Appellate Division, First Department
Jun 23, 2026
2026 NY Slip Op 03933
Insurer prevailed
The claimant failed to provide the sworn factual notice required for a hit-and-run UM/SUM claim, permitting disclaimer and a permanent stay. The SUM endorsement unambiguously replaced the policy's UM coverage and tracked Insurance Law § 3420 (f) and 11 NYCRR 60-2.3 (f). Counsel's claim letter and sworn NF-2 application did not identify a hit-and-run accident, establish physical contact, or address the offending vehicle's unascertainable identity or efforts to identify it. An accident report supplied over three months after the accident also omitted the hit-and-run characterization, which first appeared in the arbitration demand nearly 11 months later. The Appellate Division, First Department, affirmed the order permanently staying arbitration.
Appellate Division, Second Department
Jun 17, 2026
2026 NY Slip Op 03771
Provider prevailed
The insurer failed to raise a triable issue on timely denials or causation in its action for de novo review of no-fault claims. Employee affidavits lacked personal knowledge of mailing procedures or actual mailing, precluding the medical-necessity defense. The peer reviewer failed to address complete records, symptoms supporting testing, additional treatment, or the causal connection to the accident. Related awards favoring other providers lacked preclusive effect under Insurance Law § 5106 (c). The Appellate Division, Second Department, reversed the order, insofar as appealed from, granted the provider summary judgment dismissing the complaint and declaring payment due, confirmed the master arbitration award, and granted attorney's fees. It remitted for fee calculation under Insurance Law § 5106 (a) and 11 NYCRR 65-4.10 (j) (4) and entry of judgment.
Appellate Division, Second Department
Jun 3, 2026
2026 NY Slip Op 03439
Insurer prevailed
The injured claimant's UM arbitration was permanently stayed for failure to satisfy the policy's accident-reporting condition. The policy required reporting an accident to a police, peace, or judicial officer, or the Commissioner of Motor Vehicles, within 24 hours or as soon as reasonably possible. The claim arose from an alleged hit-and-run accident. The Appellate Division, Second Department, reversed the order, insofar as appealed from, and granted the insurer's CPLR article 75 request for a permanent stay. Notice must be given within a reasonable time under all the circumstances; failure to meet this condition precedent without a valid excuse vitiates coverage. Remaining contentions were not reached or lacked merit.
Appellate Term, Second Department
Jun 17, 2026
2026 NY Slip Op 51306(U)
Split result
The insurer's preclusion defense failed because it did not establish its identity with the insurer that obtained the default declaratory judgment. The Appellate Term, Second Department, modified the order, as amended and insofar as appealed from, to deny the provider's cross motion and strike the finding of timely bill mailing, while affirming denial of the insurer's motion. Res judicata did not apply because the insurers' identity and differing claim numbers remained unexplained. Collateral estoppel did not apply because the provider never appeared in the declaratory judgment action. The provider supplied no address evidence establishing the named insurer's receipt of the claim forms under Insurance Law § 5106 (a), and a factual issue remained as to whether it insured the accident.
Appellate Term, Second Department
Jun 17, 2026
2026 NY Slip Op 51309(U)
Insurer prevailed
The provider failed to raise a triable issue about the reasonableness of the insurer's EUO request. The insurer's timely mailing of the initial and follow-up scheduling letters, the provider's failure to appear for three scheduled EUOs, and the timely denial after the last nonappearance were undisputed. The Appellate Term, Second Department, concluded that the Civil Court erred in finding an issue of fact concerning the request's reasonableness. The scheduling letters and a response letter provided the basis for the request, and the provider failed to raise a triable issue in response to the insurer's prima facie showing. The appellate court reversed the order, insofar as appealed from, and granted the insurer summary judgment dismissing the complaint.
Appellate Term, Second Department
Jun 12, 2026
2026 NY Slip Op 51298(U)
Provider prevailed
MVAIC failed to establish that the vehicle carrying the assignor was insured at the time of the accident. In the provider's action for assigned no-fault benefits, MVAIC sought summary judgment on the ground that the vehicle had insurance coverage. Its certified New Jersey motor vehicle abstract showed insurance at registration, but did not establish coverage for the accident two months later. The police accident report attached to MVAIC's own motion indicated that the vehicle was uninsured at the time of the accident. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, denying MVAIC's motion for summary judgment dismissing the complaint.
