No-Fault Decisions, 2025

The First Department held that an insurer's admission of receipt in its summary judgment papers made out the provider's prima facie case, and that the insurer had to prove its verification requests were sent (Health E. Ambulatory v Country-Wide). Four Second Department decisions upheld article 75 fee awards fixed without a hearing counsel never requested. The Appellate Term, Second Department, held that MVAIC's 30-day period runs from its receipt of the claim, whatever its covered-person determination (Harvey Family Chiropractic v MVAIC); in four appeals, Foremost proved neither proper notice of cancellation under Vehicle and Traffic Law § 313 (1) (a) nor a cancellation reaching an assignor outside the household.

Our summary of the month’s decisions, not the courts’ words.

The Court of Appeals, deferring to DFS, held that 11 NYCRR 65-3.16 (a) (12) does not let an insurer deny reimbursement for alleged professional misconduct, such as paying for referrals, short of ceding control to an unlicensed party (GEICO v Mayzenberg). It distinguished Mallela and Carothers as foundational licensing violations and left open when kickbacks amount to such control. Four Second Department decisions let courts fix article 75 attorney's fees without a hearing nobody requested. Citing Hospital for Joint Diseases, the Appellate Term, First Department, held that a verification request one day late under 11 NYCRR 65-3.5 (b) only shortened the insurer's 30 days (Quazi R. Med. v Nationwide).

Our summary of the month’s decisions, not the courts’ words.

Addressing unpreserved arguments in the alternative, the First Department followed Unitrin Advantage v Bayshore: failure to subscribe EUO transcripts breaches a condition precedent to coverage, and the Thrasher willfulness test for liability policies does not apply to no-fault (Hereford v 21 Century Chiropractic). The Second Department upheld master awards as rational, one on the provider's standing (South Nassau v Avis), another dismissing a claim between New Jersey parties on forum non conveniens, as a New York accident alone gave no substantial nexus (Oasis v NJM). It held that an unvacated default declaration of no duty to pay barred the claimants' later uninsured motorist arbitration as res judicata (Hereford v Shelly).

Our summary of the month’s decisions, not the courts’ words.

The Appellate Term, Second Department, held an attorney's affirmation that he was present for the scheduled EUOs and the provider did not appear sufficient without transcripts (Brefni Chiropractic v State Farm). Declining to follow East Coast Acupuncture v Hereford, Civil Court, Kings County, held that 11 NYCRR 65-3.8 (g) (1) leaves a fee schedule defense subject to the 30-day rule, as it lacks 65-3.8 (e)'s express nonpreclusion language (Blano Med. v Hereford). Civil Court, Queens County, distinguished Burke Physical Therapy v State Farm, where verification was first sought after the EUO, holding that a request within 15 days after the EUO tolled the insurer's time (Queens Radiology v GEICO).

Our summary of the month’s decisions, not the courts’ words.

Citing Progressive v Callahan, the Second Department held that a Lyft car carrying a fare in New York City was a for-hire vehicle under Administrative Code § 19-502 (g), not a TNC vehicle, so the passenger was not a SUM insured (Progressive v Service). It reiterated that a triable issue whether a claimant occupied the insured vehicle requires a framed-issue hearing before a permanent stay (Liberty Mut. v McCormack). The Appellate Term, Second Department, held that an assignor with exclusive possession of the uninsured vehicle for over 30 days owned it under Vehicle and Traffic Law § 128, so was not a qualified person for MVAIC (Masigla v MVAIC).

Our summary of the month’s decisions, not the courts’ words.

The Appellate Term, Second Department, held that a provider bringing a CPLR 7510 proceeding to confirm a master arbitration award the insurer did not timely pay is entitled to court-fixed fees under 11 NYCRR 65-4.10 (j) (4) for that proceeding and appeal (New York Recovery PT). Applying Hauswirth, it required the assignee of a passenger aware of the owner's identity to exhaust remedies against the owner before suing MVAIC (GAO Acupuncture), but rejected MVAIC's exhaustion defense where the other policies were cancelled before the accident (NY Wellness). Police-report hearsay did not prove the insured vehicle uninvolved (Prompt Med.), and three decisions held a traverse-hearing order not appealable as of right.

Our summary of the month’s decisions, not the courts’ words.

