No-Fault Case Law

In this case, the court considered relevant facts regarding State Farm's obligation to provide no-fault coverage for claims submitted by Lifeline Medical Imaging, P.C. State Farm argued that Lifeline failed to comply with a condition precedent for coverage by not attending scheduled examinations under oath (EUOs) and not supplying a necessary individual for information verification. The main issues decided concerned whether State Farm provided an objective justification for requiring the EUOs, as mandated by no-fault regulations, and whether State Farm had adequately responded to Lifeline's discovery requests regarding the standards used for scheduling the EUOs. The holding of the court was that State Farm's motion for summary judgment was denied as premature, and the declaration that it had no obligation to pay Lifeline's claims was vacated, as the criteria for the EUO request remained undetermined.

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.

In this case, the court considered the fact that the injured claimant failed to attend two independently scheduled medical examinations (IMEs) that were properly noticed by the insurance company. The main issues decided were whether the insurer was obligated to pay no-fault benefits despite the claimant's absence from the IMEs and if the notices were timely under the applicable regulations. The court held that the plaintiffs were entitled to summary judgment, determining that the claimant's failure to attend the properly noticed IMEs foreclosed any obligation for the insurer to provide coverage for the associated medical claims. The decision emphasized that failure to attend these examinations constituted a coverage defense applicable to all claims, rather than on a bill-by-bill basis.

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.

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.

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.

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.

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.

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.

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.