No-Fault Case Law
Integrated Pain Mgt., PLLC v Empire Fire & Mar. Ins. Co. (2023 NY Slip Op 50219(U))
March 22, 2023
The relevant facts included Integrated Pain Management, PLLC seeking no-fault insurance benefits for medical services it rendered to an assignor, Mikwam Murphy, due to an automobile accident. Defendant Empire Fire & Marine Insurance Company moved for summary judgment dismissing the complaint, arguing that the plaintiff was barred from relitigating the issue of coverage due to the doctrines of res judicata, collateral estoppel, and law of the case. In 2019, Empire Fire had commenced a declaratory judgment action in Kings County Supreme Court against Integrated Pain Management and Murphy, among others. The main issue the court decided was whether the plaintiff was barred from relitigating the issue of coverage. The holding of the case went in favor of the defendant, Empire Fire, dismissing the plaintiff's complaint and ruling that the plaintiff was indeed barred from relitigating the issue of coverage due to the aforementioned legal doctrines.
Country-Wide Ins. Co. v Alicea (2023 NY Slip Op 01474)
March 21, 2023
The relevant facts in this case involved Country-Wide Insurance Company's motion for summary judgment declaring that they had no duty to pay no-fault claims to the defendants based on the injured party's failure to appear for examinations under oath (EUO). The main issue in this case was whether Country-Wide Insurance Company had a specific objective justification for requesting the EUO, as required by 11 NYCRR 65-3.5 (e). The court ultimately held that the motion to grant summary judgment was premature under CPLR 3212, as the insurer had failed to provide a medical provider with its objective justification for requesting the EUO. The Court also explained that the insurer's reason for the EUO was essential for medical providers to oppose an insurer's summary judgment motion, and that information was in the exclusive knowledge and control of the insurer. Therefore, the motion court's decision was reversed, the motion was denied, and the declaration and stay were vacated.
Kalitenko v Integon Natl. Ins. Co. (2023 NY Slip Op 50218(U))
March 20, 2023
The court considered the Defendant's motion for summary judgment due to the Assignor's failure to appear for independent medical examinations and examinations under oath. There was a procedural issue with the Defendant's answer being filed more than the 30-day statutory period after the affidavit of service was filed with the Court, and the Plaintiff rejected the Defendant's answer. The main issue decided was whether the Defendant's motion for summary judgment was proper and if issue had been joined. The holding of the case was that since issue had not been joined, the Defendant's motion for summary judgment was denied without prejudice. The Court also stated that before the Defendant's motion for summary judgment could be decided, issue must be joined by the acceptance of the Defendant's untimely answer.
American Tr. Ins. Co. v North Shore Family Chiropractic PC (2023 NY Slip Op 50208(U))
March 20, 2023
The main issue in this case was whether it was arbitrary and capricious for a No-Fault insurance arbitrator to reject a course-of-employment defense and not defer resolution of it to the Workers' Compensation Board where the only evidence provided was a police report establishing that the driver was operating a vehicle which bore "TC" plates and lacked passengers. American Transit Insurance Company ("ATIC") sought to vacate a No-Fault Insurance master arbitration award affirming the award of compensation to North Shore Family Chiropractic PC ("North Shore") for health service expenses. North Shore had filed a claim for No-Fault insurance compensation for treating its assignor, Alberto Carpinteyro, who was injured in a motor vehicle accident. The Supreme Court, Kings County ultimately granted ATIC's petition and vacated the arbitration awards, thereby denying North Shore's cross-petition to confirm the awards.
American Tr. Ins. Co. v Marta Med. Supply, Corp (2023 NY Slip Op 50513(U))
March 14, 2023
The relevant facts considered in this case were that American Transit Insurance Company sought to vacate an arbitration award in favor of Marta Medical Supply, Corp, A/A/O Sandra Gomes, for medical expenses paid to Sandra Gomes following a motor vehicle accident. The petitioner denied the claim, and the respondent sought reimbursement through arbitration. The main issue decided was whether the arbitration award in favor of the respondent was arbitrary or capricious. The court held that the evidentiary submissions and legal reasoning of the petitioner did not make a prima facie showing that the arbitration award was arbitrary or capricious, and therefore denied the petition to vacate the award and dismissed the petition.
