No-Fault Case Law
Matter of Fill Rx NY, Inc. v LM Gen. Ins. Co. (2025 NY Slip Op 04785)
August 27, 2025
The court considered the facts surrounding Fill Rx NY, Inc.'s claim for no-fault insurance benefits against LM General Insurance Company, which totaled $4,151.53 for pharmaceutical products provided to an assignor after a motor vehicle accident. The main issues decided included whether the March 2023 master arbitration award, which confirmed the earlier January 2023 arbitration award denying Fill Rx's claim, should be vacated on grounds of being irrational, arbitrary and capricious, or incorrect as a matter of law. The court held that Fill Rx failed to demonstrate valid grounds for vacating the master arbitration award, as the determinations made by the master arbitrator were supported by evidence and had a rational basis. As a result, the court affirmed the judgment in favor of LM General, dismissing Fill Rx's petition.
Matter of Progressive Ins. Co. v Service (2025 NY Slip Op 04652)
August 13, 2025
In this case, the court considered facts surrounding an accident involving Shante D. Service, who was injured while in a vehicle operated by Artur Nazaryan, a Lyft driver. The vehicle was insured by Hereford Insurance Company, and Progressive Insurance Company also provided coverage for Lyft that included supplementary uninsured motorist (SUM) benefits. Progressive denied coverage and sought to stay arbitration for Service's claim, asserting that she was not an "insured" under their policy because the accident occurred while the vehicle was being used for a prearranged trip, which was categorized as a "for-hire vehicle" and not a "TNC vehicle." The main issue was whether Service qualified as an insured under the SUM endorsement. The court held that Service did not qualify as an insured under the terms of the policy, thereby granting the petition to permanently stay arbitration.
Matter of Liberty Mut. Ins. Co. v McCormack (2025 NY Slip Op 04571)
August 6, 2025
The court considered the proceedings initiated by Liberty Mutual Insurance Company to permanently stay arbitration of a claim filed by Kerio McCormack for supplemental uninsured motorist (SUM) benefits. The main issue was whether McCormack qualified as an insured under the SUM endorsement of the relevant insurance policy, as Liberty Mutual argued that he did not. McCormack opposed the stay, asserting that there existed a triable issue of fact regarding his status as an insured, specifically whether he was occupying a vehicle insured by Liberty Mutual during the incident in question. The court ultimately held that the Supreme Court should not have granted Liberty Mutual's request to stay arbitration without first conducting a framed-issue hearing to resolve the factual dispute regarding McCormack's eligibility for SUM coverage. Consequently, the order was reversed with directions for further proceedings.
Shamrock Med., P.C. v Personal Serv. Ins. Co. (2025 NY Slip Op 51175(U))
July 18, 2025
In this case, the court considered the procedural posture of the appeal concerning a no-fault benefits dispute, where Shamrock Medical, P.C., as the assignee of Rexford Bishop, sought to recover benefits from Personal Service Insurance Company. The primary issue resolved was whether the order of the Civil Court, which granted the defendant’s motion to dismiss the complaint in part by setting a traverse hearing, was appealable. The holding determined that no appeal lies as of right from such an order, leading to the dismissal of the appeal. The court referenced relevant case law to support its decision and concluded that leave to appeal was not warranted.
LVOV Acupuncture, P.C. v Personal Serv. Ins. Co. (2025 NY Slip Op 51176(U))
July 18, 2025
In this case, the court considered the appeal by Personal Service Insurance Company regarding a prior order that granted a motion to dismiss the complaint only to the extent of setting the matter down for a traverse hearing. The main issues involved whether the dismissal of the complaint should be upheld or if the traverse hearing was warranted based on the evidence presented. Ultimately, the court held that the appeal was dismissed, reaffirming the lower court's decision to set the matter for a traverse hearing rather than fully dismissing the complaint. This decision aligns with the precedent established in a related case, indicating the court's commitment to examining the necessary facts before a final resolution.
