Appellate Division, Second Department
Jan 28, 2026
2026 NY Slip Op 00342
Insurer prevailed
An insurer need not deny a claim within 30 days after the 120-day period for providing requested verification expires. The provider sued MVAIC for assigned no-fault benefits. The Appellate Term denied MVAIC's cross motion for summary judgment and dismissed the complaint without prejudice, finding the verification defense precluded by a denial issued beyond 150 days from the initial request. The Appellate Division, Second Department, reversed the order, insofar as appealed from, and reinstated summary judgment dismissing the complaint. It held that 11 NYCRR 65-3.8 (b) (3) permits denial for failure to provide verification or reasonable justification after 120 days but specifies no deadline for issuing that denial.
Appellate Division, Second Department
Jan 14, 2026
2026 NY Slip Op 00134
Insurer prevailed
The injured claimant's SUM arbitration was permanently stayed for settling without written consent and failing to show no subrogation prejudice. The Appellate Division, Second Department, reversed the order denying the insurer's CPLR article 75 petition and granted a permanent stay. The policy's limited arbitration clause covered entitlement to recover from the uninsured or underinsured motorist and damages, leaving coverage exclusions for judicial determination. The claimant released the tortfeasors after settling for their policy limit without the insurer's written consent. The claimant failed to establish waiver or acquiescence by the insurer, an express limitation preserving subrogation rights, or circumstances necessarily implying that the release caused no prejudice to those rights. The insurer's remaining contentions were not reached.
Appellate Term, Second Department
Jan 23, 2026
2026 NY Slip Op 50202(U)
Provider prevailed
MVAIC failed to establish that the assignor was a vehicle owner disqualified from recovering no-fault benefits as a qualified person. MVAIC sought summary judgment against the provider under Insurance Law § 5202 (b) and § 5102 (e), relying on the ownership definition in Vehicle and Traffic Law § 128. Its proof did not establish exclusive use as a lessee or bailee for more than 30 days, or entitlement to use and possession of a vehicle subject to another person's security interest. The Appellate Term, Second Department, reversed the order and denied MVAIC's motion. Because the Civil Court, Kings County, had implicitly denied the provider's cross motion as moot, the matter was remitted for determination of that cross motion.
Appellate Term, Second Department
Jan 23, 2026
2026 NY Slip Op 50198(U)
Split result
MVAIC's payment log failed to establish exhaustion of available coverage because it omitted claim receipt and full verification dates. The provider sought assigned no-fault benefits, and MVAIC moved for summary judgment based on exhaustion and nonreceipt of the first claim. Although the log qualified as a business record under CPLR 4518 (a), it did not establish exhaustion in accordance with 11 NYCRR 65-3.15. The provider's billing affidavit raised a factual issue concerning mailing of the first claim despite MVAIC's proof of nonreceipt. The Appellate Term, Second Department, modified the order, insofar as appealed from, by striking the CPLR 3212 (g) finding establishing proper bill submission and timely denials for the first cause of action, and otherwise affirmed denial of MVAIC's motion.
Appellate Term, Second Department
Jan 23, 2026
2026 NY Slip Op 50197(U)
Split result
MVAIC established overbilling under the acupuncture fee schedule but failed to establish exhaustion of available coverage. The Appellate Term, Second Department, modified the order, insofar as appealed from, to grant summary judgment dismissing claims exceeding $1,580.80, and otherwise affirmed. For licensed acupuncturists' services before October 1, 2020, the applicable workers' compensation fee schedule was that for chiropractors. MVAIC conclusively showed overbilling for services coded 97139. Its payment log was admissible under CPLR 4518 (a), but lacked claim-receipt and full-verification dates necessary to establish exhaustion under 11 NYCRR 65-3.15. The branch of MVAIC's motion seeking dismissal of the entire complaint on exhaustion grounds therefore remained denied.
Appellate Term, Second Department
Jan 23, 2026
2026 NY Slip Op 50196(U)
Split result
A licensed acupuncturist's services before October 1, 2020 are reimbursed under the workers' compensation fee schedule for chiropractors. The Appellate Term, Second Department, modified the order, insofar as appealed from, to grant MVAIC summary judgment dismissing the portion of the provider's claims exceeding $1,591.51, and otherwise affirmed. MVAIC conclusively established that the billed services exceeded the applicable fee schedule amounts. Its separate request to dismiss the entire complaint for exhaustion of coverage remained denied. MVAIC supplied neither the dates it received the various claims nor the dates they became fully verified, and therefore failed to establish exhaustion in accordance with 11 NYCRR 65-3.15.
