Did the insurer show the claimed injuries did not arise from a covered accident (staged, intentional, or unrelated)?

Deciding this question means ruling on whether the insurer's evidence shows that the injuries for which no-fault benefits are claimed did not arise from an insured incident: because the collision was staged or intentionally caused, because the claimant or the insured vehicle was not involved in it, or because the condition treated was unrelated to (not caused or aggravated by) the accident. Under Central Gen. Hosp. v Chubb this is a lack-of-coverage defense that survives the 30-day preclusion rule; courts recite that as settled background, and the categories record how the court ruled on the insurer's proof (enough to raise an issue = 'founded belief'; enough for judgment = established as a matter of law or at trial). Courts sitting on summary judgment, default, declaratory-judgment, vacatur and trial postures all count.

Settled statewide by the Court of Appeals. The rule is set by the Court of Appeals: an insurer may, despite an untimely denial, 'assert a lack of coverage defense premised on the fact or founded belief that the alleged injury does not arise out of an insured incident' (Central Gen. Hosp. v Chubb, 1997), reaffirmed in Hospital for Joint Diseases v Travelers (2007) and Fair Price v Travelers (2008, in the database). Both departments that have decided it apply the same framework: causation is presumed and the insurer bears the burden; a deliberate or staged collision is not a covered accident; admissible proof is required. Decisions differ in application (sufficiency of investigator affidavits, EUO transcripts, police reports, peer reviews, low-impact studies). One point of tension to review: what an insurer must show to obtain judgment (see uncertain).

Leading authorities · Authority map · Decisions by court · Plain-text version (Markdown)

Leading authorities

National Gen. Ins. Online, Inc. v Blasco (2022 NY Slip Op 06252) Appellate Division, Second Department, 2022Second Department: staged collision not covered; insurer judgment on admissible proofAn intentional and staged collision in furtherance of an insurance fraud scheme is not a covered accident; insurers obtained summary judgment declaring no duty to pay providers by showing through admissible evidence that the collisions were intentionally caused or staged, and the providers raised no triable issue.
the plaintiffs established their prima facie entitlement to judgment as a matter of law by demonstrating, through admissible evidence, that the subject collisions were intentionally caused or staged
Nationwide Gen. Ins. Co. v South (2024 NY Slip Op 00028) Appellate Division, First Department, 2024First Department: unrebutted founded belief supports summary judgment for insurerInsurer granted summary judgment declaring no obligation to pay providers where its investigation and the driver's EUO testimony demonstrated a founded belief that the accident was not covered, and the providers submitted no affidavit of a person with knowledge.
Plaintiffs demonstrated a “founded belief” that the August 9, 2020 accident was not covered by no-fault insurance
Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co. (2009 NY Slip Op 00351) Appellate Division, Second Department, 2009Unrelated-injury defense: insurer bears burden, needs medical expert proofCausation is presumed in a provider's no-fault action; to raise the Chubb lack-of-coverage defense that treatment was unrelated to the accident, the insurer must come forward with admissible proof, and judicially noticed diagnosis codes interpreted by counsel, without a medical expert's affidavit, did not raise a triable issue. Summary judgment for the hospital affirmed.
The burden of proving the lack of a nexus between an accident and medical treatment therefore falls upon the insurer seeking to deny payment
V.S. Med. Servs., P.C. v Allstate Ins. Co. (2009 NY Slip Op 29310) Appellate Term, Second Department, 2009At trial: preponderance suffices; insurer need not prove fraudAt trial the insurer may establish lack of coverage (an intentional, non-accidental collision) by a preponderance of the evidence; it need not prove the elements of fraud, including scienter, by clear and convincing evidence. Judgment dismissing the complaint (Civ Ct, Kings County 2006, post 9788) affirmed.
defendant could properly premise its defense upon a lack of coverage and could establish this defense by a preponderance of the evidence; defendant was not required to establish that the subject collision was the product of fraud
A.B. Med. Servs., PLLC v Clarendon Natl. Ins. Co. (2009 NY Slip Op 52383(U)) Appellate Term, Second Department, 2009Founded belief defeats provider's motion but does not win insurer'sThe insurer's proof showed a founded belief that the injuries were sustained, if at all, in a staged accident, enough to defeat the provider's summary judgment motion, but its admissible evidence did not establish as a matter of law that the injuries did not arise from an insured incident, so its cross motion to dismiss should have been denied.
while defendant demonstrated that it possessed such “founded belief” so as to defeat plaintiff’s motion for summary judgment, it failed to submit sufficient evidence in admissible form, in support of its cross motion, to establish, as a matter of law, that the alleged injuries did not arise from an insured incident
Central Gen. Hosp. v Chubb Group of Ins. Cos. 90 NY2d 195Source of the rule: insurer may assert, despite an untimely denial, a lack-of-coverage defense premised on the fact or founded belief that the injury does not arise out of an insured incident; excessive treatment is precluded. Cited in at least 287 decisions in the database.Not in our database.
Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co. 90 NY2d 274Background: the general 30-day preclusion rule to which Chubb is the exception.Not in our database.
Zappone v Home Ins. Co. 55 NY2d 131Background: failure to disclaim cannot create coverage that never existed.Not in our database.
Mount Sinai Hosp. v Triboro Coach 263 AD2d 11Causation presumed; insurer must come forward with admissible proof of the fact or evidentiary foundation for its belief that the treated condition was unrelated to the accident (cited in about 100 decisions).Not in our database.
Matter of Metro Med. Diagnostics v Eagle Ins. Co. 293 AD2d 751Defense that the collision was staged in furtherance of insurance fraud survives the preclusion rule (cited in about 90 decisions).Not in our database.
State Farm Mut. Auto. Ins. Co. v Laguerre 305 AD2d 490'A deliberate collision caused in furtherance of an insurance fraud scheme is not a covered accident' (as quoted in V.S. Med. Servs.).Not in our database.
Matter of Liberty Mut. Ins. Co. v Goddard 29 AD3d 698'An intentional and staged collision caused in the furtherance of an insurance fraud scheme is not a covered accident' (quoted in Bates, McAdam, Blasco).Not in our database.
Matter of Eagle Ins. Co. v Davis 22 AD3d 846Insurer may prove a collision was not an accident without proving fraud (relied on in V.S. Med. Servs.).Not in our database.
Nationwide Gen. Ins. Co. v Pontoon 123 AD3d 1040No coverage for an intentionally caused collision even as to innocent third parties (quoted in Adirondack 2023).Not in our database.

Authority map

Each circle is a decision on this question, placed by court and date; its colour is the position it took. Lines are citations between them. Select a circle (or find a decision by name) to see its links and summary. The same decisions are listed by court below the map.

Insurer proved the injuries did not arise from a covered accidentFounded belief shown; the question must be triedInsurer's motion denied: proof did not establish the defense prima facie; defense still openInsurer's proof did not raise an issue or failed at trial; provider prevails on itRing: rules on the question, but another ground decided the caseContrasted, distinguished or limitedDeclined to follow, questioned, overruled or reversedCited Show ordinary citations

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How the rule was applied, by court

Court	Defense established	Triable issue	Insurer's motion fails	Defense not shown	Total
Appellate Division, First Department	8	0	0	0	8
Appellate Division, Second Department	2	2	2	7	13
Appellate Term, First Department	0	3	0	4	7
Appellate Term, Second Department	18	88	11	44	161
Trial courts in the First Department	3	2	2	3	10
Trial courts in the Second Department	6	10	4	22	42

Decisions (241)

Every decision in our database that rules on this question: highest court first, then by department, newest first. 202 turn on it; the others rule on it alongside a different main ground (marked "also decides"). The one-sentence summaries describe what each court said on this question.

Appellate Division, First Department (8 decisions)

Unitrin Safeguard Ins. Co. v Manuel (2025 NY Slip Op 01727) Appellate Division, First Department, March 20, 2025Insurer proved the injuries did not arise from a covered accidentHeld the insurer showed a founded belief that the injuries did not arise from the accident through investigator and adverse-vehicle occupant affidavits and EUO red flags, and the providers offered no admissible rebuttal, warranting a no-duty declaration.
Nationwide Gen. Ins. Co. v South (2024 NY Slip Op 00028) Leading case Appellate Division, First Department, January 4, 2024Insurer proved the injuries did not arise from a covered accidentGranted the insurers a declaration of no coverage because the investigation and the driver's EUO testimony that a passenger told someone to hit the car showed a founded belief the accident was staged, unrebutted by any affidavit of knowledge.
State Farm Fire & Cas. Co. v AA Acupuncture Serv., P.C. (2023 NY Slip Op 03562) Appellate Division, First Department, June 29, 2023Insurer proved the injuries did not arise from a covered accidentHeld on default that the claim representative's affidavit, other evidence and two claimants' EUO testimony adequately showed the collision was intentional or staged, warranting a declaration of no duty to pay.
State Farm Mut. Auto. Ins. Co. v All City Family Healthcare Ctr., Inc. (2022 NY Slip Op 04142) Appellate Division, First Department, June 28, 2022Insurer proved the injuries did not arise from a covered accident (also decides)Held the insurer's submissions sufficed under CPLR 3215 (f) for a default declaration of noncoverage on the ground that the crash was intentional or staged, the defaulting defendants being deemed to admit the complaint's allegations.
State Farm Fire & Cas. Co. v Axial Chiropractic, P.C. (2022 NY Slip Op 03487) Appellate Division, First Department, May 31, 2022Insurer proved the injuries did not arise from a covered accidentHeld on default that the claim representative's affidavit, the other driver's affidavit and dash-cam footage adequately showed the collision was intentional or staged, warranting a declaration of noncoverage.
State Farm Mut. Auto. Ins. Co. v AK Global Supply Corp. (2022 NY Slip Op 01890) Appellate Division, First Department, March 17, 2022Insurer proved the injuries did not arise from a covered accident (also decides)Granted a default declaration of no duty to pay because the claim specialist's affidavit and witness statements showed a founded belief the claimants were not in the vehicle and the collision was intentional.
State Farm Mut. Auto. Ins. Co. v Surgicore of Jersey City, LLC (2021 NY Slip Op 03536) Appellate Division, First Department, June 3, 2021Insurer proved the injuries did not arise from a covered accidentGranted a default declaration of noncoverage because the claims representative's affidavit and EUO red flags set out the factual basis for the founded belief that the accident was intentional and staged.
Global Liberty Ins. Co. v Laruenceau (2020 NY Slip Op 05851) Appellate Division, First Department, October 20, 2020Insurer proved the injuries did not arise from a covered accidentOn renewal, granted the insurer summary judgment declaring no coverage because a passenger's authenticated videotaped confession and other participants' statements, admissible as party admissions, proved the accident was staged and stood uncontroverted.

