No-Fault Case Law

The court considered several relevant facts, including the timeline of events surrounding the service of the summons and complaint to the defendant, Berkshire Hathaway, which was served through the New York State Department of Financial Services (DFS). The defendant received the complaint on June 3, 2019, but a default judgment was entered against it on September 12, 2019, after it failed to respond in time. The main issues in this case revolved around whether the default judgment should be vacated based on the defendant's late filing of its answer and whether it had a meritorious defense regarding the complainant’s entitlement to no-fault benefits due to potential coverage under workers' compensation. The court ultimately held that the defendant had established sufficient grounds to vacate the default judgment, as it did not have timely notice to defend itself and presented a potentially valid defense related to the plaintiff’s assignor's employment status at the time of the accident. Consequently, the order to vacate the judgment was affirmed.

In this case, the court considered whether the defendant, Nationwide General Insurance Company, had exhausted its policy limits before the plaintiff, Chiropractic Associates of Richmond Hill, submitted claims for no-fault benefits. The main issue was whether the defendant could successfully prove that the policy limits had been reached, which would lead to the dismissal of the complaint. The court concluded that the defendant failed to provide sufficient evidence to demonstrate that the policy limits were exhausted at the time the claims were received from the plaintiff. Consequently, the court affirmed the lower court's order denying the defendant's motion for summary judgment, ruling that the defendant did not make a prima facie showing of entitlement to a dismissal.

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.

In this case, the court considered relevant facts pertaining to the failure of the plaintiff, a chiropractic provider seeking to recover no-fault benefits, to appear for duly scheduled examinations under oath (EUOs). The main issue was whether the plaintiff's absence justified the defendant's motion for summary judgment, which sought to dismiss the complaint on these grounds. The court found that the attorney's affirmation regarding the plaintiff's failure to appear was sufficient evidence to establish this absence, noting that the attorney was present and prepared to conduct the EUOs. The court determined that there was no merit to the plaintiff's contention that the attorney's memory of the events was questionable. As a result, the court affirmed the lower court's order granting the defendant's motion to dismiss the complaint.

In this case, the court considered the facts surrounding a provider's attempt to recover assigned first-party no-fault benefits after the defendant, Progressive Insurance Co., moved for summary judgment on the grounds that the plaintiff's assignor had materially misrepresented where the insured vehicle was garaged. The main issues involved whether the defendant had timely denied the claims based on these misrepresentations, which could affect its ability to assert this defense in court. The court determined that the defendant's failure to establish timely denial of the claims meant that it could not rely on the misrepresentation defense, ultimately leading to a reversal of the lower court's order and a denial of the defendant's motion for summary judgment. The decision underscored the importance of timely denial in asserting defenses related to misrepresentation.

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 the facts surrounding a no-fault insurance settlement that was agreed upon in December 2001, but not paid by the insurance company until a judgment was entered in February 2017, which awarded statutory no-fault interest based on a simple rate. The appellant argued that the interest should be recalculated at a compound rate, citing statutory provisions and prior case law. A major issue involved the delay in entering the judgment, which the lower court cited as a reason to deny the compound interest and toll the accrual of that interest. The appellate court held that the lower court erred in tolling the statutory no-fault interest and ruled that the plaintiff was entitled to compound interest as a result of the settlement, remanding the case for the entry of a new judgment that reflected this decision. The appellate court emphasized that the insurance company did not deny the settlement agreement and failed to challenge the previous judgment.

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.