Appellate Term, Second Department
Jan 23, 2026
2026 NY Slip Op 50200(U)
Provider prevailed
MVAIC failed to establish exhaustion or proper fee schedule payment, and claim-submission timeliness remained disputed. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, denying MVAIC's summary judgment motion. Its payment log was admissible under CPLR 4518 (a), but omitted claim-receipt and full-verification dates needed to establish exhaustion under 11 NYCRR 65-3.15 for the first and third through sixth causes of action. On the first cause of action, the provider's billing-clerk affidavit raised a factual issue concerning timely submission within 45 days under 11 NYCRR 65-2.4 (c) and 65-3.3 (e). On the second cause of action, MVAIC failed to establish proper application of CPT code 95834 to a claim billed under CPT code 95831.
Appellate Term, Second Department
Jan 23, 2026
2026 NY Slip Op 50199(U)
Provider prevailed
MVAIC failed to establish coverage exhaustion because its payment log omitted claim receipt and full-verification dates. To obtain summary judgment, MVAIC had to show that payments exhausted available coverage in accordance with 11 NYCRR 65-3.15. Although the claims representative's affidavit established a business-record foundation for the log under CPLR 4518 (a), the missing dates prevented proof of compliant exhaustion as a matter of law. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, denying MVAIC's motion to dismiss the provider's assigned no-fault claims. It also noted that MVAIC had not raised a fee-schedule defense in support of the motion, although Civil Court had identified a factual issue on that defense.
Appellate Term, Second Department
Jan 16, 2026
2026 NY Slip Op 50189(U)
Provider prevailed
The provider obtained leave to enter a default judgment because the defendant offered no reasonable excuse for its late answer. The Appellate Term, Second Department, reversed the order, insofar as appealed from, granted the provider's motion, and denied the defendant's request to compel acceptance of its untimely answer. The provider supplied proof of service, a viable cause of action, and default under CPLR 3215 (f). The defendant supplied neither an affidavit from someone with personal knowledge explaining the delay nor an excuse through counsel. The provider's default motion, made six days after receipt of the answer, preserved its objection to untimeliness. The court did not reach whether the defendant demonstrated a meritorious defense.
Appellate Term, Second Department
Jan 16, 2026
2026 NY Slip Op 50190(U)
Insurer prevailed
An insurer need not state objective reasons for requesting EUOs as part of its prima facie showing for summary judgment based on nonappearance. The Appellate Term, Second Department, reversed the order, insofar as appealed from, and granted the insurer's motion dismissing the provider's complaint. The Civil Court's CPLR 3212 (g) findings established proper, timely scheduling and the provider's nonappearances; the insurer's affidavits also established timely mailing of the denial through standard office procedures. Following Northern Med. Care, P.C. v Nationwide Affinity Ins. Co. of Am., the provider's letters objecting that the insurer lacked an objective basis for the EUOs did not raise a triable issue. The provider neither challenged the established findings nor submitted an affidavit refuting the denial-mailing proof.
Appellate Term, Second Department
Jan 16, 2026
2026 NY Slip Op 50186(U)
Insurer prevailed
The insurer's motion for summary judgment dismissing the provider's no-fault complaint was upheld on appeal. The Appellate Term, Second Department, affirmed the order granting the motion for the reasons stated in the companion appeal decided the same day, No. 2024-874 RI C, without giving separate reasoning.
Appellate Term, Second Department
Jan 16, 2026
2026 NY Slip Op 50185(U)
Insurer prevailed
The insurer's motion for summary judgment dismissing the provider's no-fault complaint was upheld on appeal. The Appellate Term, Second Department, affirmed the order granting the motion for the reasons stated in the companion appeal decided the same day, No. 2024-874 RI C, without giving separate reasoning.
Appellate Term, Second Department
Jan 16, 2026
2026 NY Slip Op 50184(U)
Insurer prevailed
The assignor's vehicle qualified as a motorcycle requiring financial security, excluding the provider's claim from no-fault coverage. The Appellate Term, Second Department, affirmed summary judgment dismissing the complaint. The certified EUO transcript was admissible despite lacking the assignor's signature. It described a vehicle with a seat, operation using gas and electricity, and a maximum speed exceeding 40 miles per hour, establishing motorcycle status and required financial security under Insurance Law § 5102 (m) and Vehicle and Traffic Law §§ 123, 125, 2265 (3). Motorcycle occupants were excluded under Insurance Law § 5102 (f), Insurance Law § 5103 (a) (1), (2) and 11 NYCRR 65-1.1 (d). The denial's timeliness was not reached because lack of coverage was not precluded by an untimely denial.
Trial court, First Department
Jan 29, 2026
2026 NY Slip Op 50113(U)
The providers' malpractice and collection services claims were dismissed for conclusory pleading, and leave to amend was denied. The Supreme Court, New York County, granted the law firm and billing defendants' CPLR 3211 (a) (7) motions. The claims concerned representation and billing services in no-fault collections. Under CPLR 3013, the pleadings identified no discrete attorney negligence, nonspeculative causation or damages, or specific contractual breach by the billing defendants. Conflict-of-interest allegations lacked a causal link to damages; fiduciary claims against the attorneys duplicated malpractice. The billing defendants' fiduciary claims lacked facts establishing a fiduciary relationship, misconduct, or alter ego liability and impermissibly grouped defendants under CPLR 3016 (b). Leave to amend under CPLR 3025 (b) was denied because the proposed complaint did not cure these defects.