Appellate Division, Second Department (13 decisions)

American Tr. Ins. Co. v Beach Med. Rehabilitation, P.C. (2026 NY Slip Op 03771) Appellate Division, Second Department, June 17, 2026Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's unprecluded lack-of-causation defense raised no triable issue because its peer reviewer did not review the full records, address the treating physician's reasoning or other treatment, or specifically address causal connection to the accident.
Adirondack Ins. Exch. v Rodriguez (2023 NY Slip Op 02095) Appellate Division, Second Department, April 26, 2023Insurer proved the injuries did not arise from a covered accidentAffirmed summary judgment declaring no duty to pay because the insurers' admissible evidence (fraudulent procurement, near-identical collisions, related participants, common providers) showed the collisions were intentional, and the providers raised no triable issue.
National Gen. Ins. Online, Inc. v Blasco (2022 NY Slip Op 06252) Leading case Appellate Division, Second Department, November 9, 2022Insurer proved the injuries did not arise from a covered accidentAffirmed summary judgment declaring no coverage because the insurers showed by admissible evidence that the collisions were intentionally caused or staged in a fraud scheme, and the providers raised no triable issue.
Progressive Advanced Ins. Co. v McAdam (2016 NY Slip Op 03484) Appellate Division, Second Department, May 4, 2016Insurer's motion denied: proof did not establish the defense prima facie; defense still openReversed summary judgment for the insurer because its uncertified police reports were inadmissible and its representative relied on inadmissible evidence without personal knowledge, so it did not show prima facie that the collisions were staged.
Nationwide Gen. Ins. Co. v Bates (2015 NY Slip Op 06122) Appellate Division, Second Department, July 15, 2015Insurer's motion denied: proof did not establish the defense prima facie; defense still openHeld the insurer failed to show prima facie that the collisions were staged because its police reports were uncertified, the deposition transcript unsigned, and the investigator relied on inadmissible evidence without personal knowledge.
Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co. (2009 NY Slip Op 00351) Leading case Appellate Division, Second Department, January 20, 2009Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld judicially noticed diagnosis codes interpreted by counsel, without a medical expert's affidavit on causation or exacerbation, failed to raise a triable issue that the treated conditions were unrelated to the accident.
New York & Presbyt. Hosp. v Selective Ins. Co. of Am. (2007 NY Slip Op 06848) Appellate Division, Second Department, September 18, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer failed to raise a triable issue that the treated condition was unrelated to the accident because its medical expert's affidavit was conclusory, speculative and unsupported by the evidence, so the hospital's summary judgment was affirmed.
New York Univ. Hosp. Rusk Inst. v Government Empls. Ins. Co. (2007 NY Slip Op 03671) Appellate Division, Second Department, April 24, 2007Founded belief shown; the question must be triedHeld the insurer raised a triable issue by showing a timely denial based on a peer review concluding the treatment resulted from a preexisting condition and did not arise from a covered accident, so the hospital's summary judgment was reversed.

Show all 13 decisions

Montefiore Med. Ctr. v Nationwide Mut. Ins. Co. (2007 NY Slip Op 02724) Appellate Division, Second Department, March 27, 2007Founded belief shown; the question must be triedHeld the patient's hospital records and other material submitted by the insurer raised a triable issue whether the treated condition was unrelated to the motor vehicle accident, so the hospital's summary judgment motion was denied.
St. Luke's Roosevelt Hosp. v Blue Ridge Ins. Co. (2005 NY Slip Op 06666) Appellate Division, Second Department, September 12, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insurer showed no meritorious defense for vacating its default because its claims representative's affidavit did not show the treated injuries did not arise from an insured incident.
New York Hosp. Med. Ctr. of Queens v Insurance Co. of State of Pa. (2005 NY Slip Op 01691) Appellate Division, Second Department, March 7, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer showed no meritorious defense to vacate its default because its affidavit, not from someone with personal knowledge, failed to show the injuries did not arise out of an insured incident, so it was precluded.
Hospital for Joint Diseases v Hertz Corp. (2004 NY Slip Op 06024) Appellate Division, Second Department, July 12, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on itGranted the hospital summary judgment and denied the insurer's cross motion because the insurer submitted no evidentiary proof that the injury and treatment were causally unrelated to the accident.
Hospital for Joint Diseases v Hertz Corp. (2004 NY Slip Op 06025) Appellate Division, Second Department, July 12, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurers submitted no evidentiary proof that the injury and treatment were not causally related to the accident, so they raised no triable issue and the hospital was granted summary judgment.

Appellate Term, First Department (7 decisions)

Easy Care Acupuncture, PC v Hartford Ins. Co. (2017 NY Slip Op 51470(U)) Appellate Term, First Department, November 1, 2017Founded belief shown; the question must be triedHeld the investigator's affidavit, relying on inconsistencies in the occupants' accounts of the day and staged-accident red flags, showed a founded belief of a staged accident but raised only issues of fact for trial.
Valentin Avanesov, Physician PC v Travelers Prop. Cas. Co. of Am. (2017 NY Slip Op 50674(U)) Appellate Term, First Department, May 25, 2017Founded belief shown; the question must be triedReversed summary judgment for the insurer because the insured's own detailed unsworn statement and the assignor's EUO testimony raised triable issues as to whether the insured vehicle was involved in the accident.
West Tremont Med. Diagnostics P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51325(U)) Appellate Term, First Department, June 30, 2009Insurer's proof did not raise an issue or failed at trial; provider prevails on itAffirmed summary judgment for the provider because the insurer's submission on its staged-accident defense was insufficient to establish even a founded belief that the injury did not arise from an insured incident.
Bronx Radiology, P.C. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 27427) Appellate Term, First Department, October 17, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld a low-impact accident reconstruction study, made without any medical review or assessment of the assignor's injuries, insufficient to raise a triable issue that the injuries were unrelated to the accident, so the provider's summary judgment was affirmed.
Bronx Advanced Med., P.C. v Liberty Mut. Ins. Co. (2007 NY Slip Op 51334(U)) Appellate Term, First Department, July 9, 2007Founded belief shown; the question must be triedHeld the insurer's opposition papers raised triable issues of fact as to whether the alleged injury arose out of an insured incident, so the provider's summary judgment motion should have been denied.
Inwood Hill Med. P.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 51309(U)) Appellate Term, First Department, July 2, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's documentary submissions insufficient to raise an issue of fact whether the injuries arose from an insured incident or the accident was an intentional collision in an insurance fraud scheme, so the provider won summary judgment.
Diagnostic Rehab. Medicine Serv., P.C. v Farm Family Cas. Ins. Co. (2005 NYSlipOp 50826(U)) Appellate Term, First Department, June 2, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insurer failed to raise an issue of fact that its denial rested on a fact or founded belief that the injury did not arise from an insured incident, so the provider won summary judgment.

Appellate Term, Second Department (161 decisions)

Prompt Med. Group, Inc. v Erie Ins. Co. of N.Y. (2025 NY Slip Op 51164(U)) Appellate Term, Second Department, July 11, 2025Insurer's motion denied: proof did not establish the defense prima facie; defense still openHeld the insurer did not establish as a matter of law that its insured vehicle was not involved, because statements in the police report and a call transcript were inadmissible hearsay and its own papers showed conflicting accounts.
Parisien v Esurance (2023 NY Slip Op 51235(U)) Appellate Term, Second Department, September 22, 2023Founded belief shown; the question must be triedHeld the investigator's affidavit and records showed a founded belief that the collision was staged, but lacked sufficient admissible evidence to establish that as a matter of law, so the insurer's dismissal motion was denied.
Forest Hills Healthcare Physician, P.C. v Lancer Ins. Co. (2021 NY Slip Op 51170(U)) Appellate Term, Second Department, December 3, 2021Insurer's motion denied: proof did not establish the defense prima facie; defense still openHeld that the insurer did not show prima facie that the assignor was not a passenger in the insured vehicle, because her sworn application said she was and nothing about her EUO testimony was set out.
Metro Psychological Servs., P.C. v American Tr. Ins. Co. (2019 NY Slip Op 51614(U)) Appellate Term, Second Department, October 11, 2019Insurer's motion denied: proof did not establish the defense prima facie; defense still openHeld that the insured's affidavit saying he was out of town and saw no damage did not establish as a matter of law that the insured vehicle was not involved, so the insurer's motion was denied.
Dabiri v Allstate Ins. Co. (2019 NY Slip Op 51277(U)) Appellate Term, Second Department, August 2, 2019Insurer proved the injuries did not arise from a covered accidentAffirmed summary judgment for the insurer because the insured vehicle had not been involved in the alleged accident, for the reasons stated in the companion appeal.
Parisien v Allstate Ins. Co. (2019 NY Slip Op 51249(U)) Appellate Term, Second Department, August 2, 2019Insurer proved the injuries did not arise from a covered accidentHeld the insured's EUO testimony and affidavit that she was parking, no accident occurred and the pedestrian assignor was not struck showed the injury did not arise from an insured incident, and counsel's affirmation raised no triable issue.
LVOV Acupuncture, P.C. v Hereford Ins. Co. (2018 NY Slip Op 51589(U)) Appellate Term, Second Department, November 9, 2018Insurer proved the injuries did not arise from a covered accidentAffirmed summary judgment for the insurer because the insured vehicle had not been involved in the alleged accident, for the reasons stated in the companion appeal.
Jamaica Wellness Med., P.C. v Hereford Ins. Co. (2018 NY Slip Op 51587(U)) Appellate Term, Second Department, November 9, 2018Insurer proved the injuries did not arise from a covered accidentAffirmed summary judgment for the insurer because the insured vehicle had not been involved in the alleged accident, for the reasons stated in the companion appeal.

