No-Fault Case Law

The relevant facts the court considered in American Transit Insurance Company v. Nexray Medical Imaging PC involved the denial of a $1,790.67 No-Fault insurance medical claim for MRIs performed on a policyholder to diagnose injuries from a motor vehicle accident. The main issues that were decided included whether the denials of claim by ATIC were appropriate, whether the MRIs were medically necessary, and whether there was an appropriate Workers' Compensation defense. The decision held that ATIC's petition to vacate the master arbitration award was denied, and that Nexray's cross-petition to confirm the award was granted. The master arbitration award of A. Jeffrey Grob was confirmed, and ATIC was ordered to pay Nexray the principal amount of $1,790.67 plus interest, attorney's fees, and arbitration filing fees.

The main issue in this case was whether a No-Fault insurance master arbitrator correctly affirmed a hearing arbitrator's award that a health service provider had submitted additional verification in "substantial compliance," that an insurer seeking sign-in sheets was not reasonable, and that an insurer seeking information about Workers' Compensation benefits was not necessary. The court heard a petition to vacate the master arbitration award affirming the hearing arbitration award of a claim for No-Fault insurance compensation for chiropractic treatment. The services were provided to a man injured in a motor vehicle accident and the court considered whether the hearing arbitrator's decision was incorrect as a matter of law. The court held that the arbitration award was not irrational and did not vacate the award, determining that the insurer did not prove substantial compliance was unreasonable.

The main issue of this case was whether a No-Fault insurance master arbitration award must be vacated if the master arbitrator failed to address an issue of law asserted by the insurer, but the issue of law was previously decided by the court in a different Article 75 proceeding. The background of this case involved American Transit Insurance Company ("ATIC") seeking to vacate a No-Fault insurance master arbitration award granted to Rutland Medical, PC for various medical services provided to an individual in a motor vehicle accident. The arbitrator awarded Rutland $2,713.58 as compensation for the medical services provided. The court decided that the master arbitration award must be vacated since the master arbitrator failed to address an issue of law that was previously decided by the court, making the award invalid.

In this case, the court examined whether the doctrines of collateral estoppel and res judicata applied to a new action for first-party no-fault benefits initiated by the plaintiff, a medical provider, related to injuries sustained in an automobile accident. The defendant, Avis Car Rental, sought a permanent stay of the action, arguing that a prior declaratory judgment had permanently barred the plaintiff from recovering no-fault payments due to a violation of New York State laws in a previous case. The court determined that the Civil Court had incorrectly applied the earlier declaratory judgment to the current case, which was filed after that judgment and involved different circumstances. The court held that the issue of the plaintiff's entitlement to no-fault benefits for medical treatment given in late 2017 and early 2018 was not identical to the previous determination, thereby concluding that collateral estoppel did not apply. As a result, the court reversed the lower court's order granting the stay and denied the defendant's motion.

The main issue being decided in this case was whether the defendant, Garden Medical Care, P.C., failed to adequately respond to post-examination under oath (EUO) document demands from the plaintiffs, State Farm Mutual Automobile Insurance Company and State Farm Fire & Casualty Company. The plaintiffs sought a declaratory judgment that the defendant has no right to receive payment for hundreds of no-fault claims for medical treatment. Following the defendant's EUO, the plaintiffs served demands seeking further information and documents, alleging that the defendant did not adequately comply with these requests. The Supreme Court, New York County, determined that the plaintiffs' motion for default judgment should be denied due to the lack of proof provided by the plaintiffs to support their claim. The court stated that without the EUO transcript, post-EUO demands, defendant's responses and objections, or document production from the defendant, they could not assess whether the defendant failed to adequately respond to the plaintiffs' verification requests. The court ordered that if the plaintiffs do not bring a renewed default judgment motion within 30 days, the action will be dismissed. The court also required the plaintiffs to serve a copy of the order on the defendant.

The court considered the affidavit of defendant's employee as sufficient evidence to establish a presumption that the examination under oath scheduling letters and denial of claim forms as to the claims had been timely mailed. Plaintiff's appeal was limited to the issue of summary judgment dismissing the first and second causes of action, and the court found that plaintiff had not demonstrated any basis to disturb the order granting the branches of defendant's motion seeking summary judgment and denying plaintiff's cross-motion seeking summary judgment. Therefore, the order was affirmed, and the appeal was dismissed. The main issue decided was whether the defendant's evidence was sufficient to establish a presumption of timely mailing of the examination under oath scheduling letters and denial of claim forms, and the court held that it was.

The court considered the facts that defendant moved for summary judgment dismissing the first through fifth and seventh causes of action on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs), and also dismissing the sixth cause of action on the ground that it was barred by a declaratory judgment issued by the Supreme Court in an action commenced by defendant against plaintiff in regard to the same accident. Plaintiff opposed the motion and cross-moved for summary judgment. The main issue decided was whether the plaintiff's failure to appear for EUOs and the declaratory judgment issued by the Supreme Court barred their claims for first-party no-fault benefits. The court held that the plaintiff's claim was barred under the doctrine of res judicata by virtue of the declaratory judgment and also that the EUO scheduling letters and denial of claim forms had been timely mailed, so plaintiff's claims were properly dismissed. The holding of the case was that the court affirmed the order, granting defendant's motion for summary judgment on the grounds that the plaintiff had failed to appear for scheduled EUOs and that the sixth cause of action was barred by a declaratory judgment. Therefore, plaintiff's claims were properly dismissed.

The relevant facts in the case involved a provider seeking to recover assigned first-party no-fault benefits, and the defendant's (State Farm Mutual Automobile Insurance Company) motion for summary judgment dismissing the complaint on the ground that the provider failed to provide requested verification. The Court considered the proof submitted by the defendant, which demonstrated that they had timely mailed initial and follow-up verification requests and that they had not received the requested verification. The main issue decided was whether the plaintiff's owner's statement that he had mailed the requested verification "to the extent such responses were proper and in his possession" raised a triable issue of fact. The holding of the court was that the plaintiff's owner's statement did not raise a triable issue of fact, and that the order denying defendant's motion for summary judgment was reversed, with costs, and defendant's motion for summary judgment dismissing the complaint was granted.

This case involved Liberty Mutual Insurance Company's denial of no-fault-benefits claims for a person injured in an accident on the grounds that the injured person had materially misrepresented the insured vehicle's garaging address and the identity of the vehicle's operators. The plaintiffs moved for a default judgment under CPLR 3215 against non-answering defendants but it was ultimately denied. The main issue was whether Liberty Mutual's denials of the no-fault claims were timely, as it is required by law that these claims be paid or denied within 30 days after proof of the claim is received. Liberty Mutual failed to establish that its denials were timely and therefore, the court ruled in favor of denying the motion for default judgment, stating that the action would be dismissed if a renewed default-judgment motion was not filed within 30 days.

The court considered whether the defendant's motion for summary judgment and to dismiss the plaintiff's complaint on the basis that the plaintiff's assignor failed to appear for four scheduled examinations under oath (EUO) should be granted. The main issue decided was whether the denial of the claim by the defendant was timely, even though it exceeded the 30-day time period from the second EUO no-show. The court held that the defendant's motion for summary judgment was granted in its entirety, and the plaintiff's cross motion was denied. The court found that the defendant demonstrated its prima facie entitlement to judgment as a matter of law by showing that the scheduling letters were timely and properly mailed, and that the assignor failed to appear on each of the four scheduled dates. Therefore, the plaintiff's complaint was dismissed.