4 decisions · 3 Appellate Division · 1 trial court
Issues this month: Provider's prima facie case 2 Timeliness and preclusion 1 CPLR article 75 (arbitration awards) 1 Priority, other coverage 1 Jurisdiction and service 1 Discovery and procedure 1
The providers' summary judgment motion for no-fault payments was granted because the insurer raised no triable issue. The Appellate Division, Second Department, affirmed the order and judgment, finding the providers' evidence sufficient under Insurance Law § 5106 (a) and 11 NYCRR 65.15 (g) (3), and the insurer's opposition insufficient to raise a triable issue. The separate appeal from the decision was dismissed as nonappealable.
The injured claimant's summary judgment motion for lost-wage benefits was denied for an insufficient showing of untimely payment or denial. The Appellate Division, Second Department, affirmed the order, insofar as appealed from, because the claimant failed to eliminate triable issues concerning the insurer's alleged noncompliance with Insurance Law § 5106 and 11 NYCRR 65.15, including the 30-day payment-or-denial requirement in 11 NYCRR 65.15 (g) (3).
The loss-transfer arbitration awards were vacated because notice went to the self-insurer's headquarters rather than its known local representative. The petitioning no-fault insurer sought reimbursement under Insurance Law § 5105 after paying first-party benefits, and the self-insurer did not appear at the hearings. The Appellate Division, Second Department, reversed, denied confirmation, and granted vacatur under CPLR 7511 (b) (2). Notice of intention to arbitrate failed to comply with 11 NYCRR 65.10 (d) (2) (iii); the record also lacked proof of certified-mail hearing notices under CPLR 7506 (b) and 11 NYCRR 65.10 (d) (3) (iii). The court rejected the self-insurer's jurisdictional objection because the unrebutted service affidavit established proper service under CPLR 311 (a) (1).
The provider and its attorney were sanctioned for pursuing unauthorized claims and concealing a claimant's bankruptcy and death. After a sanctions hearing in an action for assigned no-fault benefits, the Civil Court, Queens County, granted the insurer's request under 22 NYCRR 130-1.1 (c). Counsel failed to verify clients or claims, submitted papers bearing signatures counsel had not supplied, and failed to establish authority to sue for several named providers. The physician provider concealed another claimant's bankruptcy and death through an employee's deposition testimony and pursued claims despite that knowledge. The court imposed $3,000 in sanctions on each and required them to share equally the insurer's reasonable legal fees, explaining that dismissal alone does not warrant sanctions.
Headnotes, outcome labels and monthly summaries are our own summaries, not the courts’ words; the decision itself is the authority. Months follow the date a decision was handed down; new decisions are added monthly, so a recent month can still grow.