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.
Appellate Division, First Department
Oct 30, 2025
2025 NY Slip Op 06022
Insurer prevailed
A claimant's failure to subscribe EUO transcripts violates a condition precedent to no-fault coverage and warrants denial of the claim. The Appellate Division, First Department, affirmed the order, insofar as appealed from, granting the insurer summary judgment against the appealing providers. Their arguments concerning contract performance, willfulness, and untimely subscription demands were unpreserved and alternatively rejected. Following Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, willfulness principles governing liability policies did not apply. The subscription demands were sent after 9 and 14 business days, within 11 NYCRR 65-3.5 (a) and (b)'s 15-business-day period. Subscribed transcripts supplied years later did not establish compliance; 11 NYCRR 65-3.8 (b) (3) permitted denial after 120 days without verification or a valid written excuse.
Appellate Division, Second Department
Oct 29, 2025
2025 NY Slip Op 05948
Provider prevailed
The insurer's petition to vacate a master arbitrator's award was denied because it failed to establish statutory grounds for vacatur. The Appellate Division, Second Department, reversed the order, granted the provider's cross-petition, and confirmed the award. It cited CPLR 7511's narrow grounds for review and the insufficiency of mere legal error, without identifying the insurer's challenge or explaining why it failed.
Appellate Division, Second Department
Oct 29, 2025
2025 NY Slip Op 05954
Insurer prevailed
The provider's petition to vacate a master award based on lack of standing was denied because the determination had a rational basis. The Appellate Division, Second Department, affirmed under CPLR article 75's limited review of substantive legal determinations, leaving the master award vacating the provider's recovery intact. It gave no explanation for upholding the standing determination and left the provider's remaining contention unaddressed.
Appellate Division, Second Department
Oct 29, 2025
2025 NY Slip Op 05952
Insurer prevailed
The provider failed to establish that a master arbitration award dismissing its New York proceeding on forum non conveniens grounds was irrational. The Appellate Division, Second Department, affirmed denial of the provider's CPLR article 75 petition to vacate the dismissal without prejudice. Under CPLR 7511 (b), the provider had to establish grounds for vacatur by clear and convincing evidence. Both parties resided in New Jersey, where the medical care was provided and the insurance contract was made, and New Jersey substantive law applied. The accident's occurrence in New York alone did not supply the required substantial nexus. The insurer did not waive its forum objection by using a New York insurance form or omitting it from its initial arbitration submission.
Appellate Division, Second Department
Oct 22, 2025
2025 NY Slip Op 05787
Provider prevailed
An order may be resettled to reflect that a dismissal was granted on default when the written order omitted that basis. The insurer brought an action under Insurance Law § 5106 (c) for a de novo determination of no-fault claims. The provider's CPLR 3211 (a) (7) dismissal motion was granted on the insurer's default, but the written order failed to say so. Applying CPLR 2221 and 5019 (a), the Appellate Division, Second Department, affirmed the later order insofar as it granted resettlement. It dismissed the appeal from the superseded original order and the appeal from denial of reargument, which was not appealable. The insurer's remaining contention was unpreserved because it was first raised on appeal.
Appellate Division, Second Department
Oct 15, 2025
2025 NY Slip Op 05681
Insurer prevailed
The claimants' uninsured motorist arbitration was barred by default declaratory rulings establishing no duty to pay claims from the accident. The insurer had obtained leave to enter default judgments against both claimants in a prior action declaring that it owed no accident-related benefits and was entitled to a permanent stay of arbitrations. The claimants later demanded arbitration of uninsured motorist benefits. The Appellate Division, Second Department, affirmed the permanent stay granted in the insurer's CPLR article 75 proceeding. An unvacated default judgment is conclusive for res judicata purposes, including issues raised or that could have been raised. Because the claimants were parties to the prior action and the rulings encompassed uninsured motorist benefits, they could not relitigate the claim.
Trial court, First Department
Oct 7, 2025
2025 NY Slip Op 51959(U)
Insurer prevailed
A staged-accident coverage defense is not precluded by untimely denial. The Supreme Court, New York County, granted the insurer's CPLR 3215 motion for default judgment against nonanswering defendants. Adjuster evidence, EUOs and other documents established a well-founded belief that the claims arose from a staged accident. An unsigned EUO transcript showed discrepancies supporting that belief, rather than the truth of its statements. EUO-request timing was irrelevant because nonappearance was not asserted. A related arbitration supported the showing but lacked preclusive effect absent privity, except possibly against one assignor defendant. The court denied a provider's CPLR 3012 (d) cross-motion to compel acceptance of a late answer, particularly in view of the potential merits of any defense.
