Appellate Division, Second Department
Dec 24, 2025
2025 NY Slip Op 07297
Provider prevailed
A master arbitrator's legal error does not warrant vacatur unless the determination is irrational. In this CPLR article 75 proceeding, the Appellate Division, Second Department, reversed the order remanding the claim to arbitration, denied the insurer's petition, and confirmed the award on the provider's cross-petition. Under 11 NYCRR 65-4.10 (h), review was limited to article 75 grounds. Despite any errors concerning burdens of proof, the award rationally rested on a reasonably justified minor notice delay: the assignor was a passenger claiming against another's insurer, under 11 NYCRR 65-3.5 (l). The matter was remitted for reasonable attorney fees under 11 NYCRR 65-4.10 (j) (4); the remaining contentions were not reached.
Appellate Division, Second Department
Dec 3, 2025
2025 NY Slip Op 06703
Insurer prevailed
The provider's $220 attorney's fee award was upheld because it supplied no sworn work or time statement and requested no hearing. The Appellate Division, Second Department, affirmed the judgment, insofar as appealed from, rejecting the provider's challenge to the additional fee awarded after the Supreme Court, Kings County, denied the insurer's vacatur petition and confirmed the arbitration award. Under Insurance Law § 5106 (a) and 11 NYCRR 65-4.10 (j) (4), the court fixes reasonable fees for article 75 representation. Counsel bears the burden of showing reasonable hours and prevailing community rates. Given the provider's omissions and the no-fault system's goal of prompt resolution, no fee hearing was required.
Appellate Division, Second Department
Dec 3, 2025
2025 NY Slip Op 06683
Provider prevailed
The injured claimant established that deposing the SUM claims adjuster could disclose relevant evidence about the insurer's investigation. After settling with the tortfeasor for the policy limit with the insurer's consent, the claimant sought SUM benefits, which the insurer denied. In the ensuing breach-of-contract action, Supreme Court granted the insurer a protective order against a representative's deposition. The Appellate Division, Second Department, reversed and denied the motion under CPLR 3103. Applying CPLR 3101 (a), it found that testimony about the investigation's nature, extent, timing, and adequacy could bear on the claims. The request was narrowly tailored to a specific employee, investigation, and claims and was not palpably improper; the claimant's remaining contention was not reached.
Appellate Division, Second Department
Dec 3, 2025
2025 NY Slip Op 06706
Insurer prevailed
The claimant's $600 attorney's fee award was upheld because it supplied no sworn work or time statement and requested no hearing. The Appellate Division, Second Department, affirmed the amended judgment, insofar as appealed from, rejecting the claimant's challenge to the additional fee awarded after the Supreme Court, Kings County, denied the insurer's vacatur petition and confirmed the arbitration award. Under Insurance Law § 5106 (a) and 11 NYCRR 65-4.10 (j) (4), the court fixes reasonable fees for article 75 representation. Counsel bears the burden of showing reasonable hours and prevailing community rates. Given the claimant's omissions and the no-fault system's goal of prompt resolution, no fee hearing was required.
Appellate Division, Second Department
Dec 3, 2025
2025 NY Slip Op 06705
Insurer prevailed
The claimant's $220 attorney's fee award was upheld because it supplied no sworn work or time statement and requested no hearing. The Appellate Division, Second Department, affirmed the judgment, insofar as appealed from, rejecting the claimant's challenge to the additional fee awarded after the Supreme Court, Kings County, denied the insurer's vacatur petition and confirmed the arbitration award. Under Insurance Law § 5106 (a) and 11 NYCRR 65-4.10 (j) (4), the court fixes reasonable fees for article 75 representation. Counsel bears the burden of showing reasonable hours and prevailing community rates. Given the claimant's omissions and the no-fault system's goal of prompt resolution, no fee hearing was required.
Appellate Division, Second Department
Dec 3, 2025
2025 NY Slip Op 06704
Insurer prevailed
The provider's $220 attorney's fee award was upheld because it supplied no sworn work or time statement and requested no hearing. The Appellate Division, Second Department, affirmed the judgment, insofar as appealed from, rejecting the provider's challenge to the additional fee awarded after the Supreme Court, Kings County, denied the insurer's vacatur petition and confirmed the arbitration award. Under Insurance Law § 5106 (a) and 11 NYCRR 65-4.10 (j) (4), the court fixes reasonable fees for article 75 representation. Counsel bears the burden of showing reasonable hours and prevailing community rates. Given the provider's omissions and the no-fault system's goal of prompt resolution, no fee hearing was required.
