No-Fault Case Law

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.

The court considered the Civil Court's order denying Nationwide General Insurance Company's motion for summary judgment, which sought to dismiss a complaint for first-party no-fault benefits claimed by Chiropractic Associates of Richmond Hill, P.C. The primary issue was whether the insurer had adequately demonstrated that the policy limits had been exhausted prior to receiving the claims from the provider. The court ruled that the defendant failed to prove this exhaustion as a matter of law, thus not meeting the required standard for summary judgment. Ultimately, the appellate court affirmed the lower court's order, confirming that the defendant had not made a prima facie showing of entitlement to dismiss the complaint.

In this case, the court considered relevant facts regarding State Farm's obligation to provide no-fault coverage for claims submitted by Lifeline Medical Imaging, P.C. State Farm argued that Lifeline failed to comply with a condition precedent for coverage by not attending scheduled examinations under oath (EUOs) and not supplying a necessary individual for information verification. The main issues decided concerned whether State Farm provided an objective justification for requiring the EUOs, as mandated by no-fault regulations, and whether State Farm had adequately responded to Lifeline's discovery requests regarding the standards used for scheduling the EUOs. The holding of the court was that State Farm's motion for summary judgment was denied as premature, and the declaration that it had no obligation to pay Lifeline's claims was vacated, as the criteria for the EUO request remained undetermined.

In this case, the court considered the admissibility of the Kuperman Affidavit, which was contested by the defendant on the grounds that it lacked a proper notarial signature, as it simply contained the word "February" scripted above the signature line instead of the notary's actual name. The main issues included whether the affidavit could still be considered valid despite this technical defect and whether the defendant was prejudiced by its admissibility. The court ultimately held that while the Kuperman Affidavit was defective in form, the defect was not fatal and could be rehabilitated per CPLR § 2001, since the defendant had not demonstrated substantial prejudice or a deprivation of a substantial right. Consequently, the court ruled the affidavit admissible and found that the plaintiff had established a triable issue regarding the outstanding verification requests, while also granting summary judgment to the defendant for having timely issued its denials.

In this case, the court considered the fact that the injured claimant failed to attend two independently scheduled medical examinations (IMEs) that were properly noticed by the insurance company. The main issues decided were whether the insurer was obligated to pay no-fault benefits despite the claimant's absence from the IMEs and if the notices were timely under the applicable regulations. The court held that the plaintiffs were entitled to summary judgment, determining that the claimant's failure to attend the properly noticed IMEs foreclosed any obligation for the insurer to provide coverage for the associated medical claims. The decision emphasized that failure to attend these examinations constituted a coverage defense applicable to all claims, rather than on a bill-by-bill basis.