Appellate Division, Second Department
May 20, 2026
2026 NY Slip Op 03161
Provider prevailed
The master arbitrator rationally determined that improper additional verification requests did not support denial of the provider's claim. After an arbitrator awarded the full claim and a master arbitrator affirmed, Supreme Court vacated the award. Judicial review under CPLR article 75 is limited to whether the compulsory arbitration determination has evidentiary support and a rational or plausible basis. Courts generally do not vacate an award for an alleged substantive legal error unless it is irrational. The Appellate Division, Second Department, reversed the judgment, denied the insurer's petition, granted confirmation, and remitted the provider's requests for attorney's fees and other fees for determination, citing 11 NYCRR 65-4.10 (j) (4).
Appellate Division, Second Department
May 20, 2026
2026 NY Slip Op 03160
Provider prevailed
The master arbitrator's application of collateral estoppel to reject a verification defense was rational and supported by evidence. The arbitrator awarded the provider its no-fault claim, relying on a prior arbitration determination that noncompliance with additional verification requests was not a valid basis for denial. The master arbitrator affirmed. Under CPLR article 75, judicial review of compulsory arbitration asks whether the determination has evidentiary support and a rational or plausible basis; a substantive legal error generally warrants vacatur only if irrational. The Appellate Division, Second Department, reversed the judgment, denied the insurer's petition, confirmed the award, and remitted the provider's fee requests for determination under 11 NYCRR 65-4.6 (h) and 65-4.10 (j) (4).
Appellate Term, Second Department
May 22, 2026
2026 NY Slip Op 50810(U)
Provider prevailed
The insurer's motion to vacate the provider's judgment entered upon a settlement default was denied on appeal. The Appellate Term, Second Department, reversed the order, insofar as appealed from, concerning the judgment entered under CPLR 5003-a (e). It relied on the reasons stated in the companion appeal decided the same day, Paramount Med. Group v Allstate Ins. Co., No. 2025-1319 Q C.
Appellate Term, Second Department
May 22, 2026
2026 NY Slip Op 50812(U)
Provider prevailed
The insurer failed to establish nonreceipt of settlement documents necessary to vacate the provider's judgment. The provider had obtained judgment under CPLR 5003-a (e) following a default under a settlement of its assigned no-fault claims. The insurer bore the initial burden on its vacatur motion of showing that it had not received a duly executed release or stipulation of discontinuance under CPLR 5003-a (a). Because that showing was not made, the provider did not have to prove tender in opposition. The Appellate Term, Second Department, reversed the order, insofar as appealed from, and denied the branch of the insurer's motion seeking vacatur.
Appellate Term, Second Department
May 22, 2026
2026 NY Slip Op 50811(U)
Provider prevailed
The insurer's motion to vacate the provider's judgment entered on default under a no-fault settlement was denied on appeal. The Appellate Term, Second Department, reversed the order, insofar as appealed from, concerning the CPLR 5003-a (e) judgment for the reasons stated in Paramount Med. Group, P.C. v Allstate Ins. Co., the companion appeal decided the same day, No. 2025-1319 Q C.
Appellate Term, Second Department
May 22, 2026
2026 NY Slip Op 50809(U)
Provider prevailed
The provider's motion to recalculate statutory no-fault interest at a compound rate was granted on appeal. The Appellate Term, Second Department, reversed the judgment, insofar as appealed from, and vacated the order denying recalculation and tolling interest sua sponte. Relying on the reasons stated in Berenblit v Country Wide Ins. Co., it remitted for entry of a new judgment.
Appellate Term, Second Department
May 22, 2026
2026 NY Slip Op 50808(U)
Provider prevailed
The provider was entitled to compound no-fault interest and correction of a judgment that understated the settlement amount. The Appellate Term, Second Department, reversed the judgment, insofar as appealed from, vacated the order denying the provider's CPLR 5019 (a) motion and tolling interest sua sponte, and granted the motion. After the insurer failed to pay a settlement, the provider obtained a judgment under CPLR 5003-a that used simple interest. Following Berenblit v Country Wide Ins. Co., the court remitted for a new judgment reflecting the agreed principal of $3,156.88 and compound statutory no-fault interest without the sua sponte tolling.
Appellate Term, Second Department
May 15, 2026
2026 NY Slip Op 50791(U)
Provider prevailed
The insurer failed to show a reasonable excuse for default because its denial of receipt did not specifically contradict the affidavit of service. The process server's affidavit established prima facie proper service on the insurer's authorized agent under CPLR 311 (a) (1). The insurer's representative reported finding no summons and complaint in its files or databases, but supplied neither a detailed contradiction nor an explanation for its absence. Without a reasonable excuse under CPLR 5015 (a) (1), the court did not reach the merits of the defense. Personal service on the agent also foreclosed relief under CPLR 317. The Appellate Term, Second Department, reversed the order and denied the insurer's motion to vacate the provider's default judgment.