Appellate Division, First Department
Dec 2, 2025
2025 NY Slip Op 06648
Provider prevailed
An insurer's admission in its motion papers that it received the claim may establish a provider's prima facie case at trial. The Appellate Division, First Department, reversed the Appellate Term's order and reinstated the provider's judgment after a nonjury trial. The insurer's admission was admissible without a witness, but its affidavit statements concerning verification requests could not serve as evidence in chief. Although the rule of completeness ordinarily would permit those statements, the insurer made no offer of proof and did not preserve that issue; it also did not argue business-record admissibility. Having conceded that it neither paid nor denied within 30 days, the insurer bore the burden of proving that verification requests were sent, rather than requiring the provider to disprove mailing.
Appellate Term, Second Department
Dec 5, 2025
2025 NY Slip Op 51971(U)
Provider prevailed
MVAIC failed to establish noncompliance with the notice-of-intention requirement or entitlement to dismissal on EUO and fee-schedule defenses. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, denying MVAIC summary judgment and finding timely bill submission under CPLR 3212 (g). MVAIC did not establish nonreceipt of the affidavit required by Insurance Law § 5208. Its 30-day period to deny or request verification ran from claim receipt regardless of a coverage determination under Insurance Law § 5221 (b) (2), and it failed to establish that its EUO defense was not precluded. It also failed to prove improper billing or excessive fees. Its admission of receipt within 45 days supported timely submission; no other element of the provider's prima facie trial burden was established.
Appellate Term, Second Department
Dec 5, 2025
2025 NY Slip Op 51982(U)
Insurer prevailed
The insurer's attorney affirmation established the provider's EUO nonappearances despite being executed approximately three years later. The Civil Court had denied summary judgment because of the interval between the no-shows and execution of the affirmation, and adhered to that determination upon renewal. Following SVP Med Supply, Inc. v GEICO, the Appellate Term, Second Department, found that the affirmation was not unworthy of belief on its face and sufficiently demonstrated nonappearance. The provider's challenge to the finding that the insurer was otherwise entitled to judgment lacked merit. The appellate court reversed the order, insofar as appealed from, and granted the insurer's motion upon renewal.
Appellate Term, Second Department
Dec 5, 2025
2025 NY Slip Op 51981(U)
Provider prevailed
The insurer's jurisdictional dismissal motion was denied because factual issues remained about whether it did business in New York. The Ohio insurer moved under CPLR 3211 (a) (8), asserting lack of personal jurisdiction and improper service, and also raised policy exhaustion. The Civil Court, Kings County, addressed only personal jurisdiction, finding evidentiary deficiencies in an out-of-state affidavit lacking a certificate of conformity and an uncertified declarations page lacking a foundation. It directed a trial on jurisdiction because factual issues remained concerning the insurer's New York business activity. The Appellate Term, Second Department, affirmed, finding that determination proper under the circumstances; the insurer's remaining contentions lacked merit or were unpreserved.
Appellate Term, Second Department
Dec 5, 2025
2025 NY Slip Op 51980(U)
Provider prevailed
The insurer's summary judgment motion based on preaccident policy cancellation was denied on appeal. The Appellate Term, Second Department, reversed the order, insofar as appealed from, and denied the branch seeking dismissal of the provider's assigned no-fault claim. It relied on the reasons stated in the companion appeal involving Prompt Med. Group, Inc., decided the same day, No. 2024-1129 RI C.
Appellate Term, Second Department
Dec 5, 2025
2025 NY Slip Op 51979(U)
Provider prevailed
The insurer's summary judgment motion based on preaccident policy cancellation was denied on appeal. The Appellate Term, Second Department, reversed the order, insofar as appealed from, and denied the branch seeking dismissal of the provider's assigned no-fault claim. It relied on the reasons stated in the companion appeal decided the same day, No. 2024-1129 RI C.
Appellate Term, Second Department
Dec 5, 2025
2025 NY Slip Op 51978(U)
Provider prevailed
The insurer's summary judgment motion based on preaccident policy cancellation was denied on appeal. The Appellate Term, Second Department, reversed the order, insofar as appealed from, and denied the branch seeking dismissal of the provider's assigned no-fault claim. It relied on the reasons stated in the companion appeal involving Prompt Med. Group, Inc., decided the same day, No. 2024-1129 RI C.