Trial court, Second Department
Jun 26, 2026
2026 NY Slip Op 50999(U)
Insurer prevailed
The provider failed to establish jurisdiction over a nonresident insurer through service under Vehicle and Traffic Law § 253. The insurer was neither an owner nor an operator. The provider had rejected the insurer's answer, leaving issue unjoined and both sides' summary judgment motions procedurally improper. The provider could not simultaneously treat the rejected answer as an appearance waiving a jurisdictional defense while refusing to treat it as a responsive pleading. The Civil Court, Kings County, denied the provider's motion for a default judgment, dismissed the action without prejudice for lack of personal jurisdiction, and denied both summary judgment motions as moot.
Trial court, Second Department
Jun 22, 2026
2026 NY Slip Op 26094
Insurer prevailed
The insurer's EUO nonappearance denials were sufficient without listing the scheduled EUO dates. The Civil Court, Richmond County, granted the insurer's motion for summary judgment dismissing the provider's action. The insurer established notice of two EUOs and the assignor's failure to appear, which the provider did not dispute. The provider challenged the denials' specificity under Unitrin Advantage Insurance Company v All of NY, Inc. Applying the NF-10 requirements of 11 NYCRR 65-3.4 (c) (11), the court found the denials proper. It followed Appellate Term, Second Department, authority allowing omission of EUO dates and distinguished Unitrin as addressing a misleading denial that listed one missed EUO but omitted the second.
Trial court, Second Department
Jun 18, 2026
2026 NY Slip Op 50992(U)
Provider prevailed
The insurer's EUO inconsistencies raised credibility issues but did not establish a staged collision as a matter of law. The Civil Court, Richmond County, denied the insurer's summary judgment motion and directed the action to proceed to trial on material misrepresentation, noncovered loss, and staged-accident defenses. The admissible evidence, including the investigator's affirmation, did not establish those defenses by a preponderance of the evidence. Much of the insurer's proof consisted of inconsistent EUO testimony, and no witness admitted that the collision was intentional. The court explained that inconsistencies alone were insufficient and that summary judgment did not permit credibility determinations or factual findings.
Trial court, Second Department
Jun 17, 2026
2026 NY Slip Op 50953(U)
Provider prevailed
The insurer failed at trial to prove two EUO nonappearances through admissible evidence based on personal knowledge. The Civil Court, Kings County, directed judgment for the provider. A prior summary judgment order established the provider's prima facie case and timely denial mailing but did not resolve nonappearance. The insurer's employee proved mailing of the EUO requests, but receipt of a statement on the record did not establish the truth of its contents. The court rejected reliance on dicta in Charles Deng Acupuncture, P.C. v Titan Ins. Co. to admit those contents. Testimony that another request customarily followed a missed EUO could bear on the first nonappearance but did not establish the second.
Trial court, Second Department
Jun 11, 2026
2026 NY Slip Op 50991(U)
Split result
The insurer's alleged overpayments could not offset additional fee-schedule reimbursement because it had asserted no counterclaim. The Civil Court, Richmond County, granted the insurer's summary judgment motion in part and denied it in part, awarding the provider $65.60 and otherwise dismissing the complaint. The insurer's coder identified underpayments for three groups of services. The provider's billing specialist did not adequately rebut the coder's fee-schedule analysis. Although the coder also identified alleged overpayments for other services, the court declined to reduce the amount owed because the insurer had not counterclaimed for reimbursement.
Trial court, Second Department
Jun 4, 2026
2026 NY Slip Op 50894(U)
Provider prevailed
The insurer's evidence of EUO inconsistencies and allegedly disproportionate injuries did not establish a staged collision as a matter of law. The Civil Court, Richmond County, denied the insurer's motion under CPLR 3212 to dismiss the provider's no-fault action. The investigator's affirmation did not explain how the alleged injuries or discrepancies in the occupants' testimony demonstrated an intentional loss. Although those discrepancies raised credibility questions, they did not eliminate triable issues. The court explained that the staged-collision defense requires proof by a preponderance of the evidence, but a founded belief based on unexplained inconsistencies was insufficient for summary judgment. Credibility determinations remained for the factfinder.
Trial court, Second Department
Jun 1, 2026
2026 NY Slip Op 50852(U)
Insurer prevailed
The insurer established a founded belief that the collision was intentionally caused, and the provider failed to raise a triable issue. The Civil Court, Queens County, granted the insurer's summary judgment motion, dismissed the complaint, and denied the provider's cross motion. The investigation disclosed a recently issued policy, delayed reporting, conflicting EUO accounts, and identical treatment by the same providers despite the claimants' testimony that they did not appear to know one another. Following V.S. Med. Services, P.C. v Allstate Ins. Co., the insurer needed to establish a nonaccidental collision by a preponderance of the evidence. Under CPLR 3212 (b), the provider's attorney affirmation, without established personal knowledge, neither raised a factual issue nor established entitlement to summary judgment.