Appellate Term, Second Department
May 15, 2026
2026 NY Slip Op 50796(U)
Provider prevailed
An insurer's defense of material misrepresentation in procuring a policy is precluded unless raised in a timely denial. The insurer sought summary judgment based on fraudulent procurement, claim misrepresentations, untruthful EUO testimony, and unanswered post-EUO verification requests. Its attorney's statement that an assistant was directed to send requests and follow-ups by email and regular mail, without further mailing proof, did not establish timely and proper mailing sufficient to toll the payment or denial period. A medical management specialist's affirmation also failed to establish mailing of the denial on the alleged date. The Appellate Term, Second Department, reversed and denied the motion in its entirety; remittal was unnecessary because verification mailing was unproved and the remaining defenses were precludable.
Appellate Term, Second Department
May 15, 2026
2026 NY Slip Op 50795(U)
Provider prevailed
The insurer failed to prove proper and timely mailing of its denial supporting the lack-of-medical-necessity defense. Its litigation specialist's description of standard mailing procedures omitted how proper postage was affixed and how and when envelopes were delivered to the Postal Service or another carrier. The insurer therefore failed to establish that the medical-necessity defense was not precluded. The Appellate Term, Second Department, reversed the order and denied summary judgment on that ground. The court remitted the matter for determination of the insurer's remaining policy-exhaustion ground, which the Civil Court had not reached, because failure to deny a claim within 30 days does not preclude a defense that policy limits have been exhausted.
Appellate Term, Second Department
May 15, 2026
2026 NY Slip Op 50793(U)
Provider prevailed
The insurer failed to prove mailing of the notice canceling the Pennsylvania policy for nonpayment of premiums. The Civil Court, Richmond County, had granted summary judgment dismissing the provider's assigned no-fault claims on the ground that coverage ended before the accident. Under 40 P.S. § 991.2006, the insurer had to establish valid cancellation by mailing written notice to the named insured at the policy address. Its representative's affidavit asserted mailing conclusorily, supplied no standard mailing practices, and omitted postal proof referenced on the notice. The provider abandoned its argument that Pennsylvania law did not govern. The Appellate Term, Second Department, reversed the order and denied the insurer's motion.
Appellate Term, Second Department
May 15, 2026
2026 NY Slip Op 50797(U)
Provider prevailed
The insurer's summary judgment motion was untimely because it was filed beyond 120 days without an explanation for the delay. The Appellate Term, Second Department, reversed the order granting dismissal for fraudulent procurement of the policy and denied the insurer's motion without reaching its merits. Under CPLR 3212 (a), a late summary judgment motion requires good cause, meaning a satisfactory explanation for untimeliness. A notice of trial is the Civil Court equivalent of a note of issue. The insurer filed its motion more than 120 days after the provider filed the notice of trial and did not address the delay in its moving papers. The Civil Court's finding that the provider suffered no prejudice did not establish good cause.
Appellate Term, Second Department
May 15, 2026
2026 NY Slip Op 50794(U)
Provider prevailed
The insurer failed to prove proper and timely mailing of denials, defeating summary judgment on its medical-necessity defense. The litigation specialist's description of standard mailing procedures omitted how proper postage was affixed and how and when envelopes reached the postal service or another carrier. The insurer therefore failed to establish that the medical-necessity defense was not precluded. The Appellate Term, Second Department, reversed and denied that branch of the insurer's motion. It remitted for determination of the unreached fee-schedule and policy-exhaustion branches, because failure to deny within 30 days does not preclude either a defense that charges exceed the fee schedule or a defense that policy limits were exhausted.
Trial court, Third Department
May 29, 2026
2026 NY Slip Op 50905(U)
Provider prevailed
The insurer failed to show likely success on its address-misrepresentation defense because it alleged only that the premium would have been higher. The Supreme Court, Schenectady County, denied a preliminary injunction against benefit litigation and arbitration and dissolved the temporary restraining order in the insurer's declaratory judgment action. Under Insurance Law § 3105 (b), materiality required a showing that truthful disclosure would have led the insurer to refuse the contract. The insurer did not allege that it would have declined coverage had it known the insureds' true residence. The court separately granted the insurer's unopposed motion under CPLR 3025 (b) to add provider defendants, finding the amendment meritorious and nonprejudicial.
Trial court, Second Department
May 5, 2026
2026 NY Slip Op 51325(U)
Split result
An insurer's delay letter requesting no specific verification does not toll the 30-day period to pay or deny a no-fault claim. The provider sought payment for two bills, and the insurer moved for summary judgment based on the assignor's alleged eligibility for workers' compensation benefits. Applying Insurance Law § 5106, the Civil Court, Kings County, found the first denial untimely: the delay letter sought no specific verification, and an EUO scheduling letter sent before receipt of the bill did not toll the period. The workers' compensation defense did not qualify as a lack-of-coverage defense. The court denied the insurer's motion as to the first bill but granted it as to the second, which was timely denied, stating that it could not determine workers' compensation eligibility.
