No-Fault Case Law
Medical Supply of NY Corp. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50412(U))
April 1, 2025
In this case, the court considered the admissibility of the Kuperman Affidavit, which was contested by the defendant on the grounds that it lacked a proper notarial signature, as it simply contained the word "February" scripted above the signature line instead of the notary's actual name. The main issues included whether the affidavit could still be considered valid despite this technical defect and whether the defendant was prejudiced by its admissibility. The court ultimately held that while the Kuperman Affidavit was defective in form, the defect was not fatal and could be rehabilitated per CPLR § 2001, since the defendant had not demonstrated substantial prejudice or a deprivation of a substantial right. Consequently, the court ruled the affidavit admissible and found that the plaintiff had established a triable issue regarding the outstanding verification requests, while also granting summary judgment to the defendant for having timely issued its denials.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2025 NY Slip Op 50376(U))
March 24, 2025
The court considered the defendant’s argument that the plaintiff, Burke Physical Therapy, failed to timely respond to verification requests as mandated by 11 NYCRR §65-3.5(o). The main issues were whether the plaintiff provided the requested verification within the required timeframe and whether any reasonable justification for the delay was offered. The court found that the plaintiff’s affidavits, which merely stated that documentation was mailed without corroborating evidence, were insufficient to raise a triable issue of fact. As a result, the court granted the defendant's cross-motion for summary judgment and dismissed the plaintiff's case with prejudice, affirming that the plaintiff did not comply with the necessary verification procedures.
Unitrin Safeguard Ins. Co. v Manuel (2025 NY Slip Op 01727)
March 20, 2025
The court considered several key facts, including that the claimants asserted they were passengers in a vehicle involved in an accident on January 9, 2022, and intended to submit no-fault insurance claims. However, the claimants did not respond to the lawsuit, leading the court to grant a default judgment against them. The plaintiff, Unitrin Safeguard Insurance Company, provided evidence that the injuries did not arise from the accident, which included an investigator's affidavit detailing the incident and testimony from occupants of the other vehicle who described the accident as minimal and indicated no visible injuries or damage. The main issues decided included whether the claims were valid based on the circumstances of the accident and the credibility of the claimants’ accounts, ultimately concluding that the claimants' lack of a plausible and supported claim negated any duty to pay. The court held that the plaintiff had no obligation to cover the no-fault claims submitted by the medical providers, confirming the summary judgment in favor of the plaintiff.
American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C. (2025 NY Slip Op 01337)
March 12, 2025
In this case, the court considered the issue of whether separate arbitral awards could be treated as a single award for the purposes of establishing subject matter jurisdiction under Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii). The relevant facts included four distinct arbitral awards issued in favor of the defendant, Comfort Choice Chiropractic, for chiropractic services provided to a single individual, each award being less than the $5,000 threshold required for de novo review in court. The main issue was whether the court could aggregate these separate awards to meet the jurisdictional threshold. The court held that the plain language of the statutes did not allow for such aggregation, stating that each award must independently meet the $5,000 requirement. Consequently, the court reversed the lower court's order, dismissed the complaint due to lack of jurisdiction, and granted an award of reasonable attorney's fees to the defendant.
Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C. (2025 NY Slip Op 01363)
March 12, 2025
The court considered the arbitration award issued in favor of Comfort Choice Chiropractic, P.C. on February 11, 2022, and the subsequent proceeding initiated by American Transit Insurance Company to vacate that award. The main issues decided included Comfort Choice's request for attorney's fees in connection with enforcing the arbitration award, as specified under 11 NYCRR 65-4.10(j)(4). The Appellate Division reversed the lower court's decision that denied Comfort Choice's cross-motion for attorney's fees and granted that request, ordering the case be remitted to the Supreme Court for a determination of the reasonable attorney's fees owed to Comfort Choice. The ruling reinforced the entitlement to attorney's fees under the specified regulation when a valid claim for no-fault benefits is overdue.
Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50306(U))
March 7, 2025
In this case, Burke 2 Physical Therapy, P.C. appealed a Civil Court order that dismissed its complaint seeking no-fault benefits from State Farm Mutual Automobile Insurance Company. The court considered the legitimacy of State Farm's verification requests, which aimed to determine the provider's eligibility for benefits based on licensing requirements, as established by prior case law. The main issues were whether State Farm's requests for documentation were proper and whether the plaintiff's cross-motion for summary judgment and separate motion to dismiss affirmative defenses should have been granted. Ultimately, the court held that State Farm's verification requests were appropriate and affirmed the dismissal of the plaintiff's complaint, denying the plaintiff’s motions as lacking merit.
Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50306(U))
March 7, 2025
The court considered the relevance of the defendant's verification requests, which sought to gather various documents from the plaintiff to assess whether the plaintiff met the necessary licensing requirements to collect no-fault benefit payments. The main issues addressed were whether the defendant's requests for documentation were justified and whether the plaintiff had grounds for their appeal concerning the denial of their cross-motion for summary judgment and a separate motion to dismiss the defendant's affirmative defenses. Ultimately, the court held that the defendant's motion for summary judgment to dismiss the complaint was valid, the plaintiff's cross-motion was appropriately denied, and the order from the Civil Court was affirmed with costs to the defendant. The court also noted that the plaintiff's amended cross-motion was not addressed in the order on appeal, so the issue was not considered.
KBJ Med. Practice, P.C. v Lancer Ins. Co. (2025 NY Slip Op 50277(U))
March 3, 2025
The court considered whether the defendant, Lancer Insurance Co., met its burden to demonstrate that proper notices for an examination under oath were mailed to the assignor, Ismael Sejour, and whether Sejour failed to appear. The key issues were whether the notices were properly sent and if the defendant could establish personal knowledge of the mailing procedures. The court found that while the defendant successfully demonstrated Sejour's nonappearance through a certified transcript, it failed to conclusively show that the notices had been properly mailed. Consequently, the motion for summary judgment was granted in part, confirming the assignor's failure to appear at the examination, while leaving the question of proper notice mailing to be resolved at trial.
KBJ Med. Practice, P.C. v Lancer Ins. Co. (2025 NY Slip Op 50277(U))
March 3, 2025
The court considered several key facts in determining the outcome of the case, particularly regarding the procedural requirements for providing notice for an examination under oath (EUO). The main issue was whether the defendant, Lancer Insurance Co., properly mailed the notices to the assignor, Ismael Sejour, and whether Sejour's failure to appear for the EUO justified granting summary judgment. The court found that while Lancer Insurance Co. had demonstrated the assignor's failure to appear, it failed to establish that proper notice was given, as the evidence presented included boilerplate language lacking personal knowledge and did not satisfactorily prove the mailing procedures. Consequently, the court granted the defendant's motion only to the extent that it recognized the assignor's failure to appear for the EUO, while leaving the question of whether the notices were properly mailed unresolved for trial.
Medical Supply of NY Servs. Inc. v State Farm Mut. Auto Ins. Co. (2025 NY Slip Op 50301(U))
February 21, 2025
In this case, the Plaintiff, as assignee of a medical treatments provider, sought to recover No-Fault benefits from the Defendant for a treatment rendered. The main issue revolved around the Defendant’s claim that the Assignor had failed to attend two scheduled Examinations Under Oath (EUOs), which the Defendant asserted as grounds for seeking summary judgment. The Court previously denied the Defendant's summary judgment motion, determining that there were issues of fact regarding the Assignor's non-attendance and noting that the Defendant failed to provide sufficient proof that the Assignor did not appear. In the subsequent motion to reargue, the Court found the Defendant's supporting affidavit did not sufficiently demonstrate personal knowledge of the non-appearance, reiterating that mere assertions of absence without presence at the EUO lacked probative value. Ultimately, the Court denied the reargue motion, affirming its earlier decision that the Defendant had not met its burden of proof.