No-Fault Case Law
Matter of American Tr. Ins. Co. v Jong Won Yom (2025 NY Slip Op 06706)
December 3, 2025
The court considered the proceeding initiated by American Transit Insurance Company seeking to vacate a master arbitration award favoring Jong Won Yom. The main issues included the validity of the arbitration award and Yom's request for additional attorney's fees under 11 NYCRR 65-4.10(j)(4). The Supreme Court confirmed the arbitration award and granted Yom an additional attorney's fee of $600, which was contested on appeal. Ultimately, the Appellate Division upheld the lower court's decision, affirming the award without requiring a hearing, citing Yom's failure to provide sufficient support for a larger fee request and emphasizing the legislative intent for expeditious resolution of no-fault claims.
Government Empls. Ins. Co. v Picone (2025 NY Slip Op 06604)
November 26, 2025
In this case, the court considered the defendant's claim for no-fault lost wage benefits following an arbitration award in his favor, as well as his counterclaims for breach of contract and unfair claims settlement practices against the plaintiff, an insurance company. The main issues addressed included whether the plaintiff was liable for the claimed lost wages and whether the counterclaims were valid. The court found that the plaintiff provided sufficient evidence to demonstrate that the defendant's tax returns and deposition testimony contained inconsistencies that undermined his claims for lost wages. Consequently, the court affirmed the lower court's judgment, declaring that the plaintiff was not liable for payment of any lost wages and dismissing the defendant's counterclaims, including that of unfair claims settlement practices, due to lack of a private right of action under the relevant statute.
Town RX Inc. v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51853(U))
November 24, 2025
In the case, the court considered the issue of whether the plaintiff failed to comply with the requirements for no-fault insurance benefits by not appearing at scheduled examinations under oath (EUOs). The defendant insurer successfully demonstrated that the plaintiff did not attend these EUOs, supported by affidavits detailing their standard mailing practices for scheduling notices. The court determined that the evidence presented by the defendant was sufficient to establish that proper notice was given to the plaintiff regarding the EUOs. Consequently, the appellate court reversed the lower court's order, denied the plaintiff's cross-motion for summary judgment, and granted the defendant's motion for summary judgment to dismiss the complaint.
Government Employees Ins. Co. v Mayzenberg (2025 NY Slip Op 06527)
November 24, 2025
The court considered whether a regulation from the Department of Financial Services (DFS) allows insurers to deny a healthcare provider's no-fault benefits claim based on allegations of professional misconduct, specifically related to paying for patient referrals. The key issue centered on whether such misconduct constituted a failure to meet a foundational licensing requirement necessary for delivering healthcare services. The court found that DFS's interpretation of the regulation restricts insurers from denying claims based on claims of misconduct unless the misconduct involves relinquishing control to an unlicensed party. This interpretation aligns with the no-fault statutory framework, which aims to ensure prompt compensation for accident victims and reduce court burdens. Ultimately, the court held that insurers cannot deny benefits under these circumstances, answering the certified question in the negative.
One RX Chemist, Inc. v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51848(U))
November 21, 2025
The court considered the fact that the defendant-insurer's unopposed motion for summary judgment was based on the plaintiff's failure to appear for scheduled examinations under oath (EUOs). It noted that the defendant demonstrated a prima facie case by providing evidence of its standard mailing practices for EUO scheduling letters and an affidavit from its attorney affirming that these procedures were followed in this case. The main issue decided was whether the plaintiff's noncompliance with the EUO requirement justified the dismissal of the complaint for first-party no-fault benefits. Ultimately, the court reversed the lower court's order, granting the defendant's motion for summary judgment and dismissing the plaintiff's complaint, concluding that the defendant had met its burden of proof regarding the EUO issue.
Quazi R. Med. Servs., PC v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51784(U))
November 13, 2025
The court considered that the defendant, Nationwide Mutual Insurance Company, made an unopposed motion for summary judgment in a case involving first-party no-fault benefits, asserting that the plaintiff, Quazi R. Medical Services, failed to appear for scheduled examinations under oath (EUOs). A key issue was whether the defendant's request for verification, which occurred one day past the standard 15-day timeframe set by regulations but prior to the expiration of a 30-day claim denial period, invalidated its requests. The court concluded that the late request did not invalidate the verification requirements and maintained that it merely shortened the timeframe for claim payment or denial. Ultimately, the appellate court reversed the lower court's decision, granted the defendant's motion for summary judgment, and dismissed the complaint, affirming that the plaintiff's failure to comply with the examination requests warranted this outcome.
New York Ctr. for Specialty Surgery v Infinity Ins. Co. (2025 NY Slip Op 51832(U))
November 7, 2025
In this case, the court considered the appeal from an order of the Civil Court that denied Infinity Insurance Company's motion for summary judgment on the grounds that they had not received the claims related to first-party no-fault benefits. The main issue decided was whether the insurance company could establish, prima facie, that they had not received the relevant claims submitted by New York Center for Specialty Surgery as an assignee of Sawyers Franklin. The court found that the affidavit from the defendant's litigation specialist was inadequate as it did not sufficiently detail the practices and procedures for processing incoming mail. Consequently, the court affirmed the lower court's order, thereby allowing the claim to proceed.
John A. Nasrinpay 2 v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51833(U))
November 7, 2025
In this case, the court considered relevant facts surrounding the plaintiff's claim for assigned first-party no-fault benefits, notably that the plaintiff's assignor failed to attend scheduled examinations under oath (EUOs). The main issues decided included whether the defendant's motion for summary judgment, which sought to dismiss the complaint due to the assignor's non-compliance, was justified and whether the plaintiff's cross-motion for summary judgment should have been granted. The court held that the defendant's affidavits were adequate to establish a presumption that the notices for the EUOs were properly mailed, thereby supporting the defendant's case. As a result, the court affirmed the lower court's order dismissing the complaint and denying the plaintiff's cross-motion.
Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC (2025 NY Slip Op 06054)
November 5, 2025
In this case, the court considered the procedural aspects surrounding the arbitration awards related to a no-fault insurance claim involving Bay Ridge Surgi-Center, LLC and American Transit Insurance Company. The main issues included whether Bay Ridge properly substantiated its request for additional attorney's fees under 11 NYCRR 65-4.10(j)(4) and whether a hearing was necessary prior to the court's decision on the fee amount. The court ultimately decided to affirm the lower court's judgment, which had granted Bay Ridge an additional $250 in attorney's fees while confirming the master arbitration award in favor of Bay Ridge. The ruling clarified that Bay Ridge's failure to provide adequate documentation regarding the fees and the lack of a request for a hearing did not warrant revising the awarded amount, thus supporting the discretion of the Supreme Court in determining reasonable attorney's fees.
Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC (2025 NY Slip Op 06055)
November 5, 2025
The court considered the procedural context of a case in which Bay Ridge Surgi-Center, LLC sought to vacate a master arbitration award favorable to it, while also cross-petitioning for additional attorney's fees under a specific regulation (11 NYCRR 65-4.10(j)(4)). The primary issues included the validity of the arbitration award and the assessment of reasonable attorney's fees related to the no-fault insurance claim. Ultimately, the Supreme Court awarded Bay Ridge additional attorney's fees amounting to $1,100, despite Bay Ridge's claim for $4,450, determining that the lower amount was reasonable given the circumstances. The Appellate Division affirmed the Supreme Court's decision, noting that the court acted within its discretion in both adjudicating the fee award and not requiring a hearing before ruling on the matter.