Show all 161 decisions

Jamaica Wellness Med., P.C. v Hereford Ins. Co. (2018 NY Slip Op 51586(U)) Appellate Term, Second Department, November 9, 2018Insurer proved the injuries did not arise from a covered accidentHeld the insured driver's EUO testimony that his vehicle had not been in any accident while the passengers were aboard showed the injuries did not arise from an insured incident, and the provider raised no triable issue.
Pavlova v Allstate Ins. Co. (2018 NY Slip Op 51061(U)) Appellate Term, Second Department, June 29, 2018Insurer proved the injuries did not arise from a covered accidentHeld the insured's EUO testimony and affidavit that she was parking, no accident occurred and the pedestrian assignor was not struck showed the injury did not arise from an insured incident, and counsel's affirmation raised no triable issue.
Tyorkin v Country Wide Ins. Co. (2017 NY Slip Op 51827(U)) Appellate Term, Second Department, December 19, 2017Founded belief shown; the question must be triedHeld the insurer's evidence did not establish as a matter of law that the injuries did not arise from an insured incident, but sufficed to raise a triable issue, so the provider's summary judgment was denied.
Shur v Unitrin Advantage Ins. Co. (2017 NY Slip Op 51011(U)) Appellate Term, Second Department, August 10, 2017Insurer's motion denied: proof did not establish the defense prima facie; defense still openHeld the insurer failed to make a prima facie showing of lack of causation because its IME report was internally contradictory about whether the knee injury was accident-related or degenerative and did not address the MRI or operative report.
St. Anna Wellcare, P.C. v GEICO Ins. Co. (2017 NY Slip Op 50948(U)) Appellate Term, Second Department, July 21, 2017Insurer's motion denied: proof did not establish the defense prima facie; defense still openHeld the insurer's proof did not establish as a matter of law that the assignor's injuries did not arise from a covered incident, so its cross motion for summary judgment should have been denied.
Acupuncture Healthcare Plaza I, P.C. v 21st Century Advantage Ins. Co. (2017 NY Slip Op 50945(U)) Appellate Term, Second Department, July 21, 2017Founded belief shown; the question must be tried (also decides)Held the insurer's evidence did not establish as a matter of law that the injuries did not arise from an insured incident, but sufficed to raise a triable issue defeating the provider's cross motion on two claims.
Hu-Nam-Nam v Allstate Ins. Co. (2017 NY Slip Op 50685(U)) Appellate Term, Second Department, May 19, 2017Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer showed no potentially meritorious staged-accident defense for vacating its default because its proof concerned a collision on a different date than the accident sued upon, with the discrepancy unexplained.
Charles Deng Acupuncture, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 50402(U)) Appellate Term, Second Department, March 31, 2017Insurer's motion denied: proof did not establish the defense prima facie; defense still open (also decides)Held the insurer's evidence insufficient to establish as a matter of law that the assignor's injuries did not arise from an insured incident, so summary judgment on its lack-of-coverage defense was denied.
City Care Acupuncture, P.C. v Hereford Ins. Co. (2017 NY Slip Op 50037(U)) Appellate Term, Second Department, January 5, 2017Insurer proved the injuries did not arise from a covered accidentHeld the insurer established that the injuries did not arise from an insured incident through the certified EUO of the insured vehicle's driver, who testified the vehicle was not in any accident, and the providers raised no triable issue.
Tam Med. Supply Corp. v 21st Century Ins. Co. (2016 NY Slip Op 50402(U)) Appellate Term, Second Department, March 23, 2016Insurer's motion denied: proof did not establish the defense prima facie; defense still open (also decides)Held the insurer's evidence insufficient to establish as a matter of law that the assignor's injuries did not arise from an insured incident, so its cross motion on the lack-of-coverage ground was denied.
Alleviation Med., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51630(U)) Appellate Term, Second Department, November 9, 2015Insurer proved the injuries did not arise from a covered accidentAffirmed summary judgment for the insurer on the ground that the alleged injuries did not arise out of a covered loss, finding the provider's arguments, raised for the first time on appeal, insufficient to defeat it.
V.S. Med. Servs., P.C. v State Farm Mut. Ins. Co. (2014 NY Slip Op 50615(U)) Appellate Term, Second Department, March 31, 2014Insurer proved the injuries did not arise from a covered accidentAffirmed a jury verdict for the insurer because a fair interpretation of the investigator's trial testimony supported the finding that the collision was intentionally caused, a coverage defense not precluded by an untimely denial.
Jesa Med. Supply, Inc. v NYC Tr. Auth. (2013 NY Slip Op 50188(U)) Appellate Term, Second Department, February 8, 2013Insurer proved the injuries did not arise from a covered accidentAffirmed summary judgment for the transit authority because its claims examiner's search of its accident log showed no record that the assignor was injured by or involved in an accident with its vehicle, and the provider raised no triable issue.
New York Hosp. Med. Ctr. of Queens v Utica Mut. Ins. Co. (2012 NY Slip Op 52388(U)) Appellate Term, Second Department, December 20, 2012Insurer proved the injuries did not arise from a covered accidentHeld the insured's sworn statement that the assignor merely jumped on his parked car established the injuries did not arise from an insured incident, and the provider's uncertified police report and hospital records raised no issue on the insured vehicle's involvement.
Andromeda Med. Care, P.C. v Utica Mut. Ins. Co. (2012 NY Slip Op 50344(U)) Appellate Term, Second Department, February 21, 2012Insurer proved the injuries did not arise from a covered accidentGranted the insurer summary judgment because its biomechanical engineer's affidavit, in admissible form, showed the assignors' injuries could not have arisen from the accident, and the provider offered no rebuttal.
Friendly Physician, P.C. v GEICO Ins. Co. (2011 NY Slip Op 52359(U)) Appellate Term, Second Department, December 21, 2011Founded belief shown; the question must be triedHeld the insurer's sworn statements raised a triable issue whether the alleged injuries arose out of an insured incident, so the provider's summary judgment was reversed.
Jamaica Med. Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 21359) Appellate Term, Second Department, October 11, 2011Insurer's motion denied: proof did not establish the defense prima facie; defense still open (also decides)Held the insurer did not make a prima facie showing that the assignor was not involved in the accident because its supporting proof was not in admissible form, so its alternative summary judgment branch failed.
Jesa Med. Supply, Inc. v Republic W. Ins. Co. (2011 NY Slip Op 51127(U)) Appellate Term, Second Department, June 15, 2011Founded belief shown; the question must be triedHeld the insurer's investigator affidavit sufficient to demonstrate a founded belief that the injuries did not arise from an insured incident, so the provider's summary judgment motion should have been denied.
Infinity Health Prods., Ltd. v American Tr. Ins. Co. (2011 NY Slip Op 50195(U)) Appellate Term, Second Department, February 14, 2011Insurer's motion denied: proof did not establish the defense prima facie; defense still openAffirmed denial of the insurer's cross motion because the police accident report was inadmissible and the investigator's affidavit relied on it, so the proof did not establish that the injuries did not arise from an insured incident.
Stephen Fealy, M.D., P.C. v State Farm Mut. Auto Ins. Co. (2010 NY Slip Op 51442(U)) Appellate Term, Second Department, August 2, 2010Founded belief shown; the question must be triedHeld the insurer's peer reviews and radiology report made a prima facie showing that the knee condition was degenerative and unrelated, but the treating surgeon's affirmation and early knee complaints raised an issue of fact for trial.
Crossbay Acupuncture, P.C. v Hartford Cas. Ins. Co. (2010 NY Slip Op 50487(U)) Appellate Term, Second Department, March 19, 2010Insurer proved the injuries did not arise from a covered accidentAffirmed summary judgment for the insurer because the insured's affidavit showed prima facie that the pedestrian's injuries did not arise from an insured incident and the provider raised no triable issue.
Andromeda Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 52601(U)) Appellate Term, Second Department, December 15, 2009Insurer proved the injuries did not arise from a covered accidentGranted the insurer summary judgment because its insured's affidavit that she had not hit any pedestrian showed the injuries did not arise from an insured incident, and the provider raised no triable issue.
Excel Radiology Servs., P.C. v Clarendon Natl. Ins. Co. (2009 NY Slip Op 52444(U)) Appellate Term, Second Department, December 1, 2009Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the assignor's alleged misrepresentation that her daughter was in the car was irrelevant to whether her injuries arose from an insured incident, as no staged or nonexistent accident was alleged, so no triable issue arose.
A.B. Med. Servs., PLLC v Clarendon Natl. Ins. Co. (2009 NY Slip Op 52383(U)) Leading case Appellate Term, Second Department, November 19, 2009Founded belief shown; the question must be triedHeld the insurer showed a founded belief that the injuries were sustained, if at all, in a staged accident, enough to defeat the provider's motion, but not admissible proof establishing that as a matter of law for its cross motion.
Midwood Med. Equip. & Supply, Inc. v USAA Cas. Ins. Co. (2009 NY Slip Op 52379(U)) Appellate Term, Second Department, November 19, 2009Insurer proved the injuries did not arise from a covered accidentAffirmed summary judgment for the insurer because its insured's affidavit showed her vehicle never contacted the pedestrian assignor, and the provider's attorney affirmation failed to rebut it.
V.S. Med. Servs., P.C. v Allstate Ins. Co. (2009 NY Slip Op 29310) Leading case Appellate Term, Second Department, July 20, 2009Insurer proved the injuries did not arise from a covered accidentHeld that the insurer could prove a deliberate, non-accidental collision by a preponderance of the evidence without proving fraud's elements by clear and convincing evidence, and that its unrebutted trial proof established lack of coverage.
D.S. Chiropractic, P.C. v Country-Wide Ins. Co. (2009 NY Slip Op 51584(U)) Appellate Term, Second Department, July 14, 2009Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insurer's submissions failed to show its lack-of-coverage defense rested on a founded belief that the injuries did not arise from an insured incident, so the provider's summary judgment was affirmed.
Vitality Chiropractic, P.C. v State Farm Mut. Ins. Co. (2009 NY Slip Op 51026(U)) Appellate Term, Second Department, May 22, 2009Insurer proved the injuries did not arise from a covered accidentHeld that at trial the insurer met its burden of proving the loss did not arise from an insured incident, its investigator's testimony and unobjected records showing the assignor took part in an insurance fraud scheme.
Advanced Med., P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51023(U)) Appellate Term, Second Department, May 22, 2009Founded belief shown; the question must be triedHeld the attorney affirmation, witness statement and testimony transcripts, and the no-fault specialist's and investigator's affidavits sufficient to show a founded belief that the injuries did not arise from an insured incident, defeating the provider's summary judgment.
A.B. Chiropractic, P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51022(U)) Appellate Term, Second Department, May 22, 2009Founded belief shown; the question must be triedHeld the insurer's attorney affirmation, witness statement and testimony transcripts, and affidavits of its no-fault specialist and investigator sufficient to show a founded belief that the injuries did not arise from an insured incident, defeating summary judgment.
Amaze Med. Supply, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 52690(U)) Appellate Term, Second Department, March 19, 2009Founded belief shown; the question must be triedHeld the insurer's submissions showed a founded belief that the injuries did not arise from an insured incident in an alleged staged loss, defeating the provider's summary judgment motion.
Vista Surgical Supplies, Inc. v Utica Mut. Ins. Co. (2009 NY Slip Op 50493(U)) Appellate Term, Second Department, March 17, 2009Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the investigator's affidavit, the EUO testimony of the assignor and driver, and an unsworn adverse-driver statement insufficient to show a founded belief that the injuries did not arise from a covered accident, so the provider's summary judgment stood.
A.B. Med. Servs., PLLC v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50331(U)) Appellate Term, Second Department, February 24, 2009Founded belief shown; the question must be triedHeld the litigation examiner's and investigator's affidavits, police report and recorded statements showed a founded belief that the injuries did not arise out of an insured incident, so the providers' motion was denied.
A.B. Med. Servs., PLLC v Utica Mut. Ins. Co. (2008 NY Slip Op 51859(U)) Appellate Term, Second Department, September 2, 2008Founded belief shown; the question must be triedHeld the insurer's investigators' affidavits showed a founded belief that the injuries did not arise out of an insured incident, raising a triable issue of coverage.
Supple Mind Acupuncture, P.C. v State Farm Ins. Co. (2008 NY Slip Op 51856(U)) Appellate Term, Second Department, September 2, 2008Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer failed at trial to prove the injuries were not caused by the accident because its biomechanical expert relied on hearsay materials not shown to be accepted in the profession as reliable, making his testimony and report inadmissible.
Freeport Med., P.C. v Utica Natl. Ins. Co. of Tex. (2008 NY Slip Op 51448(U)) Appellate Term, Second Department, July 8, 2008Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's investigator affidavit insufficient to show a founded belief that the loss resulted from an intentional act, so summary judgment for the provider was affirmed and the insurer's cross motion denied.
Lexington Acupuncture, P.C. v GEICO Ins. Co. (2008 NY Slip Op 50519(U)) Appellate Term, Second Department, March 7, 2008Founded belief shown; the question must be triedHeld the insurer showed a founded belief that the injuries did not arise from an insured incident, enough to defeat the provider's motion, but its admissible evidence did not establish that as a matter of law, so neither side won summary judgment.
