No-Fault Case Law

The court considered several key facts in this case, including the timely mailing of examination under oath (EUO) scheduling letters by the defendant, State Farm, and the plaintiffs' failure to appear for two scheduled EUOs. The main issues decided included whether the defendant's denial of claims was timely and if the plaintiff had effectively rebutted the defendant's arguments regarding the denial of one particular bill, which was denied after a missed EUO. The court held that the defendant's denial was indeed timely, as the time to deny remained tolled due to the pending EUO request when subsequent bills were submitted. As a result, the court granted the defendant's cross-motion for summary judgment, denied the plaintiff's motion, and dismissed the case with prejudice.

The court considered the motions of the defendants-appellants to vacate default judgments that were previously granted in favor of Hereford Insurance Company, which had denied them no-fault insurance coverage. The main issues decided included whether the appellants provided a reasonable excuse for their defaults and whether the default judgments were null and void due to the plaintiff's failure to submit evidentiary proof as required by law. The court affirmed the lower court's decision to deny the motion to vacate, stating that the appellants failed to demonstrate a reasonable excuse for not responding to the complaint and that their arguments lacked merit. Additionally, the court noted that the failure to submit the required proof for default judgments was not a jurisdictional defect, thus not rendering the judgments null. Ultimately, the court upheld the denial of the appellants' motions, affirming the plaintiff's position on the issue of coverage.

In this case, the court considered whether the action brought by Ocean View Medical Care to recover assigned no-fault benefits was barred by the statute of limitations. The main issue was whether the claim determination period had been tolled due to requests for verification from the insurance company. The court found that the argument presented by the defendant regarding the accrual date of the cause of action, which arose in response to new evidence submitted by the plaintiff, was appropriately considered. Ultimately, the Civil Court granted the defendant's cross-motion to dismiss the complaint on statute of limitations grounds and denied the plaintiff's motion for a default judgment as moot. The order was affirmed with costs.

The court considered several relevant facts in this case, particularly focusing on the plaintiff's failure to comply with scheduled examinations under oath (EUOs). Although the owner of the plaintiff appeared for an EUO on April 10, 2018, their counsel refused to allow answers to the questions posed, leading the defendant to view it as a no-show. Subsequently, the defendant scheduled four additional EUOs, but the plaintiff’s owner left the last scheduled EUO on September 6, 2018, before it could commence. The main issues decided included whether the plaintiff's actions constituted a failure to appear for the EUOs and whether the defendant's denial of the claim was timely issued following these failures. The court held that the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's non-compliance with the EUO requirements, affirming the lower court's decision.

The court considered relevant facts surrounding an injury sustained by the plaintiff while operating a tractor trailer during his employment with Casa Builders, Inc., which did not provide workers' compensation coverage. The primary issue was whether the plaintiff was entitled to no-fault insurance benefits despite not applying for workers' compensation benefits through the Uninsured Employers' Fund, particularly since the employer lacked workers' compensation coverage at the time of the accident. The court held that the plaintiff must first seek workers' compensation benefits, as they are the primary source for recovery in such cases, before pursuing no-fault insurance benefits. Consequently, the Supreme Court properly granted the defendant's motion for summary judgment dismissing the complaint, reinforcing the principle that benefits from workers' compensation and no-fault insurance cannot be pursued simultaneously.

The court considered the plaintiffs' entitlement to first-party no-fault benefits for interventional pain management services, specifically for radiologic assistance used in administering trigger point injections. The main issue was whether the plaintiffs were entitled to reimbursement for multiple units of radiology services (CPT 76942) billed in conjunction with the trigger point injection code (CPT 20553). The defendant contended that only one unit of the radiology service was reimbursable, relying on expert testimony that referenced coding opinions from the American Medical Association. In contrast, the plaintiffs argued for multiple reimbursements based on the guidance provided in the New York State Workers' Compensation Medical Fee Schedule. Ultimately, the court held that the Fee Schedule allowed for multiple billing and reimbursement of the radiology codes, thus ruling in favor of the plaintiffs and awarding them the stipulated amounts.

In this case, the court considered the petitions and cross-petitions relating to an arbitrator's award that denied a claim for first-party no-fault benefits for medical services rendered to Eufrosine Ola. The main issues decided included whether the arbitrator’s award and the master arbitrator’s affirmation of that award were valid, and whether the matter should be remitted for a rehearing before a new arbitrator. The Civil Court initially vacated the arbitrator's awards, finding them arbitrary and contrary to settled law, but did not order a rehearing. Upon reargument, the court affirmed the vacatur of the awards and specifically ordered that the case be heard before a new arbitrator, effectively granting the insured’s request for a rehearing. The final holding confirmed that both the petition to vacate the awards was properly granted and the insurer's cross-petition was denied.

The court considered several relevant facts, including that the plaintiff, AVK RX Inc., was seeking to recover No-Fault insurance benefits for medical treatment provided to an assignor, Hassan Shuaib, following a motor vehicle accident. The defendant, Progressive Advanced Insurance Co., moved for summary judgment on the grounds that the assignor had failed to attend scheduled independent medical examinations (IMEs), which the defendant claimed was a condition precedent to coverage. The court focused primarily on whether the defendant had adequately demonstrated that the assignor was properly notified of the IMEs. The main issues decided included the sufficiency of the defendant’s proof regarding the mailing of IME notices and compliance with standard office practices or procedures related to notification. The court held that the defendant failed to meet its burden of proof for summary judgment, as the affidavit provided did not satisfactorily demonstrate that the notices were indeed mailed or adequately addressed. Consequently, the motion for summary judgment was denied, and the court instructed the plaintiff to file a Notice of Trial.

The court considered the relevant fact that the plaintiff, Central Pharmacy, Inc., as the assignee of Roger Darbasie, failed to appear for scheduled examinations under oath (EUOs) as part of their claim for no-fault benefits from the defendant, Nationwide Mutual Insurance Company. The main issue decided was whether the plaintiff's absence at these EUOs justified the dismissal of the complaint. The Civil Court initially found an issue of fact regarding the reasonableness of the EUO locations, but the appellate court noted that defendants had offered the option to participate virtually, a fact the plaintiff did not dispute. Consequently, the appellate court held that the defendant was entitled to summary judgment, granting the dismissal of the complaint based on the plaintiff's failure to comply with the EUO requirements.

The court considered relevant facts surrounding a no-fault benefits dispute between a pharmacy and an insurance company, where the pharmacy, as assignee of a patient, sought to recover benefits but had failed to attend scheduled examinations under oath (EUOs). The main issue was whether the pharmacy's failure to appear at the EUOs warranted a dismissal of their complaint, which the insurance company claimed should be granted through a summary judgment motion. The Civil Court initially found that the only issue for trial pertained to the scheduling of the EUOs, suggesting there may have been a reasonable disagreement about their location. However, since the insurance company provided options for virtual attendance and the pharmacy did not contest this finding or present any other issues, the appellate court ultimately reversed the Civil Court's order and granted summary judgment in favor of the insurance company, dismissing the complaint.