture, P.C. v GEICO Insurance. Plaintiff commenced the action to recover assigned first-party no-fault benefits on May 10, 2011, and defendant served a 90-day written demand pursuant to CPLR 3216, which plaintiff failed to respond to or explain the delay. Despite serving a notice of trial and opposing the motion, the court held that plaintiff failed to establish a justifiable excuse for its delay and the existence of a meritorious cause of action, and therefore, the motion to dismiss the complaint was granted. The holding of the case was the reversal of the order, with the decision that defendant's motion to dismiss the complaint pursuant to CPLR 3216 is granted.

The main issue decided in this case was whether the defendant, Metropolitan Group Prop. & Cas. Ins, was entitled to summary judgment based on the plaintiff's alleged failure to appear for an Examination Under Oath (EUO) in an action to recover assigned first-party no-fault insurance benefits. The court found that while the plaintiff did not attend the scheduled EUOs, the defendant failed to establish through admissible evidence that the EUO scheduling letters and denials were properly addressed and mailed to the plaintiff. The court concluded that the defendant did not fulfill the requirements of CPLR 4518(a) and failed to eliminate all triable issues of fact in connection with establishing its proper mailing of the EUO scheduling letters and denials. As a result, the defendant's motion for summary judgment was denied.

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.