Mani Med., P.C. v NY Cent. Mut. Ins. Co. (2008 NY Slip Op 50508(U)) Appellate Term, Second Department, March 5, 2008Founded belief shown; the question must be triedHeld the sworn accident reconstruction report showed a founded belief that the injuries were not causally related to the accident, raising a triable issue of coverage.
Impulse Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 50498(U)) Appellate Term, Second Department, February 29, 2008Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's out-of-state accident-analysis consultant's affidavit, lacking a CPLR 2309(c) certificate of conformity over the provider's objection, was inadmissible, so the insurer failed to show a founded belief and the provider's summary judgment was affirmed.
Medical Care G.M., P.C. v GEICO Ins. (2008 NY Slip Op 50379(U)) Appellate Term, Second Department, February 27, 2008Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer failed to proffer sufficient evidence in admissible form showing a founded belief that the injuries did not arise from an insured incident, so the providers' summary judgment motion was granted.
A.M. Med. Servs., P.C. v State Farm Mut. Ins. Co. (2007 NY Slip Op 52300(U)) Appellate Term, Second Department, November 29, 2007Founded belief shown; the question must be triedHeld the insurer's investigator's affidavit sufficient to show a founded belief that the injuries did not arise from an insured incident, raising a triable issue of lack of coverage that defeated the provider's summary judgment.
Bedford Park Med. Practice, P.C. v State Farm Mut. Ins. Co. (2007 NY Slip Op 52285(U)) Appellate Term, Second Department, November 21, 2007Founded belief shown; the question must be triedHeld the insurer's investigator's affidavit sufficient to show a founded belief that the injuries did not arise from an insured incident, raising a triable issue of lack of coverage, so the provider's summary judgment was vacated.
Allstate Social Work & Psychological Servs., P.L.L.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 52042(U)) Appellate Term, Second Department, October 19, 2007Insurer's motion denied: proof did not establish the defense prima facie; defense still open (also decides)Held the insurer's affidavits on its fraud-based denial were inadequate to establish as a matter of law that the injuries did not arise from an insured incident, so its cross motion was denied.
Rockaway Med. & Diagnostic, P.C. v State Farm Mut. Ins. Co. (2007 NY Slip Op 52039(U)) Appellate Term, Second Department, October 19, 2007Founded belief shown; the question must be triedHeld the insurer's investigator's affidavit sufficient to show a founded belief that the injuries did not arise from an insured incident, raising a triable issue of lack of coverage, so the provider's cross motion was denied.
Dan Med., P.C. v New York Cent. Mut. Ins. Co. (2007 NY Slip Op 51981(U)) Appellate Term, Second Department, September 4, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the accident reconstructionist's out-of-state affidavit, lacking CPLR 2309(c) compliance over the provider's objection, was inadmissible, so the insurer introduced no competent evidence of a founded belief and the provider's judgment was affirmed.
Infinity Health Prods., Ltd. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 51612(U)) Appellate Term, Second Department, August 16, 2007Founded belief shown; the question must be triedHeld the insurer's investigator's affidavit sufficient to show a founded belief that the injuries did not arise from an insured incident, raising a triable issue of lack of coverage, so the provider's summary judgment was vacated.
Infinity Health Prods. Ltd. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 51611(U)) Appellate Term, Second Department, August 16, 2007Founded belief shown; the question must be triedHeld the insurer's investigator's affidavit sufficient to show a founded belief that the injuries did not arise from an insured incident, raising a triable issue, and the provider waived its CPLR 2309(c) objection by raising it first on appeal.
Great Wall Acupuncture v Peerless Ins. Co. (2007 NY Slip Op 51606(U)) Appellate Term, Second Department, August 16, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's facts supporting its defense that the insured vehicle was not involved were not in admissible form and in any event did not raise a triable coverage issue, so the provider won summary judgment.
Ema Acupuncture, P.C. v State Farm Ins. Co. (2007 NY Slip Op 51603(U)) Appellate Term, Second Department, August 16, 2007Founded belief shown; the question must be tried (also decides)Held the investigator's affidavit showed a founded belief that one assignor's injuries did not arise from an insured incident, raising a triable issue for that claim, but was insufficient as to the other three assignors.
East Acupuncture, P.C. v Electric Ins. Co. (2007 NY Slip Op 51281(U)) Appellate Term, Second Department, June 25, 2007Founded belief shown; the question must be tried (also decides)Held the insurer's EUO transcripts with implausible statements and evidence of guilty pleas by the provider's billing agency and an associated provider showed a founded belief the incident was staged, warranting a trial on coverage.
VA Acutherapy Acupuncture, P.C. v State Farm Ins. Co. (2007 NY Slip Op 51217(U)) Appellate Term, Second Department, June 15, 2007Founded belief shown; the question must be tried (also decides)Held the investigator's affidavit showed a founded belief that the collision was part of an insurance fraud scheme, raising a triable issue of coverage that defeated the provider's motion.
First Help Acupuncture, P.C. v Progressive Northeastern Ins. Co. (2007 NY Slip Op 51167(U)) Appellate Term, Second Department, June 5, 2007Founded belief shown; the question must be tried (also decides)Held affirmed peer reviews concluding three assignors' injuries were unrelated to the accident raised a triable issue, but unsworn accident analysis and chiropractor reports, and a peer review finding only no disability, showed no founded belief for another assignor.
Capri Med., P.C. v Progressive Cas. Ins. Co. (2007 NY Slip Op 51158(U)) Appellate Term, Second Department, June 1, 2007Insurer's motion denied: proof did not establish the defense prima facie; defense still openHeld the insurer did not prove as a matter of law that the injuries arose, if at all, from a staged accident, so its cross motion for summary judgment should have been denied.
LMS Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 51072(U)) Appellate Term, Second Department, May 24, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer failed to show a founded belief that the injuries did not arise from a covered incident because its accident reports and other documents were unsworn and unsupported by anyone with personal knowledge.
Executive MRI Imaging, P.C. v State Farm Ins. Co. (2007 NY Slip Op 50994(U)) Appellate Term, Second Department, May 14, 2007Founded belief shown; the question must be triedHeld the insurer's investigator affidavit sufficient to show a founded belief that the injuries did not arise out of an insured incident, raising a triable issue of lack of coverage and defeating the provider's summary judgment motion.
Umed Med., P.C. v State Farm Ins. Co. (2007 NY Slip Op 50892(U)) Appellate Term, Second Department, April 27, 2007Founded belief shown; the question must be triedHeld the insurer's sworn special investigator affidavit sufficient to show a founded belief that the accident was staged, despite containing hearsay, so summary judgment for the provider on that claim was denied.
Bronx Expert Radiology, P.C. v Allstate Ins. Co. (2007 NY Slip Op 50682(U)) Appellate Term, Second Department, March 28, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's investigator affidavit insufficient to show a founded belief that the collision was part of an insurance fraud scheme, so no triable issue of coverage existed and judgment for the provider was affirmed.
Webster Diagnostic Medicine, P.C. v State Farm Ins. Co. (2007 NY Slip Op 27134) Appellate Term, Second Department, March 28, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the investigator's conclusory affidavit about a staging ring, discrepancies in two passengers' EUO testimony and the insured's failure to attend an unauthorized EUO did not show a founded belief that the accident was staged.
New Way Med., P.C. v Kemper Ins. Co. (2007 NY Slip Op 50535(U)) Appellate Term, Second Department, March 19, 2007Founded belief shown; the question must be triedHeld the insurer raised a triable issue premised on a founded belief that the alleged injury did not arise out of an insured incident, so the provider's summary judgment motion was properly denied.
Wei Wei Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 50394(U)) Appellate Term, Second Department, March 5, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the SIU investigator's affidavit, lacking facts on personal knowledge or admissible evidence with sufficient particularity, failed to show a founded belief that the injuries did not arise from an insured incident; summary judgment for the provider affirmed.
Great Wall Acupuncture v Utica Mut. Ins. Co. (2007 NY Slip Op 50389(U)) Appellate Term, Second Department, March 2, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's fraud defense insufficient to show a founded belief that the injuries did not arise from an insured incident because the investigator relied on unsworn reports and made conclusory statements.
Vista Surgical Supplies, Inc. v State Farm Mut. Ins. Co. (2007 NY Slip Op 50163(U)) Appellate Term, Second Department, January 31, 2007Founded belief shown; the question must be triedHeld the investigator's affidavit showed a founded belief that the collision was part of an insurance fraud scheme, raising a triable issue that defeated the provider's summary judgment despite the untimely denial.
Comprehensive Mental v Allstate Ins. Co. (2007 NY Slip Op 50017(U)) Appellate Term, Second Department, January 2, 2007Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld a claims representative's file-review affidavit, asserting the accident was intentional because the assignor and driver had multiple accidents, insufficient to raise a triable issue that the accident was staged.
Oleg Barshay, D.C., P.C. v State Farm Ins. Co. (2006 NY Slip Op 26496) Appellate Term, Second Department, December 8, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer raised no triable issue of a staged accident because counsel's affirmation lacked personal knowledge, the attached documents were unsworn, and the claims representative's affidavit offered only unsubstantiated suppositions.
Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 26483) Appellate Term, Second Department, December 1, 2006Founded belief shown; the question must be tried (also decides)Held that the insurer's special investigator affidavit and report on lack of causal relation to a covered accident raised a triable issue whether the injuries arose from an insured incident, an alternative ground for denying the provider's motion.
Executive MRI Imaging, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52250(U)) Appellate Term, Second Department, November 13, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's low-impact accident study, offered to show the injuries were not causally related to the accident, was not in admissible form, and the admissible version submitted only in sur-reply could not be considered.
New Century Chiropractic, P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 52236(U)) Appellate Term, Second Department, November 2, 2006Founded belief shown; the question must be triedHeld the special investigator's affidavit sufficient to show a founded belief that the collision was in furtherance of an insurance fraud scheme, raising a triable coverage issue that defeated the provider's motion.
Bell Air Med. Supply LLC v State Farm Ins. Claim Off. (2006 NY Slip Op 52218(U)) Appellate Term, Second Department, October 27, 2006Founded belief shown; the question must be triedHeld the special investigator's affidavit sufficient to show a founded belief that the collision was in furtherance of an insurance fraud scheme, raising a triable coverage issue that defeated the provider's motion.
Midborough Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51879(U)) Appellate Term, Second Department, October 2, 2006Founded belief shown; the question must be tried (also decides)Held, as an alternative ground, that the insurer's opposition amply raised a triable issue whether the alleged injuries arose out of an insured incident, requiring denial of the provider's summary judgment motion.
Magnezit Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51434(U)) Appellate Term, Second Department, July 18, 2006Founded belief shown; the question must be triedHeld the provider principal's own statement that the injuries were caused by multiple motor vehicle accidents supported a founded belief that the injuries did not arise from the insured incident, raising a triable issue.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 51437(U)) Appellate Term, Second Department, July 18, 2006Founded belief shown; the question must be tried (also decides)Held the insurer's papers showed a founded belief that the injuries did not arise from an insured incident because of a fraudulent scheme in the accident's happening, defeating the provider's summary judgment motion.
A.M. Med. Servs., P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 51425(U)) Appellate Term, Second Department, July 14, 2006Founded belief shown; the question must be triedHeld EUO transcripts showing the driver withdrew his claim when confronted with his family's many suspicious accidents, and the assignor then withdrew hers, showed a founded belief of no insured incident, raising a fact issue defeating both motions.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51424(U)) Appellate Term, Second Department, July 14, 2006Founded belief shown; the question must be triedHeld the special investigator's affidavit, showing the insured vehicle in five accidents within seven months involving connected participants, established a founded belief of a staged collision and an issue of fact defeating the provider's summary judgment.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 51417(U)) Appellate Term, Second Department, July 12, 2006Founded belief shown; the question must be triedHeld the insurer's papers showed a founded belief that the injuries did not arise from an insured incident because of a fraudulent scheme in the accident's happening, so the provider's summary judgment was properly denied.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 26269) Appellate Term, Second Department, July 3, 2006Founded belief shown; the question must be triedHeld the insurer's papers showing a fraudulent scheme in the happening of the accident demonstrated a founded belief that the injuries did not arise from an insured incident, so the provider's summary judgment motion was properly denied.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51275(U)) Appellate Term, Second Department, June 28, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's investigator affidavit insufficient to show a founded belief that the collision was a staged insurance fraud scheme, so the insurer's summary judgment was reversed and the provider's cross motion granted.