Hand By Hand PT, P.C. v Personal Serv. Ins. Co. (2025 NY Slip Op 51177(U))
July 18, 2025
In this case, the court considered the appeal from a Civil Court order that partially granted the defendant's motion to dismiss the complaint filed by a medical provider seeking to recover assigned no-fault benefits. The main issue was whether the dismissal of the complaint should proceed in full or if a traverse hearing was necessary to evaluate the facts presented. The court ultimately held that the appeal was dismissed, affirming the lower court's decision to set the matter down for a traverse hearing rather than granting a complete dismissal of the complaint. This decision aligns with precedents established in similar cases involving insurance disputes over no-fault benefits.
New York Recovery PT, P.C. v American Tr. Ins. Co. (2025 NY Slip Op 25166)
July 17, 2025
The court considered the denial of attorney's fees to New York Recovery PT, P.C., after the provider's claims for assigned first-party no-fault benefits were initially denied, leading to an arbitration award in favor of the provider. The main issues addressed were whether the provider was entitled to attorney's fees despite the proceeding primarily involving the confirmation of a master arbitration award rather than resolving a dispute de novo. The court held that the provider was indeed entitled to attorney's fees since the insurer failed to timely pay the arbitration award, as dictated by the regulations governing no-fault claims. Consequently, the appellate court reversed the district court's ruling, granting the provider's motion for attorney's fees and remitting the case for determination of the reasonable fee amount.
Prompt Med. Group, Inc. v Erie Ins. Co. of N.Y. (2025 NY Slip Op 51164(U))
July 11, 2025
In this case, the court considered the relevant facts surrounding an accident involving a vehicle insured by Erie Insurance Company and an attempt by Prompt Medical Group, as an assignee, to recover no-fault benefits. The main issue was whether the vehicle insured by the defendant was involved in the accident, as claimed by the plaintiff. The defendant's motion for summary judgment was based on statements in a police report, but the court found these statements to be inadmissible hearsay, lacking proper exceptions to the hearsay rule. Additionally, the court noted that conflicting accounts regarding the occurrence of the accident raised material issues of fact. Ultimately, the court reversed the lower court’s order, denied the defendant's motion for summary judgment, and ruled that the plaintiff's claims needed to be further examined in court.
State Farm Mut. Auto. Ins. Co. v Rubel (2025 NY Slip Op 25186)
July 9, 2025
In this case, the court considered facts surrounding a motor vehicle accident that occurred on January 5, 2024, involving a driver associated with Uber. The main issues revolved around whether Uber could be held vicariously liable for the driver’s actions during the incident, given that the driver was characterized as an independent contractor. Defendants Uber sought to dismiss the complaint on the grounds that they had no control over the driver or the vehicle involved. The court found that Uber's documentary evidence did not conclusively refute the plaintiff's allegations regarding the existence of an employer-employee relationship, highlighting that the agreement between Uber and the driver still indicated some degree of control by Uber. Ultimately, the court denied Uber's motion to dismiss, allowing the case to proceed.
Medtech Med. Supply, Inc. v Liberty Mut. Ins. Co. (2025 NY Slip Op 51150(U))
June 20, 2025
In this case, the court evaluated the procedural compliance of the plaintiff, Medtech Medical Supply, Inc., with CPLR 5003-a regarding the tender of a release and a stipulation of discontinuance before entering judgment for no-fault benefits. The main issues addressed included whether the plaintiff had fulfilled its obligations under CPLR 5003-a (a) by properly tendering the necessary documents and whether the defendant, Liberty Mutual Ins. Co., adequately demonstrated noncompliance. The court found that the defendant did not provide sufficient evidence to support its claim that the plaintiff failed to tender the requisite documents in accordance with the statute. Consequently, the court upheld the earlier decision, affirming the order that denied the defendant’s motion to vacate the judgment entered against it.