Trial court, Second Department
Jan 28, 2026
2026 NY Slip Op 50099(U)
Insurer prevailed
A provider cannot unilaterally reschedule an EUO; the insurer must agree to the requested change. The Civil Court, Kings County, granted the insurer's summary judgment motion, denied the provider's cross motion, and dismissed the action with prejudice. Although the provider established timely mailing of its bills, the insurer established timely EUO notices and the provider's nonappearance at two scheduled EUOs. The insurer had accommodated the provider's requests for September and November appointments. A further rescheduling request made the day before the September EUO, based on ongoing negotiations, did not change the appointment because the insurer had not agreed.
Trial court, Second Department
Jan 27, 2026
2026 NY Slip Op 50245(U)
Provider prevailed
An insurer's defense that an assignor is eligible for workers' compensation benefits is subject to preclusion for an untimely denial. The Civil Court, Richmond County, denied the insurer's CPLR 3211 motion to dismiss the provider's action and referred the matter for trial. The Workers' Compensation Board had determined that the injuries were work related, but its primary jurisdiction under Workers' Compensation Law § 20 did not deprive the court of jurisdiction to determine compliance with no-fault payment requirements. The insurer offered no evidence of a timely denial or verification request under 11 NYCRR 65-3.8. If held liable after trial, it could seek recovery from the workers' compensation carrier under Workers' Compensation Law § 13 (d) (1).
Trial court, Second Department
Jan 27, 2026
2026 NY Slip Op 50089(U)
Insurer prevailed
The insurer's answer was deemed accepted because the court found its approximately seven-day delay de minimis. The provider supplied conflicting service affidavits and sought both a default judgment and a traverse hearing. The Civil Court, Kings County, rejected the hearing request because both affidavits came from the provider, and the insurer had supplied no contradictory affidavit. It rejected the asserted scrivener's error, considered the affidavit appended to the motion, and selected the later service date. The court found jurisdiction established and exercised its limited equitable fact-finding authority on the pending motions. Favoring resolution on the merits, it granted the insurer's motion to compel acceptance of the answer and denied the provider's cross motion.
Trial court, Second Department
Jan 23, 2026
2026 NY Slip Op 50084(U)
Provider prevailed
The petitioning insurer failed to justify a stay of UM arbitration on coverage or discovery grounds. The Supreme Court, Kings County, denied its CPLR 7503 (c) petition and dismissed the proceeding, allowing the injured claimants' arbitration to proceed. The insurer bore the initial burden of presenting admissible facts justifying a stay. Its Pennsylvania vehicle records showed coverage ending before the accident, rather than coverage on the accident date, so no framed-issue hearing was warranted. The insurer also failed to identify when the UM claim was submitted or establish that it had sought discovery that remained unprovided. It therefore failed to justify a stay to obtain medical records, authorizations, an EUO, or physical examinations.
Trial court, Second Department
Jan 13, 2026
2026 NY Slip Op 50073(U)
Split result
A timely verification request's toll does not give an insurer further opportunities to make otherwise untimely verification requests. The Civil Court, Kings County, denied the insurer's summary judgment cross motion based on failure to supply verification within 120 days. Under 11 NYCRR 65-3.5 (b) and 65-3.8 (a) (1), the provider's EUO completed that verification, and the post-EUO requests were untimely. Nationwide Affinity Ins. Co. v Gepp was distinguished because its parties had agreed to written demands instead of further EUOs. The court also denied the provider's CPLR 3211 (b) motion to dismiss affirmative defenses, declining to separate potentially valid arguments from numerous invalid or questionable ones, and found no basis for attorney fees as sanctions under Rule 130-1.1.
Trial court, Second Department
Jan 7, 2026
2026 NY Slip Op 50292(U)
Insurer prevailed
An insurer need not provide coverage for an intentionally caused collision, even to innocent third parties. The Supreme Court, Suffolk County, granted the insurer's summary judgment motion in full in a CPLR 3001 action concerning eight collisions, declaring no obligation to provide no-fault or uninsured/underinsured motorist benefits. Investigator evidence, inconsistent EUO testimony, adverse drivers' affidavits and supporting documents established that the collisions were staged and intentional. Unsigned EUO transcripts were admissible under CPLR 3116 (a) after submission for review and expiration of 60 days, and as certified party admissions. The opposing passengers and providers failed to raise triable issues or justify further discovery under CPLR 3212 (f). The providers, as assignees, acquired no greater coverage rights than their assignors.