A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51347(U)) Appellate Term, Second Department, June 22, 2006Founded belief shown; the question must be triedHeld the insurer's low impact study, supported by the reconstructionist's affidavit, showed a founded belief that the injuries were unrelated to the accident, raising a triable issue that defeated the providers' summary judgment.
Amaze Med. Supply Inc. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 51051(U)) Appellate Term, Second Department, June 5, 2006Founded belief shown; the question must be triedHeld the insurer's low-impact accident analysis report, with its reconstructionist's affidavit, showed a founded belief that the injuries were not causally related to the accident, raising a triable coverage issue.
Delta Diagnostic Radiology, P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 51345(U)) Appellate Term, Second Department, May 25, 2006Founded belief shown; the question must be triedHeld the special investigator's affidavit showed a founded belief that the collision was part of an insurance fraud scheme, raising an issue of fact so that both parties' summary judgment motions were denied.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51033(U)) Appellate Term, Second Department, May 19, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld that counsel's affirmation and inconsistencies among EUO testimonies did not show a founded belief that the accident was a non-covered event, so the providers were granted summary judgment.
AT Med. P.C. v Utica Mut. Ins. Co. (2006 NY Slip Op 50739(U)) Appellate Term, Second Department, April 14, 2006Founded belief shown; the question must be triedHeld the insurer's submissions sufficed to show a founded belief that the collision was in furtherance of an insurance fraud scheme, a non-precludable defense, so the provider's summary judgment motion should have been denied.
A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2006 NY Slip Op 51334(U)) Appellate Term, Second Department, April 6, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's staged-accident proof insufficient to show a founded belief because investigators' reports and drivers' statements were unsworn, counsel lacked personal knowledge and the employee's affidavit was conclusory, so the providers won summary judgment.
Star Med. Servs. P.C. v Utica Mut. Ins. Co. (2006 NY Slip Op 50505(U)) Appellate Term, Second Department, March 27, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the staged-accident defense raised no triable issue because the investigative reports and statements were not in admissible form, counsel's allegations were hearsay and the claims representative's affirmation alone was insufficient.
A.B. Med. Servs. PLLC v Allstate Ins. Co. (2006 NY Slip Op 50474(U)) Appellate Term, Second Department, March 27, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's proof that the assignor was not in the insured vehicle insufficient to raise a triable issue because counsel lacked personal knowledge, the adverse driver's letter was unsworn, and the claims representative's allegations were conclusory.
Star Med. Servs., P.C. v Allstate Ins. Co. (2006 NYSlipOp 50344(U)) Appellate Term, Second Department, March 7, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the EUO transcripts of an assignor and the insured insufficient to show a founded belief that the injuries did not arise from an insured incident, so the provider's summary judgment was affirmed.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50862(U)) Appellate Term, Second Department, March 2, 2006Founded belief shown; the question must be tried (also decides)Held the insurer's papers showed a founded belief that the accident was part of a fraudulent scheme, raising a triable coverage issue that defeated summary judgment on the one claim for which a prima facie case was made.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50858(U)) Appellate Term, Second Department, February 28, 2006Founded belief shown; the question must be triedHeld the insurer's papers showed a founded belief that the accident was part of a fraudulent scheme, raising a triable coverage issue that defeated the supplier's summary judgment motion.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50859(U)) Appellate Term, Second Department, February 28, 2006Founded belief shown; the question must be triedHeld the insurer's papers sufficiently showed a founded belief that the injuries arose from a fraudulent accident scheme, raising a triable issue of coverage and defeating the provider's motion.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50860(U)) Appellate Term, Second Department, February 28, 2006Founded belief shown; the question must be triedHeld the insurer's papers sufficiently showed a founded belief that the injuries did not arise from an insured incident, raising a triable issue of lack of coverage that defeated the provider's motion.
Fair Price Med. Supply Corp. v ELRAC Inc. (2006 NY Slip Op 50861(U)) Appellate Term, Second Department, February 28, 2006Founded belief shown; the question must be triedHeld the insurer's papers showed a founded belief that the injuries did not arise from an insured incident because of a fraudulent accident scheme, raising a triable issue that warranted denying the provider's motion.
V.S. Med. Servs., P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 50304(U)) Appellate Term, Second Department, February 27, 2006Founded belief shown; the question must be triedHeld the insurer's investigator affidavit sufficient to show a founded belief that the injuries did not arise from an insured incident, raising a triable coverage issue that required denial of the provider's summary judgment motion.
Star Med. Servs., P.C. v Allstate Ins. Co. (2006 NY Slip Op 50245(U)) Appellate Term, Second Department, February 14, 2006Founded belief shown; the question must be tried (also decides)Held the insurer's submissions legally sufficient to support its claim that one assignor's injuries did not arise from an insured incident, raising a triable issue that defeated the provider's summary judgment on those claims.
Star Med. Servs. P.C. v Allstate Ins. Co. (2006 NY Slip Op 50129(U)) Appellate Term, Second Department, February 1, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insurer did not show a founded belief that the second assignor's injuries arose from a staged collision, because it relied on its bare representation of another passenger's EUO statements; summary judgment for the provider was affirmed.
Jeffrey I. Rubin, Phd Psyc. Svcs., P.C. v Utica Mut. Ins. Co. (2005 NY Slip Op 52206(U)) Appellate Term, Second Department, December 30, 2005Founded belief shown; the question must be triedHeld the claims specialist's affidavit and the assignor's EUO transcript sufficient to show a founded belief that the injuries did not arise from an insured incident, raising a triable issue that defeated the provider's motion.
Ocean Diagnostic Imaging P.C. v AIU Ins. Co. (2005 NY Slip Op 52200(U)) Appellate Term, Second Department, December 30, 2005Founded belief shown; the question must be triedHeld the special investigator's affidavit sufficient to show a founded belief that the injuries did not arise from a covered accident, raising a triable coverage issue, so the provider's motion was properly denied.
Millennium Med. Instruments Inc. v NYC Tr. Auth. (2005 NY Slip Op 52205(U)) Appellate Term, Second Department, December 30, 2005Insurer proved the injuries did not arise from a covered accidentHeld the bus driver's unrebutted affidavit established prima facie a lack of causal nexus between the accident and the injuries treated, so the insurer's cross motion dismissing the complaint was granted.
Amaze Med. Supply Inc. v Lumbermens Mut. Cas. Co. (2005 NY Slip Op 51898(U)) Appellate Term, Second Department, November 21, 2005Founded belief shown; the question must be triedHeld the insurer's documentation that the assignor's injuries were not caused by the accident showed a founded belief that they did not arise from an insured incident, warranting denial of the supplier's summary judgment motion.
A.B. Med. Servs. PLLC v Encompass Ins. (2005 NY Slip Op 51892(U)) Appellate Term, Second Department, November 4, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the assignor's EUO excerpts and claim representative's affidavit insufficient to show a founded belief that the injuries were unrelated or arose from a fraudulent collision, so the providers won summary judgment.
Ocean Diagnostic Imaging, P.C. v Utica Mut. Ins. Co. (2005 NY Slip Op 51747(U)) Appellate Term, Second Department, October 21, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's staged-accident fraud defense raised no triable issue because the investigators' reports and statements were unsworn and counsel's affirmation and the employee's affidavit were conclusory and not based on personal knowledge.
Ocean Diagnostic Imaging, P.C. v Utica Mut. Ins. Co. (2005 NYSlipOp 51745(U)) Appellate Term, Second Department, October 21, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the staged-accident defense not shown because counsel lacked personal knowledge, the examiner's assertion was conclusory, investigators' reports were unsworn and addressed billing, and the police-report statements were inadmissible hearsay.
A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2005 NY Slip Op 25456) Appellate Term, Second Department, October 21, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the staged-accident defense not shown because the investigators' reports and statements were unsworn, counsel lacked personal knowledge, and the claims representative's affidavit was conclusory.
Corona Med. Imaging, P.C. v State Farm Ins. Cos. (2005 NY Slip Op 51685(U)) Appellate Term, Second Department, October 20, 2005Founded belief shown; the question must be triedHeld the special investigator's affidavit revealing numerous discrepancies in the assignor's and insured's EUO accounts of the accident sufficient to show a founded belief of a fraudulent collision, raising a triable issue that defeated the provider's motion.
Careplus Med. Medical Supply Inc. v Allstate Ins. Co. (2005 NY Slip Op 51598(U)) Appellate Term, Second Department, September 30, 2005Founded belief shown; the question must be triedHeld the claims representative's affidavit that the insureds were involved in intentionally caused collisions sufficient to raise a triable issue of fraud, so the provider's motion was denied on those claims.
Careplus Med. Supply Inc. v Allstate Ins. Co. (2005 NYSlipOp 51526(U)) Appellate Term, Second Department, September 20, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insurer offered no proof creating a triable issue that any of the accidents were staged with intent to defraud, so it failed to show a founded belief that the injuries did not arise from an insured incident.
Ultra Diagnostics Imaging v Liberty Mut. Ins. Co. (2005 NY Slip Op 25402) Appellate Term, Second Department, September 20, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's attorney affirmation and unsworn handwriting expert report on a wage verification form were inadmissible and insufficient to raise an issue that the accident was in furtherance of an insurance fraud scheme, so summary judgment went to the provider.
Ocean Diagnostic Imaging P.C. v Utica Mut. Ins. Co. (2005 NYSlipOp 51080(U)) Appellate Term, Second Department, July 7, 2005Founded belief shown; the question must be triedHeld the claims representative's affidavit sufficient to show a founded belief that the collision furthered an insurance fraud scheme, so the provider's motion was denied and the insurer's cross motion properly denied for triable issues.
A.B. Med. Servs. PLLC v GMAC Ins. (2005 NYSlipOp 51079(U)) Appellate Term, Second Department, July 7, 2005Founded belief shown; the question must be triedHeld the claims representative's affidavit set forth additional facts sufficient to show a founded belief that the injuries were not causally related to the accident, raising a triable issue that defeated the providers' motion.
Ocean Diagnostic Imaging P.C. v Travelers Prop. Cas. Corp. (2005 NY Slip Op 51047(U)) Appellate Term, Second Department, July 6, 2005Founded belief shown; the question must be triedHeld the investigators' affidavits showed a founded belief that the collision furthered an insurance fraud scheme, raising a triable issue that defeated the provider's motion while leaving the insurer's cross motion properly denied.
Ocean Diagnostic Imaging P.C. v Eagle Ins. Co. (2005 NYSlipOp 51027(U)) Appellate Term, Second Department, June 27, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's showing of a staged collision insufficient to defeat summary judgment, for the reasons given in an earlier ruling on the same accident, assignor and showing, so the provider's motion was granted.
Careplus Med. Supply Inc. v Kemper Auto & Home Ins. Co. (2005 NYSlipOp 50958(U)) Appellate Term, Second Department, June 9, 2005Founded belief shown; the question must be triedHeld the consultant's sworn accident reconstruction report admissible expert evidence of no causal nexus between the accident and the injuries, sufficient to show a founded belief and raise a triable coverage issue.
Struhl v Progressive Cas. Ins. Co. (2005 NYSlipOp 50864(U)) Appellate Term, Second Department, June 3, 2005Founded belief shown; the question must be triedHeld the insurer's admissible peer review report raised a triable issue whether the condition treated arose from a covered incident, a defense not subject to preclusion, so the provider's motion was denied.
GPM Chiropractic, P.C. v State Farm Mut. Ins. Co (2005 NYSlipOp 50861(U)) Appellate Term, Second Department, June 3, 2005Founded belief shown; the question must be triedHeld the special investigator's affidavit sufficient to show a founded belief that the collision furthered an insurance fraud scheme, raising a triable coverage issue that required denial of the provider's cross motion.
A.B. Med. Servs. PLLC v State-Wide Ins. Co. (2005 NYSlipOp 50785(U)) Appellate Term, Second Department, May 23, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's staged-collision defense unsupported because its attorney's affirmation lacked personal knowledge and the investigative reports were unsworn without excuse, so the providers won summary judgment, with leave to renew.
Ocean Diagnostic Imaging P.C. v Travelers Prop. Cas. Corp. (2005 NY Slip Op 50790(U)) Appellate Term, Second Department, May 23, 2005Founded belief shown; the question must be triedHeld the investigator's and claims representative's affidavits showed a founded belief that the collision furthered an insurance fraud scheme, raising triable issues that defeated both the provider's motion and the insurer's cross motion.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 50747(U)) Appellate Term, Second Department, May 19, 2005Founded belief shown; the question must be triedHeld the insurer's SIU investigator affidavit sufficient to show a founded belief that the collision was part of an insurance fraud scheme, raising a triable issue that defeated the supplier's summary judgment.