Country-Wide Ins. Co. v Hackensack Surgery Ctr., LLC (2023 NY Slip Op 50207(U))
March 8, 2023
The main issue in this case was whether the defendant was entitled to compel the plaintiff to comply with their discovery requests, specifically for production of the entire claim file and SIU file. The court considered the plaintiff's objection to the defendant's discovery demands, where the plaintiff argued that the demands were irrelevant, overly broad, and privileged. The court weighed the need for discovery against the burden on the opposing party, and ultimately held that the plaintiff must produce the entire claim file to the defendant within 60 days. The court did not grant the defendant's motion to compel in regards to the SIU file and certain information related to other actions or arbitrations, as it was deemed overly broad and burdensome to the plaintiff. Therefore, the court granted the defendant's motion in part and denied it in part.
Thrall v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op50183(U))
March 7, 2023
The court considered the allegations made by the plaintiff, Jeffrey Thrall, that he had purchased an automobile insurance policy from State Farm Mutual Automobile Insurance Company and alleged that State Farm denied his insurance benefits based on a medical examination report that was cursory and incomplete. Thrall alleged that State Farm engaged in a larger conspiracy to defraud accident victims. In response to this action, State Farm sought to dismiss several causes of action in the amended complaint and sought to dismiss Thrall's claims for consequential and punitive damages. The main issue decided by the court was whether Thrall sufficiently pleaded the claims of bad faith breach of contract and consequential damages, and the court held that the allegations were sufficient for Thrall to satisfy his pleading requirement and that a determination of whether such damages were, in fact, foreseeable should await a fully developed record.
MSB Physical Therapy, P.C. v Nationwide Ins. (2023 NY Slip Op 50284(U))
March 3, 2023
The court considered this case when a provider sought to recover assigned first-party no-fault benefits. Plaintiff appealed after the lower court granted defendant's motion for summary judgment dismissing the complaint and denied plaintiff's cross motion for summary judgment. The main issue decided was whether the provider could recover assigned first-party no-fault benefits, and the court ultimately affirmed the lower court's decision to grant the defendant's motion for summary judgment and dismiss the complaint. Therefore, the holding of this case is that the lower court's decision was affirmed, and the provider was not entitled to recover assigned first-party no-fault benefits.
New York Manual, P.T., P.C. v Nationwide Affinity Ins. Co. of Am. (2023 NY Slip Op 50281(U))
February 24, 2023
The court considered the case of New York Manual, P.T., P.C. as the appellant and Nationwide Affinity Insurance Company of America as the respondent. The main issue decided in the case was whether the defendant had timely mailed initial and follow-up requests for verification, and if the plaintiff had failed to provide the requested verification. The court held that the defendant had demonstrated, prima facie, that it had timely mailed initial and follow-up requests for verification and that it had not received all of the requested verification. The court also found that the plaintiff had failed to establish a triable issue of fact by demonstrating that it had provided the requested verification or had set forth a reasonable justification for the failure to comply with defendant's verification requests. Therefore, the court affirmed the order of the Civil Court, which granted defendant's motion for summary judgment dismissing the complaint and denied plaintiff's cross motion for summary judgment.
Clove Med. Supply, Inc. v Country-Wide Ins. Co. (2023 NY Slip Op 50280(U))
February 24, 2023
The main issue in the case was whether the defendant's payment to the plaintiff was timely according to the terms of a stipulation of settlement. The court considered conflicting evidence regarding the terms of the stipulation of settlement, with the plaintiff providing a signed copy stating that the payment was due within 21 days, and the defendant providing a signed copy with a handwritten notation stating that the payment was due within 45 days. The court held that there was an apparent factual dispute regarding the terms of the settlement and the defendant's compliance, and therefore it was an error for the Civil Court to grant the defendant's motion without holding a hearing to determine the disputed issues of fact. As a result, the order was reversed, the default judgment was reinstated, and the matter was remitted to the Civil Court for a new determination, following a hearing, of defendant's motion to vacate the default judgment.