Appellate Term, Second Department
Dec 5, 2025
2025 NY Slip Op 51977(U)
Provider prevailed
The insurer failed to prove proper cancellation notice or that cancellation was effective against an assignor outside the insured's household. The insurer obtained summary judgment dismissing the provider's assigned no-fault claim on the ground that the vehicle's policy had been cancelled before the alleged accident. Its submissions did not establish by admissible proof proper notice to the insured under Vehicle and Traffic Law § 313 (1) (a). It also failed to demonstrate effectiveness against the assignor, who was neither the named insured nor a household member, under Vehicle and Traffic Law § 313 (2) (a) and (3). The Appellate Term, Second Department, reversed the order, insofar as appealed from, and denied the dismissal branch.
Appellate Term, Second Department
Dec 5, 2025
2025 NY Slip Op 51974(U)
Provider prevailed
The insurer's jurisdictional dismissal motion was denied because factual issues remained about whether it did business in New York. The Ohio insurer moved under CPLR 3211 (a) (8), asserting lack of personal jurisdiction and improper service, and also raised policy exhaustion. The Civil Court, Kings County, addressed only personal jurisdiction, finding evidentiary deficiencies in an out-of-state affidavit lacking a certificate of conformity and an uncertified declarations page lacking a foundation. It directed a trial on jurisdiction because factual issues remained concerning the insurer's New York business activity. The Appellate Term, Second Department, affirmed, finding that determination proper under the circumstances; the insurer's remaining contentions lacked merit or were unpreserved.
Appellate Term, Second Department
Dec 5, 2025
2025 NY Slip Op 51972(U)
Provider prevailed
The insurer failed to establish lack of coverage with an affidavit addressing a different company's insurance records. The insurer sought summary judgment on the ground that it had issued no policy covering the assignor, who therefore was not an eligible injured person. The adjuster did not establish employment by the defendant insurer, the relationship between the companies, personal knowledge of the defendant's policy-record practices, or any search of its records. The affidavit stated only that the adjuster's employer did not insure the assignor, the vehicle, or household residents. The Appellate Term, Second Department, reversed and denied the insurer's motion regardless of the sufficiency of the provider's opposition.
Trial court, First Department
Dec 23, 2025
2025 NY Slip Op 52120(U)
Split result
The injured claimant avoided arbitration-based collateral estoppel because the claimant lacked a full and fair opportunity to litigate. The Supreme Court, Bronx County, denied the insurer's CPLR 3211 (a) (5) dismissal motion despite identity of issues and privity through assignment to the arbitrating provider. The claimant lacked notice of the arbitration and opportunities to submit evidence, testify, or cross-examine witnesses; available photographs and witness evidence had not been presented. Insurance Law § 5106 (e) did not apply to this benefits action, rather than a personal-injury action under Insurance Law § 5104, and Insurance Law § 3420 (d) did not apply absent policy coverage. The claimant's summary judgment cross motion was also denied because conflicting accounts of the accident required credibility assessments.
Trial court, Second Department
Dec 17, 2025
2025 NY Slip Op 52018(U)
Split result
Payment of no-fault principal before judgment ends the 2% monthly rate; unpaid accrued interest then bears 9% annual interest. The Civil Court, Kings County, granted the provider's summary judgment motion to the extent of awarding interest after the defendant paid the benefit principal in full before judgment. Under Insurance Law § 5106 (a) and 11 NYCRR 65-3.9 (a), 2% monthly simple interest accrued until principal payment. The court treated that accrued interest as the remaining debt, subject to 9% interest under CPLR 5004, with a toll for the provider's inactivity. It distinguished Matter of B.Z. Chiropractic, P.C. v Allstate Ins. Co. as addressing payment after judgment and rejected continued 2% interest on the unpaid interest alone.
Trial court, Second Department
Dec 12, 2025
2025 NY Slip Op 51996(U)
Provider prevailed
The insurer failed to establish that the provider's EUO statements conclusively waived the claims at issue. The Civil Court, Kings County, granted the provider's summary judgment motion only to establish its prima facie case for all purposes and denied the insurer's cross motion under CPLR 3212 (b). The insurer relied on an unsigned EUO transcript in which the provider's owner agreed to withdraw prior claims. The transcript contemplated a separate waiver affidavit, which the insurer did not produce, and noted an off-record discussion before the withdrawal statements. The EUO concerned different claimants and claims. The owner's intent presented a factual issue requiring trial, and the insurer failed to meet its initial burden. The action was to proceed to trial on the insurer's proof and defenses.