Gpm Chiropractic, P.C. v State Farm Mut. Ins. Co. (2005 NYSlipOp 50744(U)) Appellate Term, Second Department, May 19, 2005Founded belief shown; the question must be triedHeld the insurer's investigator affidavit sufficient to show a founded belief that the injuries did not arise from an insured incident, raising a triable issue so the provider's summary judgment was denied.
Ocean Diagnostic Imaging P.C. v Travelers Indem. Co. (2005 NY Slip Op 50644(U)) Appellate Term, Second Department, April 29, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the claims representative's affidavit, unsworn investigator's report and assignor's questionnaire did not show the nature of the claimed discrepancies and so failed to show a founded belief of a staged collision; provider granted summary judgment.
Ocean Diagnostic Imaging P.C. v Utica Mut. Ins. Co. (2005 NYSlipOp 50611(U)) Appellate Term, Second Department, April 22, 2005Founded belief shown; the question must be triedHeld the claims representative's affidavit sufficient to show a founded belief that the collision was in furtherance of an insurance fraud scheme, raising an issue of fact that defeated the provider's summary judgment motion.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 50607(U)) Appellate Term, Second Department, April 22, 2005Founded belief shown; the question must be triedHeld an accident analysis (low impact) report with the reconstructionist's affidavit sufficient to show a founded belief that the injuries were causally unrelated to the accident, raising a triable coverage issue and requiring denial of the provider's motion.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 50606(U)) Appellate Term, Second Department, April 22, 2005Founded belief shown; the question must be triedHeld an accident analysis (low impact) report with the reconstructionist's affidavit sufficient to show a founded belief that the injuries were causally unrelated to the accident, raising a triable coverage issue and requiring denial of the provider's motion.
A.B. Med. Servs. PLLC v GMAC Ins. (2005 NYSlipOp 50602(U)) Appellate Term, Second Department, April 22, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the claims representative's affidavit insufficient to show a founded belief that the injuries were not causally related to the accident, because the injury potential analysis and peer review were unsworn and inadmissible, so summary judgment went to the providers.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 50535(U)) Appellate Term, Second Department, April 13, 2005Founded belief shown; the question must be triedHeld the special investigator's affidavit sufficient to show a founded belief that the collision was part of an insurance fraud scheme, raising a triable issue that defeated the provider's motion, but insufficient to establish lack of coverage as a matter of law.
Ocean Diagnostic Imaging P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 50525(U)) Appellate Term, Second Department, April 13, 2005Founded belief shown; the question must be triedHeld a sworn accident analysis (low impact study) admissible and relevant to causation and sufficient to show a founded belief that the injuries were not causally related to the accident, raising a triable coverage issue.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 25336) Appellate Term, Second Department, March 1, 2005Founded belief shown; the question must be triedHeld the special investigator's affidavit showed a founded belief that the injuries arose from a collision staged as an insurance fraud scheme, raising a triable issue that defeated the provider's summary judgment motion despite the untimely denial.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2005 NYSlipOp 50454(U)) Appellate Term, Second Department, February 17, 2005Founded belief shown; the question must be triedHeld the special investigator's affidavit sufficient to show a founded belief that the collision was in furtherance of an insurance fraud scheme, raising a triable coverage issue that defeated the provider's motion.
Ocean Diagnostic Imaging P.C. v Allstate Ins. Co. (2005 NY Slip Op 50189(U)) Appellate Term, Second Department, February 17, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer failed to raise a triable staged-accident issue because counsel's affirmation lacked personal knowledge and the claims representative's statement that investigation revealed a staged accident was conclusory, so summary judgment for the provider was affirmed.
Ocean Diagnostic Imaging P.C. v AIU Ins. Co. (2005 NY Slip Op 50188(U)) Appellate Term, Second Department, February 17, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's assertion that the accident was fraudulent unsupported by admissible evidence because its investigator's report was unsworn without excuse, so the provider was granted summary judgment.
Ocean Diagnostic Imaging, Inc. v Utica Mut. Ins. Co. (2005 NY Slip Op 50081(U)) Appellate Term, Second Department, January 27, 2005Founded belief shown; the question must be triedHeld the claims specialist's affidavit showed a founded belief that the collision furthered an insurance fraud scheme, raising a triable issue that defeated the provider's motion but not entitling the insurer to judgment.
A.B. Med. Servs. PLLC v Prudential Prop. & Cas. Ins. Co. (2005 NY Slip Op 50076(U)) Appellate Term, Second Department, January 27, 2005Founded belief shown; the question must be triedHeld the litigation coordinator's affidavit and accompanying examinations under oath sufficient to show a founded belief that the injuries did not arise from a covered accident, raising a triable issue that defeated the providers' motion.
A.B. Med. Servs. PLLC v Prudential Prop. & Cas. Ins. Co. (2005 NY Slip Op 25032) Appellate Term, Second Department, January 20, 2005Founded belief shown; the question must be triedHeld the litigation coordinator's affidavit and the accompanying EUO transcripts showed a founded belief that the injuries did not arise from a covered accident, raising a triable issue that defeated the providers' motion.
Ocean Diagnostic Imaging P.C. v Eagle Ins. Co. (2004 NY Slip Op 51640(U)) Appellate Term, Second Department, December 15, 2004Founded belief shown; the question must be triedHeld the investigator's affidavit supported by the assignor's examination under oath sufficient to show a founded belief that the injuries did not arise from an insured incident, raising a triable coverage issue that defeated the provider's motion.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51639(U)) Appellate Term, Second Department, December 15, 2004Founded belief shown; the question must be triedHeld the special investigator's affidavit showed a founded belief that the collision was part of an insurance fraud scheme, raising a triable coverage issue that defeated the providers' summary judgment motion despite the untimely denial.
Amaze Med. Supply Inc. v AIU Ins. Co. (2004 NY Slip Op 51629(U)) Appellate Term, Second Department, December 15, 2004Founded belief shown; the question must be triedHeld the investigator's affidavit set forth enough facts to show a founded belief that the collision was staged in a fraud scheme, raising an issue of fact that warranted denying the supplier's summary judgment motion.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51627(U)) Appellate Term, Second Department, December 14, 2004Founded belief shown; the question must be triedHeld the special investigator's affidavit showed a founded belief that the collision furthered an insurance fraud scheme, raising a triable coverage issue that defeated the providers' summary judgment motion.
Ocean Diagnostic Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51624(U)) Appellate Term, Second Department, December 14, 2004Founded belief shown; the question must be triedHeld the special investigator's affidavit showed a founded belief that the collision furthered an insurance fraud scheme, raising a triable coverage issue that defeated the provider's summary judgment motion.
Ocean Diagnostic Imaging, P.C. v Lancer Ins. Co. (2004 NY Slip Op 24501) Appellate Term, Second Department, December 8, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's claims representative affidavit did not show a founded belief that the injuries were unrelated to the accident, and its unsworn engineering report was not competent proof, so the provider's summary judgment stood.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51432(U)) Appellate Term, Second Department, November 19, 2004Founded belief shown; the question must be triedHeld the special investigator's affidavit showed a founded belief that the collision furthered an insurance fraud scheme, raising a triable coverage issue that defeated the providers' summary judgment motion.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51429(U)) Appellate Term, Second Department, November 19, 2004Founded belief shown; the question must be triedHeld the special investigator's affidavit showed a founded belief that the collision furthered an insurance fraud scheme, raising a triable coverage issue that defeated the supplier's summary judgment motion.
Fair Price Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51242(U)) Appellate Term, Second Department, October 21, 2004Founded belief shown; the question must be triedHeld the special investigator's affidavit, supported by EUOs of the assignor and others involved, raised a triable issue whether the collision was part of a fraudulent insurance scheme, so the provider's motion was properly denied.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51251(U)) Appellate Term, Second Department, October 20, 2004Founded belief shown; the question must be triedHeld the special investigator's affidavit showed a founded belief that the collision furthered an insurance fraud scheme, raising a triable coverage issue that defeated the provider's summary judgment motion.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51250(U)) Appellate Term, Second Department, October 20, 2004Founded belief shown; the question must be triedHeld the staged-accident defense was not subject to preclusion and the insurer's submissions demonstrated a founded belief that the injuries did not arise from an insured incident, so the provider's summary judgment motion was properly denied.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51104(U)) Appellate Term, Second Department, September 29, 2004Founded belief shown; the question must be triedHeld the special investigator's affidavit showed a founded belief that the collision furthered an insurance fraud scheme, raising a triable issue of lack of coverage that required denial of the providers' motion.
Ocean Diagnostic Imaging, P.C. v Geico Ins. (2004 NY Slip Op 51038(U)) Appellate Term, Second Department, September 20, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's opposition, an attorney's affidavit without personal knowledge making bare conclusory fraud allegations, did not raise an issue of fact that the injuries did not arise from a covered accident.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51032(U)) Appellate Term, Second Department, September 17, 2004Founded belief shown; the question must be triedHeld the investigator's affidavit set forth enough facts to show a founded belief that the collision was staged in a fraud scheme, raising a triable coverage issue that defeated the provider's summary judgment motion.
A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51031(U)) Appellate Term, Second Department, September 17, 2004Founded belief shown; the question must be tried (also decides)Held the insurer's staged-accident claim supported by sufficient admissible factual allegations to require a trial, though not established enough to warrant summary judgment for the insurer.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 24342) Appellate Term, Second Department, September 17, 2004Founded belief shown; the question must be triedHeld the investigator's affidavit set forth enough facts to show a founded belief that the collision was a staged event in a fraud scheme, raising a triable coverage issue that defeated the provider's summary judgment motion.
S & M Supply Inc. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50693(U)) Appellate Term, Second Department, June 30, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's staged-accident fraud defense failed to raise a triable issue because it rested only on an attorney's affirmation without personal knowledge and an unsworn investigator's letter, which are not admissible proof.
Melbourne Med., P.C. v Utica Mut. Ins. Co. (2004 NY Slip Op 24221) Appellate Term, Second Department, June 7, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insurer's fraud defense, even if based on a staged accident, raised no triable issue because it rested only on an attorney's hearsay allegations without an affidavit from anyone with knowledge of the investigation.
A.B. Med. Servs. Pllc v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50575(U)) Appellate Term, Second Department, June 4, 2004Founded belief shown; the question must be triedHeld the special investigations unit investigator's detailed affidavit set forth enough facts and founded beliefs to raise a triable issue whether the injuries arose from an insured incident, so the providers' motion was properly denied.
S & M Supply, Inc. v Nationwide Mut. Ins. Co. (2004 NY Slip Op 50557(U)) Appellate Term, Second Department, June 3, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the defense that the insured vehicle was not involved raised no triable issue because the insurer relied only on hearsay statements of its insured without excusing the lack of admissible proof.
A.B. Med. Servs. PLCC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 24181) Appellate Term, Second Department, March 17, 2004Founded belief shown; the question must be triedHeld EUO transcripts and an investigator's affidavit revealing discrepancies in the assignors' accounts and the insured's identities raised triable issues whether the accident was staged to defraud, defeating the provider's summary judgment motion.
A.B. Med. Servs. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 50387(U)) Appellate Term, Second Department, February 10, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insurer failed to allege facts in admissible form and with particularity raising a triable issue that the accident claims were fraudulent, so partial summary judgment went to the providers.
A.B. Med. Servs. v Eagle Ins. Co. (2003 NY Slip Op 23978) Appellate Term, Second Department, December 24, 2003Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the staged-accident defense not raised because the investigator's unsworn report offered only suppositions about the insured's prior suspicious accidents and a recommendation to defer payment, so partial summary judgment for the providers was granted.

