No-Fault Case Law

The court considered several relevant facts, including the original accident date (September 28, 2017), the issuance of a declaratory judgment declaring the incident a "Staged Accident," and the subsequent default judgments against both the plaintiff and his assignor. The main issues decided involved the application of res judicata and collateral estoppel based on the prior default judgments obtained by "National General Insurance Online, Inc." and whether the defendant was the proper insurer. The court concluded that the default judgment from the earlier action did not have res judicata effect against the plaintiff since the defendant was not the party who obtained the prior judgment, and the plaintiff did not have a fair opportunity to litigate the issue. Furthermore, the court denied the plaintiff's motion for summary judgment due to his failure to demonstrate that the claim form had been received by the defendant, ultimately modifying the order to deny the defendant's cross-motion for summary judgment and affirming the denial of the plaintiff's motion.

In this case, the court considered the failure of the plaintiff’s assignor to appear for three scheduled examinations under oath (EUOs), specifically on May 17, 2019, June 17, 2019, and June 20, 2019. The main issues decided included whether the defendant had appropriately notified the assignor of the rescheduling of the EUO and whether the assignor's absence justified the denial of the no-fault claim. The court found that the assignor had requested to reschedule the June 17 EUO to June 20 and that sufficient oral notice of the new date, time, and location was provided. As a result, the court held that the defendant was entitled to summary judgment dismissing the complaint, as the assignor's failure to appear for the EUOs constituted a valid basis for denying the claim.

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.

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.

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.

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.

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.

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.

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.

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.