No-Fault Case Law

The main issue in the case New York First Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. involved the defendant's motion seeking to amend the answer to include the defense of fraudulent incorporation and to compel the plaintiff to produce its owner, Valentina Anikeyeva, for a deposition. The Civil Court granted the branches of defendant's motion and directed the plaintiff to produce its owner for a deposition within 60 days of the order, with the consequence of failure to do so resulting in dismissal. Subsequently, the Civil Court entered an order dismissing the complaint with prejudice due to plaintiff's failure to comply with the previous order. The main holding of the case was that the appeal must be dismissed because the right of direct appeal from the previous order terminated with the entry of judgment in the action. Therefore, the appeal was dismissed.

The main issues in this case were whether a provider was entitled to recover assigned first-party no-fault benefits, and whether the defendant insurance company was entitled to a deposition of the owner of the plaintiff corporation. The court considered the defendant's motion to dismiss the complaint due to the plaintiff's inadequate response to discovery demands and failure to produce its owner for a deposition. The main holding of the case was that the defendant was entitled to a deposition of the plaintiff's owner, as the defendant had set forth reasons for believing that the plaintiff may be ineligible to recover benefits as a fraudulently incorporated professional service corporation. The court reversed the order denying the defendant's motion to dismiss the complaint and granted the defendant's motion to direct the plaintiff to produce its owner for a deposition within 60 days.

The relevant facts considered by the court were whether an automobile collision was covered by the plaintiff's insurance policy and whether the injuries purportedly sustained due to the collision were a result of an insurance fraud scheme. The main issue decided was whether the defendant, in order to prove lack of coverage for the alleged injuries, needed to prove, by clear and convincing evidence, that the injuries were a result of an insurance fraud scheme or that the collision was not a covered accident. The court held that in order to prove lack of coverage, the defendant needed to establish, by a preponderance of the evidence, that the collision was not an accident and was instead a deliberate intentional occurrence, regardless of whether it was part of an insurance fraud scheme, and that the coverage was not required to be established by clear and convincing evidence. The court found that the defendant met its burden and the judgment was affirmed.

The relevant facts of this case involved an action by a provider to recover assigned first-party no-fault benefits. The Civil Court granted the provider's motion for summary judgment and implicitly denied the insurer's cross motion for summary judgment. On appeal, the Appellate Term affirmed the judgment, finding that the provider's affidavit and documents established evidence in admissible form and that any deficiency regarding proof of mailing of the claim forms was cured by the insurer's affidavit. The main issues decided in this case were whether the insurer's follow-up requests for verification were premature and without effect, and whether the insurer was precluded from raising certain defenses due to untimely denials of the provider's claims. The court held that the follow-up requests were premature and without effect, and that the insurer was precluded from raising most defenses due to the untimely denials. Additionally, the insurer's submissions were found to be insufficient to demonstrate that the defense of lack of coverage was valid.

The court considered the issue of whether the defendant insurance company was in compliance with regulations regarding the timing of follow-up requests for verification of claims submitted by a chiropractic provider. The main issues decided in this case were whether the plaintiff had made out a prima facie case to recover first-party no-fault benefits and whether the defendant's follow-up requests for verification were timely. The holding of this case was that the plaintiff had provided sufficient evidence to establish a prima facie case, and the defendant's follow-up requests for verification of claims were premature and without effect, as they were issued before the 30-day period had lapsed, therefore the judgment of the lower court was affirmed.

The court considered the issue of whether a follow-up request for verification of a no-fault benefits claim was issued prematurely, which would preclude the insurance company from raising certain defenses. The main issue decided in the case was whether the insurance company's premature follow-up request for verification affected its ability to deny the provider's claim on the basis of lack of medical necessity. The holding was that the insurance company's premature follow-up request for verification was without effect, and as a result, the 30-day claim determination period was not tolled. The insurance company was therefore precluded from raising certain defenses, including lack of medical necessity, and its failure to timely deny the provider's claim meant that there was no triable issue of fact. The judgment in favor of the provider was affirmed.

The court considered a motion by the defendant to dismiss the complaint due to the plaintiff's allegedly insufficient response to defendant's interrogatories. While the motion was pending, the defendant served the plaintiff with a notice to take the deposition of plaintiff's owner, Perumunda K. Sharma. The Civil Court denied defendant's motion and stated that the defendant did not establish its need for a deposition of Sharma. The court also noted that the plaintiff's purported cross motion, seeking a protective order with respect to the deposition of Sharma, was denied as moot. The main issue was whether the defendant had the entitlement to depose Sharma, and the holding of the case was that the portion of the order which provided that defendant did not establish its entitlement to depose Sharma is not appealable as of right, and the appeal was dismissed.

The court considered a motion by the defendant seeking to vacate a default judgment and compel the plaintiff to accept its late answer in an action to recover assigned first-party no-fault benefits. The main issues decided were whether the defendant had a reasonable excuse for its default and whether it had a potentially meritorious defense to the action. The holding was that the defendant demonstrated a reasonable excuse for its relatively short delay in answering the complaint, and made a prima facie showing of a potentially meritorious defense. Therefore, the branches of the defendant's motion seeking to vacate the default judgment and to compel the plaintiff to accept its late answer were granted. The court did not support the imposition of sanctions against the plaintiff, so the Civil Court's denial of the branch of defendant's motion seeking sanctions was left undisturbed.

The relevant facts considered by the court in this case included a provider's attempt to recover assigned first-party no-fault benefits and a cross motion by the defendant seeking to amend its answer to add affirmative defenses and to compel the plaintiff to respond to amended discovery demands. The main issue decided by the court was whether the Civil Court properly granted the defendant's cross motion, which sought to assert the affirmative defenses that the plaintiff was a fraudulently incorporated professional service corporation and lacked standing to bring the action, as well as to compel the plaintiff to respond to the amended discovery demands. The holding of the court was that the Civil Court did not improperly exercise its discretion in granting the defendant leave to amend its answer and to compel the plaintiff to respond to the amended discovery demands, as the proposed affirmative defenses were not devoid of merit and the amended discovery demands were material and necessary to the defendant's defenses.

The relevant facts considered by the court were that Liberty Medical Group, P.C. entered into a stipulation to settle a first party no-fault benefits action with New York Central Mutual Fire Insurance Company in 2002. The main issue decided was whether the stipulation was enforceable, as the defendant sought to vacate it, claiming it was based on fraud. The holding of the court was that the defendant failed to provide any competent evidence to support their claim that the stipulation was unenforceable, and that stipulations of settlement are favored by the courts and not lightly set aside. The court also noted that the defendant had failed to demonstrate any basis to excuse it from complying with the terms to which it had assented, and may not avoid its enforceability by claiming that the plaintiff's claims were the product of fraud. Therefore, the motion to vacate the stipulation was denied, and the decision of the court was affirmed.