Trial courts in the First Department (10 decisions)

Hertz Vehs., LLC v Ace Med Supplies Inc. (2025 NY Slip Op 51959(U)) Supreme Court, New York County, October 7, 2025Insurer proved the injuries did not arise from a covered accidentGranted a default declaration of no coverage because the adjuster's affidavit, EUO testimony discrepancies and other documents established a well-founded belief that the claims arose from a staged accident, a defense not subject to preclusion.
Unitrin Safeguard Ins. Co. v Advanced Recovery Solution, Inc. (2022 NY Slip Op 50517(U)) Supreme Court, New York County, June 21, 2022Insurer proved the injuries did not arise from a covered accidentGranted the insurer a default judgment because its claims representative's affidavit and the police report showed a founded belief that the claimants' injuries did not arise from a covered collision.
Sabodash v Hereford Ins. Co. (2021 NY Slip Op 51099(U)) Civil Court of the City of New York, Bronx County, November 19, 2021Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer failed to prove that its vehicle was not involved in the accident because its supervisor's assertion rested entirely on a police report without foundation, so the defense lacked merit and the provider won.
American Tr. Ins. Co. v 21st Century Pharmacy Inc. (2020 NY Slip Op 50532(U)) Supreme Court, New York County, May 7, 2020Insurer's motion denied: proof did not establish the defense prima facie; defense still openDenied the insurer summary and default judgment because its investigator's staged-collision affidavit rested on a hearsay police report and an unsigned EUO transcript; the date, time and place alone did not show a founded belief.
Liberty Mut. Ins. Co. v Martin (2020 NY Slip Op 50511(U)) Supreme Court, New York County, May 4, 2020Insurer's motion denied: proof did not establish the defense prima facie; defense still open (also decides)Held the insurer did not show prima facie a founded belief that the collision was staged, because its investigator's affidavit rested on unsigned EUO transcripts not shown to comply with CPLR 3116 (a) and on conclusory assertions.
American Alternative Ins. Corp. v Washington (2018 NY Slip Op 51210(U)) Supreme Court, New York County, August 14, 2018Insurer proved the injuries did not arise from a covered accidentGranted a default declaration of no coverage because the claims manager's affidavit that the vehicle's video showed neither claimant was knocked down sufficed as proof that the claimed injuries did not arise from the incident.
Ameriprise Ins. Co. v Hampton (2018 NY Slip Op 51207(U)) Supreme Court, New York County, August 14, 2018Founded belief shown; the question must be tried (also decides)Held the investigator's affidavit and the occupants' admissible unsigned EUO transcripts showed a likelihood that the collision was intentional and staged, enough for preliminary relief, without declaring no coverage on the merits.
Ocean Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 50565(U)) Civil Court, New York County, April 2, 2009Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer showed no founded belief that the collision was intentional because counsel's affirmation and a claims representative's file-review affidavit lacked personal knowledge, were conclusory, and the EUO transcripts were not annexed.

Show all 10 decisions

AA Acupuncture Serv., P.C. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 51066(U)) Civil Court of the City of New York, New York County, May 30, 2008Founded belief shown; the question must be triedHeld the investigator's detailed, uncontradicted affidavit showed the accident was likely staged, but denied the insurer summary judgment because a founded belief of a staged accident only raises an issue of fact.
Inwood Hill Med. v Allstate Ins. Co. (2004 NY Slip Op 50565(U)) Civil Court of the City of New York, New York County, June 18, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld minor discrepancies in the claimants' EUO testimony, little lost work time and use of the same clinic did not raise a triable issue that the accident was staged or the injuries unrelated, absent expert or investigator proof.

Trial courts in the Second Department (42 decisions)

Liberty RX Inc v Liberty Mut. Ins. Co. (2026 NY Slip Op 50992(U)) Civil Court of the City of New York, Richmond County, June 18, 2026Founded belief shown; the question must be triedDenied the insurer's summary judgment motion and sent the case to trial, finding triable issues of fact on its staged-accident and non-covered-loss defenses because investigator proof and inconsistent EUO testimony did not establish staging as a matter of law.
Empire State Rehab PT PC v Liberty Mut. Ins. Co. (2026 NY Slip Op 50894(U)) Civil Court of the City of New York, Richmond County, June 4, 2026Founded belief shown; the question must be triedDenied the insurer's summary judgment motion because its investigator's conclusory affirmation and the occupants' inconsistent EUO testimony raised questions of fact and credibility but did not establish as a matter of law that the incident was staged.
CuraHealth Specialty Pharm. Corp v State Farm Ins. Co. (2026 NY Slip Op 50852(U)) Civil Court of the City of New York, Queens County, June 1, 2026Insurer proved the injuries did not arise from a covered accidentHeld the insurer established the collision was intentionally caused through investigation showing a recently issued policy, delayed reporting, conflicting EUO accounts and identical treatment of strangers, and the provider raised no triable issue.
Parisien v Erie Ins. Co. of N.Y. (2026 NY Slip Op 50400(U)) Civil Court of the City of New York, Richmond County, March 25, 2026Founded belief shown; the question must be triedDenied the insurer's summary judgment motion on its staged-accident defense because the other driver's testimony that only two occupants were present conflicted with three occupants' EUO testimony, creating credibility issues for trial.
Medical Diagnostic Ctr. v Ameriprise Ins. Co. (2026 NY Slip Op 50235(U)) Civil Court of the City of New York, Kings County, February 25, 2026Insurer's motion denied: proof did not establish the defense prima facie; defense still openDenied the insurer's summary judgment motion because the driver's leading, speculative and inconsistent EUO testimony about suspicious passengers did not establish by admissible proof that the collision was intentional and staged.
Integon Natl. Ins. Co. v Salazar-Ochoa (2026 NY Slip Op 50292(U)) Supreme Court, Suffolk County, January 7, 2026Insurer proved the injuries did not arise from a covered accidentGranted the insurer summary judgment declaring no coverage because investigator affirmations, admissible unsigned but certified EUO transcripts, adverse drivers' affidavits and records showed staged collisions, and opponents offered only attorney affirmations or insufficient affidavits.
NYRX Pharm. Inc. v Mid-Century Ins. Co. (2023 NY Slip Op51094(U)) Civil Court of the City of New York, Kings County, October 11, 2023Insurer's motion denied: proof did not establish the defense prima facie; defense still openHeld the insurer failed to make a prima facie showing of a staged collision because it relied only on unreliable, uncorroborated fillable confessions of the drivers, with no investigator or other affiant with personal knowledge of how they were made.
State Farm Fire & Cas. Co. v R.L. (2023 NY Slip Op 50497(U)) Supreme Court, Nassau County, April 21, 2023Insurer's motion denied: proof did not establish the defense prima facie; defense still open (also decides)Held the insurer did not show a likely staged accident by clear and convincing evidence because its claim specialist's affidavit rested largely on hearsay, uncertified police reports and an unidentified third-party database record.