The Second Department reiterated that overdue-claim interest is 2% a month, pro rata on a 30-day month (11 NYCRR 65-3.9 (a)), and held that a court vacating a master arbitration award on finding the denial improper should award 65-4.6 (d) fees (Lam Quan). Following Marine Midland Bank, the Appellate Term, Second Department, rejected limitations and CPLR 3215 (c) challenges to a stipulation allowing judgment on any future default without time limit (Arguelles v AIG). It held that an insurer moving to vacate a CPLR 5003-a judgment must show improper tender (Medtech), and found late MVAIC submission unexcused where the provider never explained first billing another insurer (Queens Diagnostic Radiology).

Our summary of the month’s decisions, not the courts’ words.

Seven Appellate Term, Second Department, Burke decisions reaffirmed under Mallela that insurers may verify licensing eligibility through business records; in one, a denial issued over 150 days after the initial request was a nullity, so the action was premature. Three MSB Physical Therapy decisions applied the Second Department's Quality Health Supply to uphold denials issued after the last scheduled EUO. The Appellate Term also held that a CPLR 5519 deposit does not stop no-fault interest (GC Chiropractic), that an owner-passenger is not a qualified person for MVAIC benefits (Medical Supply Depot), and that a default declaratory judgment bars the bills it covers but not others (Ahmed Med. Care).

Our summary of the month’s decisions, not the courts’ words.

Applying Delacruz, the First Department held an EUO-based summary judgment motion premature where the insurer had not disclosed its objective justification under 11 NYCRR 65-3.5 (e) or fully answered discovery seeking it (State Farm v Lifeline). Following Hereford v Lida's, it held the 65-3.5 and 65-3.6 notification requirements inapplicable to IME notices sent before claims arrived, and required no timely disclaimer for an IME no-show (Nationwide v Gaines). The Appellate Term, Second Department, required proof of exhaustion before completed claims arrived (Chiropractic Assoc. of Richmond Hill) and allowed CPLR 317 vacatur without a reasonable excuse after service through the Department of Financial Services (Medical Supply of NY v Berkshire).

Our summary of the month’s decisions, not the courts’ words.

Deciding an issue it called one of first impression, the Second Department held that separate master arbitration awards cannot be combined to reach the $5,000 de novo threshold of Insurance Law § 5106 (c), agreeing with the First Department and criticizing trial decisions that aggregated awards (American Tr. v Comfort Choice); a companion decision granted 65-4.10 (j) (4) fees for defeating an article 75 petition. The First Department treated defaulting claimants as admitting their EUO accounts false (Unitrin v Manuel). The Appellate Term, Second Department, held a garaging misrepresentation defense precludable (Integral Med. Supply v Progressive) and refused to toll interest on an unpaid settlement (Berenblit v Country Wide).

Our summary of the month’s decisions, not the courts’ words.

Applying Delacruz, the First Department accepted a specific objective justification for EUOs under 11 NYCRR 65-3.5 (e), noting it was disclosed in discovery (Liberty Mut. v Mercado); the Civil Court, Queens County, noted that the Second Department, unlike the First, does not require the insurer to show why it sought the EUO (Flatbush Acupuncture v Repwest). The Second Department limited a claimant who settled her medical bills to the amount she paid (Allstate v Kapeleris). The Appellate Term, Second Department, upheld licensing-eligibility verification requests under Mallela in three Burke appeals, and held article 75 fees under 65-4.10 (j) (4) free of the 65-4.6 (d) cap (Quick Health v American Tr.).

Our summary of the month’s decisions, not the courts’ words.

Applying Manhattan Telecom., the First Department held that missing CPLR 3215 (f) proof does not make a default declaratory judgment a nullity, so claimants seeking vacatur had to show a reasonable excuse under CPLR 5015 (a) (1) (Hereford v Interdependent Acupuncture). The Appellate Term, Second Department, found res judicata unproven where the insurer's default declaratory judgment concerned an accident on a different date (Trapezius v Adirondack). In the Civil Court, Kings County applied ARCO and NGM Acupuncture to toll the time to deny a later bill received before the second EUO no-show, and Bronx County treated a requested NF-2 as primarily proof of claim, whose non-submission precluded coverage.

Our summary of the month’s decisions, not the courts’ words.