No-Fault Case Law
LPM Pharm., Inc. v Nationwide Prop. & Cas. Ins. Co. (2024 NY Slip Op 51191(U))
August 13, 2024
In this case, the court considered relevant facts surrounding the plaintiff's assignor's failure to appear for three scheduled examinations under oath (EUOs) related to a no-fault insurance claim. The main issues addressed included whether the notices for the EUOs were adequately communicated and whether the claim was timely denied. The court found that the defendant had provided sufficient notice regarding the rescheduled EUO on June 20, 2019, and that the assignor's absence from the earlier EUOs on May 17, 2019, and June 20, 2019, justified the denial of the claim. Ultimately, the court held that the defendant was entitled to summary judgment, dismissing the complaint based on the assignor's failure to appear at the scheduled EUOs.
Titan Diagnostic Imaging Servs. Inc. v State Farm Mut. Auto Ins. Co (2024 NY Slip Op 24209)
July 15, 2024
In this case, the court evaluated whether the defendant, an insurance company, timely denied a claim from the plaintiff, a diagnostic imaging service. The central issue was whether the plaintiff complied with verification requests required by insurance regulations within 120 days, as well as whether the defendant acted timely in denying the claim. The court found that the defendant had properly requested additional verification within the regulatory timeline and, despite a brief delay in doing so, did not forfeit its right to deny the claim. Ultimately, the court held that the denial was timely and appropriate, granting the defendant's motion for summary judgment and dismissing the plaintiff's complaint.
American Tr. Ins. Co. v Excell Clinical Lab (2024 NY Slip Op 50820(U))
June 28, 2024
The court considered the procedural history of an arbitration decision where an arbitrator awarded Excell Clinical Lab $3,129.75 in No-Fault benefits related to a motor vehicle accident. American Transit Insurance Company sought to vacate the arbitration award, arguing that Excell had not established the medical necessity of the disputed services, as they failed to provide an Independent Medical Examination (IME) report or peer review evidence of their own. The key issues addressed included whether the arbitrators' decision was final and definite, as well as whether the award should be vacated under the grounds outlined in CPLR 7511(b). The court ultimately denied the petition to vacate the arbitration award, concluding that the arbitrators had made a rational decision based on the evidence presented and that the award was sufficiently final and definitive.
UGP Acupuncture, P.C. v Progressive N. Ins. Co. (2024 NY Slip Op 50814(U))
June 26, 2024
The court considered several relevant facts, including the procedural history of the case, which involved UGP Acupuncture, P.C. seeking reimbursement from Progressive Northern Insurance Company for medical services rendered following a motor vehicle accident. The initial action was settled between the parties, leading to a Stipulation of Settlement and Discontinuance which was executed on July 23, 2021, and resulted in the case being deemed disposed. The plaintiff then attempted to amend the complaint to substitute Country Wide Insurance Company as the new defendant, arguing that the original index number was preserved for this purpose. The court decided that the index number was extinguished as a result of the prior settlement, and since the motion to amend was moot, the court vacated its earlier interim order related to this motion. Ultimately, the court held that the motion to amend was deemed moot, affirming that the case had been properly settled and disposed of through the Stipulation of Settlement and Discontinuance.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 50803(U))
June 14, 2024
In this case, the court considered the validity of the plaintiff's claims for no-fault benefits assigned by a patient after the defendant, an insurance company, sought summary judgment to dismiss the complaint. The main issues included whether the plaintiff provided sufficient verification of the claims and the procedural implications of an unrelated declaratory judgment action involving the same parties. The court determined that the affidavit from the plaintiff sufficiently demonstrated that verification had been mailed and received by the defendant, thus providing a presumption in favor of the plaintiff. Ultimately, the holding modified the previous order by denying the defendant's motion for summary judgment and affirming the case without costs, allowing the plaintiff's claims to proceed.
Pak Hong Sik, MD, Med. Care, P.C. v Mid-Century Ins. Co. (2024 NY Slip Op 50804(U))
June 14, 2024
The court considered a case where a medical provider, as the assignee of a patient, sought to recover no-fault insurance benefits from Mid-Century Insurance Company. The main issues involved whether the insurance company had appropriately demonstrated that the policy limits were exhausted and if the provider was barred from recovering based on the fee schedule. The court found that the defendant's payment log did not meet the necessary evidentiary standards to prove that payments had been made to the provider for the claims in question. However, the court noted that the plaintiff's argument regarding the fee schedule was not preserved for appeal since it was raised for the first time on appeal. Ultimately, the order granting summary judgment in favor of the defendant was affirmed.
American Tr. Ins. Co. v Jong Won Yom (2024 NY Slip Op 50723(U))
June 12, 2024
The court considered multiple instances where Respondents' attorneys pursued aggressive litigation tactics, including failure to issue satisfactions of judgment despite partial payments by Petitioner. It assessed the reasonableness of Petitioner's attorney fees at $210 per hour, totaling $1,470 for each proceeding, based on the complexity and time spent on each case. The main issue was whether Respondents' conduct warranted sanctions and attorney fees under CPLR 130-1.1, which the court granted, imposing $735 in fees against each attorney and daily sanctions of $10 for delays in issuing satisfactions of judgment, totaling $2,570 to $3,010 per case. The holding affirmed the awards of attorney fees and sanctions, emphasizing the excessive litigation tactics of Respondents' counsel.
Kim v State Farm Ins. Co. (2024 NY Slip Op 51364(U))
June 10, 2024
In this case, Denar Balcazar sought to recover $2,101.17 from State Farm Insurance for medical services, while State Farm moved for summary judgment dismissing the case due to Balcazar's failure to appear for an examination under oath (EUO). The court examined whether State Farm properly requested the EUO and established a specific objective justification for it, ultimately finding that State Farm's scheduling letters did not provide sufficient specific justification related to Balcazar's claim. The court concluded that the defendant did not meet its burden of proof to warrant summary judgment. Conversely, the plaintiff's cross-motion for summary judgment was denied due to a lack of a party affidavit from someone with personal knowledge of the claim. Consequently, both motions were denied, and the case was scheduled for a pre-trial conference.
Akai Acupuncture, P.C. v Foremost Prop. & Cas. Ins. Co. (2024 NY Slip Op 50630(U))
May 17, 2024
The court considered a case where a provider was seeking first-party no-fault benefits for services rendered after a motor vehicle accident, with the vehicle insured under a Florida automobile insurance policy. The insurer had claimed the policy was cancelled before the accident due to nonpayment of the premium, but the provider disputed this based on Florida law requirements for notice of cancellation. The issue was whether the insurer had provided sufficient proof of mailing the cancellation notice to the insured, as required by Florida law. The court held that the insurer's submitted Certificate of Bulk Mailing did not meet the requirements for proof of mailing under the statute, and therefore, the branch of the insurer's motion seeking to dismiss the complaint was denied.
Community Med. Imaging P.C. v American Tr. Ins. Co. (2024 NY Slip Op 50301(U))
March 21, 2024
The main issue in this case was whether a No-Fault insurance arbitration determination should be vacated where the hearing arbitrator found that the respective bill was mailed past the 45-day deadline for submitting proof of claim due to a lack of an affidavit describing mailing procedures or confirming the actual mailing of the bill. Petitioner's sole evidence on the issue was a USPS certificate of mailing found to contain an illegible postmark. The court considered the arbitration award, the submissions from both parties, and relevant case law in making its decision. The court held that the No-Fault insurance arbitration determination should be vacated based on the lack of sufficient evidence supporting the mailing of the bill. This was made in consideration of the specific procedures and deadlines outlined in the relevant state law and regulations.