Show all 42 decisions

Precise Physical Therapy Solutions v State Farm Mut. Auto. Ins. Co. (2020 NY Slip Op 20254) Civil Court of the City of New York, Queens County, October 8, 2020Insurer's motion denied: proof did not establish the defense prima facie; defense still openHeld the insurer's evidence of a staged collision (adverse driver's account, prior damage, a passenger's prior loss, vague EUO answers) insufficient for summary judgment, noting conflicting accounts of the collision and that the assignor answered most EUO questions.
Krasner Chiropractic, P.C. v IDS Prop. & Cas. Ins. Co. (2019 NY Slip Op 29382) Civil Court of the City of New York, Richmond County, November 12, 2019Founded belief shown; the question must be triedDenied the insurer summary judgment on its staged-accident defense because conflicting EUO testimony created rather than removed issues of fact and the police report was uncertified hearsay, leaving coverage as the sole trial issue.
ACH Chiropractic P.C. v Geico Ins. Co. (2019 NY Slip Op 51439(U)) Civil Court of the City of New York, Kings County, September 4, 2019Insurer proved the injuries did not arise from a covered accidentHeld the insurer proved by a preponderance, through police, arrest and investigator records, that the insured deliberately struck the assignor with his vehicle, so the injuries were not caused by an accident and were not covered.
Pavlova v Allstate Ins. Co. (2019 NY Slip Op 50016(U)) Civil Court of the City of New York, Kings County, January 2, 2019Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld vague and inconsistent EUO testimony of the occupants, without an investigator's affidavit explaining why the inconsistencies showed an intentional loss, did not show a founded belief that the collision was staged or raise a triable issue.
Westchester Med. Ctr. v Travelers Prop. Cas. Co. of Am. (2014 NY Slip Op 51216(U)) District Court of Nassau County, First District, August 7, 2014Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the peer review asserting only part of the treatment was unrelated did not show the treatments were unrelated to the accident at all, so the hybrid-case causation defense fell outside Chubb and was precluded.
Lancer Ins. Co. v Saravia (2013 NY Slip Op 23095) Supreme Court, Kings County, March 29, 2013Founded belief shown; the question must be triedDenied the insurer summary judgment declaring the accident staged, because its circumstantial proof, partly inadmissible hearsay from another insurer's investigation, would let a reasonable jury infer either that the accident was or was not staged.
Mount Sinai Hosp. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 51423(U)) Supreme Court, Nassau County, June 24, 2011Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld that, despite the investigator's admissible affidavit, the assignor's injuries arose from an accident because her actions after the collision were reflexive rather than intended, so the lack-of-coverage defense failed and the hospital won summary judgment.
Globe Surgical Supply v Allstate Ins. Co. (2011 NY Slip Op 50884(U)) Supreme Court, Nassau County, April 18, 2011Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Dismissed the insurer's staged-accident affirmative defense because its only evidence, a claims examiner's affidavit, described fraudulent invoicing rather than any staging of accidents, so it failed its burden to show a founded belief of no coverage.
Gegerson v State Farm Ins. Co. (2010 NY Slip Op 50604(U)) District Court of Nassau County, Second District, April 8, 2010Founded belief shown; the question must be tried (also decides)Rejected the insurer's request, on searching the record, to dismiss one provider's claim for lack of causation, holding the record at best presented a triable issue as to causation.
Style Acupuncture, P.C. v State-Wide Ins. Co. (2010 NY Slip Op 50089(U)) Civil Court of the City of New York, Kings County, January 22, 2010Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insurer's fraud defense did not defeat the claim because its investigator's report was unsworn and in any event concluded there was no evidence the accident was caused or staged.
Manhattan Med. Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 51844(U)) Civil Court of the City of New York, Richmond County, September 4, 2008Founded belief shown; the question must be tried (also decides)Held the investigator's sworn affidavit and transcriber-certified assignor statements showing inconsistencies about the collision enough to raise a triable issue that the accident was staged, defeating the provider's summary judgment motion.
Rizz Mgt. Inc. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 51191(U)) District Court of Nassau County, First District, June 17, 2008Founded belief shown; the question must be triedDenied the insurer summary judgment on its staged-accident defense because its investigator affidavit was hearsay and the EUO transcripts were unsigned and uncertified, and in any event its proof showed only a founded belief raising factual issues for trial.
Northern Med. P.C. v State Farm Mut. Auto. Ins. Co. (2008 NY Slip Op 50753(U)) Civil Court of the City of New York, Queens County, March 19, 2008Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld after trial that the insurer did not prove by a preponderance of credible evidence that the collision was staged, because its unprepared investigator's testimony was weak and the assignor's testimony of receiving no treatment alone was insufficient.
Mary Immaculate Hosp. Caritas Health Care v Government Employees Ins. Co. (2008 NY Slip Op 50638(U)) Supreme Court, Nassau County, February 25, 2008Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer raised no triable issue that the injury resulted from an intentional act, because its claim-note entry of the insured's account was inadmissible hearsay and the emergency room entry had no disclosed source and was not germane to treatment.
Alpha Health Care Plus Med. v Progressive Ins. Co. (2007 NY Slip Op 52209(U)) Civil Court of the City of New York, Kings County, November 23, 2007Founded belief shown; the question must be tried (also decides)Vacated the default summary judgment for the provider because the Supreme Court's staged-accident order, together with the staged-accident facts in the insurer's opposition, raised a question of fact on coverage.
KOI Med. Acupuncture v State Farm Ins. Co. (2007 NY Slip Op 51705(U)) Nassau District Court, September 10, 2007Founded belief shown; the question must be tried (also decides)Held the investigator's affidavit lacked a business-records foundation and the EUO transcripts were unsigned, but that, if admissible, the proof showed a founded belief of a staged accident raising fact issues, so neither side won judgment.
New York Massage Therapy P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 52573(U)) Civil Court of the City of New York, Kings County, December 22, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld after trial that the insurer failed to prove a staged accident because its only witness, an investigator without personal knowledge of the investigation or denial, offered merely speculative 'suspicious indicators', so judgment went to the provider.
Bronx Expert Radiology, P.C. v Allstate Ins. Co. (2006 NY Slip Op 51992(U)) District Court of Nassau County, Third District, October 13, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's investigator affidavit, which withheld the information it relied on, and EUO transcripts with alleged inconsistencies did not show a staged event or raise a triable issue, so the provider's summary judgment was granted.
PDG Psychological, P.C. v State Farm Ins. Co. (2006 NY Slip Op 51398(U)) Civil Court, Kings County, July 14, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held at trial that the investigator's testimony about a new policy, prior accidents and unadmitted EUO discrepancies did not produce admissible evidence of a founded belief that the collision was intentional.
Deajess Med. Imaging, P.C. v State Farm Fire & Cas. Co. (2006 NY Slip Op 51281(U)) Civil Court of the City of New York, Kings County, June 28, 2006Insurer proved the injuries did not arise from a covered accident (also decides)Held investigators' findings showed a founded belief that six assignors' injuries did not arise from a covered accident, raising a triable issue, and dismissed the claim of an assignor who impersonated the person actually in the vehicle.
Universal Open MRI of the Bronx, P.C. v State Farm Mut. Auto Ins. (2006 NY Slip Op 50853(U)) Civil Court of the City of New York, Kings County, May 11, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld after trial that the insurer failed to come forward with admissible proof of a staged accident, since its investigator's NICB and claims-database information was inadmissible hearsay and no admissible noncooperation evidence was offered, so the burden never shifted.
Capri Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50538(U)) Civil Court of the City of New York, Kings County, March 30, 2006Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's low-impact causation defense unsupported by competent evidence because its consultant's out-of-state affidavit lacked a CPLR 2309(c) certificate and the unsworn accident analysis report was inadmissible, so the provider won summary judgment.
V.S. Med. Servs., P.C. v Allstate Ins. Co. (2006 NY Slip Op 26000) Civil Court, Kings County, January 3, 2006Insurer proved the injuries did not arise from a covered accidentHeld after trial that the collision was intentional and not covered, because the insurer's credible evidence of the vehicle's claim history, minimal damage, and occupants' inconsistent accounts went unrebutted; insurer need not prove fraud.
Mega Supply & Billing Inc. v Allstate Ins. Co. (2005 NY Slip Op 52168(U)) Civil Court, Kings County, December 30, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's staged-accident defense unsupported because counsel lacked personal knowledge and the claims adjuster's assertions of aggressive treatment and suspicious circumstances were speculative and not specific to the accident.
City Wide Social Work & Psychological Servs., P.L.L.C. v General Assur. Co. (2005 NY Slip Op 51197(U)) Civil Court of the City of New York, Kings County, July 27, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insurer's evidence that the assignor was not at the accident scene was inadmissible hearsay (unsworn investigator, uncertified police report) without excuse, so it raised no triable issue and the provider won summary judgment.
Boai Zhong Yi Acupuncture Servs., P.C. v New York Cent. Mut. Fire Ins Co. (2005 NY Slip Op 51058(U)) Civil Court of the City of New York, Queens County, July 8, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the low-impact study affidavit inadmissible for lack of a certificate of conformity and insufficient anyway because the study was not annexed and the affiant did not prepare it, so no founded belief was shown.
JSI Expert Serv. v Liberty Mut. Ins. Co. (2005 NY Slip Op 50513(U)) Civil Court, Kings County, March 23, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld after trial that the insurer failed to prove a staged accident because the assignors' EUO statements were inadmissible hearsay against the assignee and the investigator's remaining inferences were minor, unexplained and not clear and convincing.
A.B. Med. Servs., PLLC v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 25089) Civil Court, Kings County, March 9, 2005Insurer proved the injuries did not arise from a covered accidentHeld after trial that the investigator's testimony and circumstantial evidence carried the insurer's burden of showing a founded belief the collisions were staged, and plaintiffs, calling no assignors, failed to rebut it or prove coverage; claims dismissed.
Vital Points Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co. (2005 NY Slip Op 50267(U)) Civil Court of the City of New York, Kings County, March 3, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's low-impact study affidavit and claims specialist affidavit failed to raise a triable issue that the injuries did not arise from the accident, as they gave no factual basis, methodology or link to the assignor's injuries.
Delta Diagnostic Radiology, P.C. v Lumbermans Mut. Ins. Co. (2005 NY Slip Op 50326(U)) Civil Court, Kings County, February 10, 2005Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer failed to raise a triable issue that the injuries did not arise from the accident because its unsworn EUO report, hearsay employee affidavit and counsel's affirmation were not in admissible form.
Star Med. Servs., P.C. v Allstate Ins. Co. (2004 NY Slip Op 24410) Civil Court, Kings County, October 25, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held the insured's EUO testimony that the passenger was not in the car, given without personal knowledge, was unsubstantiated supposition that raised no triable issue that her injuries did not result from the accident.
Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 24356) Civil Court of the City of New York, Kings County, September 24, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Held, though moot, that the staged-accident defense lacked merit because the insurer offered no evidence of fraud by the assignor, all allegations concerning other participants.
A.M Med. v New York Cent. Mut. Ins. Co. (2004 NY Slip Op 50298(U)) Civil Court of the City of New York, Queens County, April 2, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on itHeld the insurer's low-impact study defense failed because the accident report was unsworn, the adjuster's affidavit lacked personal knowledge or expertise, and the study did not show a deliberate or fraudulent accident.
Ocean Diagnostic Imaging v Utica Mut. Ins. Co. (2004 NY Slip Op 50203(U)) District Court of Nassau County, Third District, March 29, 2004Insurer's proof did not raise an issue or failed at trial; provider prevails on it (also decides)Rejected the insurer's suggestion of a staged accident, offered to escape preclusion, because it rested only on unsworn investigator reports about treatment-form signatures, with no evidentiary proof and no explanation of how billing fraud made the accident non-covered.

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