No-Fault Case Law

The court considered several relevant facts, particularly focused on the plaintiff's failure to provide requested verification of documents necessary to substantiate their claim for no-fault benefits. The main issues involved whether the defendant was entitled to summary judgment based on the plaintiff's noncompliance with verification requests and whether collateral estoppel applied from a previous Supreme Court ruling that denied the defendant's summary judgment in a separate declaratory judgment action. The court held that the defendant's request for additional information during the verification process was proper and that the denial of the previous summary judgment motion did not have preclusive effect on the current case, as it was not a final determination on the merits. Consequently, the Civil Court's decision to dismiss the complaint was affirmed, with the appeal rejected.

The court considered the relevant facts surrounding a provider's attempt to recover assigned first-party no-fault benefits from an automobile insurance company. The primary issue was whether the plaintiff had met the necessary verification requirements as demanded by the defendant for the claim to proceed. The Civil Court had granted the defendant's cross-motion for summary judgment, dismissing the complaint on the grounds that the plaintiff failed to provide the requested verification. The Appellate Term upheld this decision, affirming the dismissal of the complaint and ruling that the plaintiff had not fulfilled the verification obligations necessary for recovery of benefits.

The court considered the facts surrounding a no-fault insurance claim filed by Burke Physical Therapy, P.C. as an assignee of Felix Guzman. The main issue was whether the plaintiff provided the necessary verification requested by State Farm, which led to the dismissal of the complaint. The Civil Court had granted State Farm's cross-motion for summary judgment based on the plaintiff's failure to comply with verification requests. Ultimately, the appellate court affirmed this decision, concluding that the lower court's ruling was justified in light of the lack of required documentation from the plaintiff. The affirmation included a directive to pay $25 in costs to the defendant.

In this case, the court addressed a claim by a physical therapy provider seeking to recover assigned no-fault benefits from an insurance company. The central issue was whether the provider had adequately provided the necessary verification requested by the insurer. The court found that the failure to supply this verification justified the dismissal of the complaint. Consequently, the Appellate Term affirmed the lower court's decision to grant the insurance company's cross-motion for summary judgment. The ruling underscored the importance of compliance with verification requests in no-fault benefit claims. The court also noted a parallel case with similar reasoning, reinforcing the decision made.

The court considered several relevant facts, including the initial action brought by Horizon P.T. Care against Kemper Insurance Company to recover no-fault benefits for services provided to Anthony Ghee, who was involved in a motor vehicle accident. The defendant, Kemper Insurance, argued that the case was barred by res judicata due to a prior declaratory judgment action in which Unitrin Auto & Home Insurance Company claimed that Horizon had breached policy terms by not appearing for scheduled examinations under oath. The main issues decided included whether the declaratory judgment barred Horizon's claims and the adequacy of the evidence presented by Kemper to support its assertion as the proper insurer. The holding of the court was that Kemper's cross-motion for summary judgment was properly denied since it did not provide sufficient evidence to demonstrate that the declaratory judgment constituted a final adjudication of the present claims, but the court modified the order regarding the prima facie case finding, emphasizing that it could not be conclusively established at this point.

The court considered that the plaintiff, Ahmed Medical Care, P.C., filed an action to recover no-fault benefits for services provided to Wesley Isaacs, stemming from a motor vehicle accident. The Civil Court dismissed the complaint based on the doctrine of res judicata, referencing a prior judicial determination that the plaintiff was not entitled to payment for several bills that included seven of the eight claims in the current action. The main issues decided included whether the prior judgment barred the current claims and whether the eighth and ninth causes of action were also affected. The court held that the first through seventh causes of action were properly dismissed as they were indeed barred by res judicata, while the eighth cause of action, which was not part of the earlier judgment, and the ninth cause concerning interest and attorney's fees, were improperly dismissed. The order was modified to allow these two causes of action to proceed and remitted the case to the Civil Court for a merits determination on the discovery motion.

The court considered the facts surrounding an arbitration award that upheld the denial of claims for assigned first-party no-fault benefits due to the assignor's failure to appear for scheduled independent medical examinations (IMEs). The dispute focused on whether the arbitrator's decision was contrary to law, particularly regarding the timeliness of the IME scheduling and the denial of claim forms. The main issues included evaluating the evidentiary support and rational basis for the arbitrator's determination, as guided by CPLR article 75. The court ultimately held that there was a rational basis for the master arbitrator's award, affirmed the denial of the petition to vacate it, and modified the order to confirm the master arbitrator's award.

The court considered several relevant facts, including the timeline of events surrounding the service of the summons and complaint to the defendant, Berkshire Hathaway, which was served through the New York State Department of Financial Services (DFS). The defendant received the complaint on June 3, 2019, but a default judgment was entered against it on September 12, 2019, after it failed to respond in time. The main issues in this case revolved around whether the default judgment should be vacated based on the defendant's late filing of its answer and whether it had a meritorious defense regarding the complainant’s entitlement to no-fault benefits due to potential coverage under workers' compensation. The court ultimately held that the defendant had established sufficient grounds to vacate the default judgment, as it did not have timely notice to defend itself and presented a potentially valid defense related to the plaintiff’s assignor's employment status at the time of the accident. Consequently, the order to vacate the judgment was affirmed.

In this case, the court considered whether the defendant, Nationwide General Insurance Company, had exhausted its policy limits before the plaintiff, Chiropractic Associates of Richmond Hill, submitted claims for no-fault benefits. The main issue was whether the defendant could successfully prove that the policy limits had been reached, which would lead to the dismissal of the complaint. The court concluded that the defendant failed to provide sufficient evidence to demonstrate that the policy limits were exhausted at the time the claims were received from the plaintiff. Consequently, the court affirmed the lower court's order denying the defendant's motion for summary judgment, ruling that the defendant did not make a prima facie showing of entitlement to a dismissal.

The court considered several relevant facts, including that the plaintiff served the summons and complaint on the New York State Department of Financial Services, which was then forwarded to the defendant. The defendant claimed it did not receive actual notice until June 3, 2019, and argued that it had filed a timely answer and had a reasonable excuse for any delay. The main issues included whether the default judgment entered against the defendant should be vacated and whether the defendant had a meritorious defense concerning the plaintiff's claim for no-fault benefits. The court held that the default judgment was properly vacated under CPLR 317, as the defendant did not receive sufficient notice to defend the action in time and demonstrated a potentially meritorious defense regarding the assignor's employment status at the time of the accident.