No-Fault Case Law

The case involves a life insurance policy issued by John Hancock Life Insurance Company of New York to defendant Shavy Hirsch insuring the life of her stepmother Rivka Landau. Landau applied for the policy on December 11, 2006, and she was diagnosed with breast cancer on December 14, 2006. The policy was delivered on December 26, 2006, and the first premium was paid on December 28, 2006. In 2008, John Hancock discovered the cancer diagnosis and commenced an action to rescind the policy in December 2008. The main issue in the case was whether the policy was void because Landau and Hirsch failed to disclose material health information at the time of the application or because there had been a deteriorative change in Landau's health between the time of the application and the issuance of the policy which required notification to the insurer. The court held that John Hancock's motion for summary judgment was granted and that the policy was declared null and void because an express condition precedent to coverage under the policy was not met. Therefore, John Hancock did not have to pay any benefits or perform under the policy.

The main issue decided by the court in this case was whether the recent Court of Appeals decision in Fair Price Medical Supply Corp. V. Travelers Indemnity Co., 10 NY3d 556 (2008) requires an insurer to deny a claim on the grounds that the assignor was involved in an accident while on the job and that workers compensation is hence primary within 30 days, or whether that defense is not subject to the preclusion rule. The court held that the defense that a "claimant is eligible for workers compensation" is not a coverage defense but rather a "statutory offset" which must be contained in a timely denial. It also held that the defense of workers compensation is not subject to preclusion and a no-fault insurer is only obligated to pay no-fault benefits if the workers compensation carrier denies liability for benefits. The court granted summary judgment to the plaintiff with respect to the defense of workers compensation, but the case proceeded to trial on the issue of medical necessity.

The relevant facts considered were that the plaintiff, as the assignee of medical benefits of a for-hire vehicle operator, filed a claim for no-fault insurance benefits for injuries arising from an automobile accident. The defendant argued that the claim should be covered by Workers' Compensation Insurance from the New York Black Car Operators' Injury Compensation Fund and not under the No Fault Insurance Law. The main issue decided was whether the defendant was entitled to summary judgment based on the argument that the claim should be covered under Workers' Compensation Insurance. The holding of the court was that the defendant failed to meet the required prima facie showing of entitlement to judgment as a matter of law to support its summary judgment motion, and therefore, the defendant's motion for summary judgment was denied in its entirety.

The relevant facts of the case were that Media Neurology P.C. provided medical treatment to Jerome Ajodhasingh following a car accident, and Liberty Mutual Insurance Company denied payment for the treatment on the grounds it was not medically necessary. The principal of Media Neurology, German Laufer, was indicted on charges of no-fault insurance fraud. Liberty Mutual sought to compel Laufer's deposition more than 3 years after the Notice of Trial was filed, citing the indictment as an unusual and unanticipated circumstance necessitating the discovery. The court held that since Liberty did not raise fraud as a defense in a timely served denial, they were precluded from raising it as a defense at trial, and Laufer's deposition was not material or relevant to the action. Therefore, Liberty's motion to compel Laufer's deposition was denied.

The court in this case considered the fact that the plaintiff, Hastava & Aleman Associate, brought a no-fault action against State Farm Mutual Auto Insurance Company, regarding the issue of Examination Under Oath (EUO). The plaintiff alleged that State Farm willfully delayed and/or refused to pay no-fault benefits to its client, Lionel McIntyre, who was injured in a car accident and received treatment from the plaintiff. The main issue that the court decided was whether State Farm had the right to demand an EUO from the injured party, and if its refusal to pay benefits was justified. The court held that State Farm was within its rights to demand an EUO from McIntyre and that its refusal to pay benefits was not willful, as the plaintiff's failure to provide requested documents was material and prejudicial to State Farm's ability to investigate the claim. Therefore, State Farm did not violate any provisions of the no-fault regulations and was entitled to the relief requested.

The relevant facts to this legal case are that the claimant was injured in an automobile accident and sought no-fault benefits from her insurer. After one arbitration award was issued in her favor, she also sought supplementary uninsured motorist benefits, which were denied by the arbitrator. The claimant then sought to vacate or modify the supplementary uninsured motorist arbitration award, claiming that her insurer was collaterally estopped from relitigating the issue of causation. The main issue in this case was whether or not the award with respect to supplementary uninsured motorist benefits violated public policy and whether it exceeded the arbitrator's power. The holding of this case was that the motion to vacate or modify the arbitration award was denied and the original award was confirmed. It was determined that despite the fact that a prior arbitration award was inconsistent with the subsequent award, this alone was not an enumerated ground for vacating or modifying the award. Arbitrators are not required to provide reasons for their decisions, and as such, the supplementary uninsured motorist arbitrator was not required to state that he had considered the contention of collateral estoppel.

The court considered the defendant's submission in support of its staged accident defense, as well as its reliance on a policy exclusion defense. The main issue decided was whether the defendant's submission was sufficient to establish a "founded belief that the alleged injury did not arise out of an insured incident" and whether the policy exclusion defense was precluded due to the defendant's failure to timely deny the claims. The holding of the case was that the defendant's submission was insufficient to establish a "founded belief" and that any policy exclusion defense was precluded due to the defendant's failure to timely deny the claims. The appellate court affirmed the order of the Civil Court of the City of New York, Bronx County which granted the plaintiff's motion for summary judgment.

The relevant facts the court considered in this case involved an insurance carrier's failure to adhere to the time limits for requesting follow-up verification in a no-fault insurance case. The main issue decided by the court was whether an insurance carrier should be subject to greater penalties for submitting a late follow-up verification request than for submitting a late additional verification request. The court held that the insurance carrier should not be subject to greater penalties for submitting a late follow-up verification request than for submitting a late additional verification request. The court concluded that the regulations do not contain a punitive provision for an insurer who does not make a follow-up verification request within the 10-day period and that the penalties should be consistent across both types of verification requests. Consequently, the court granted the defendant's motion for summary judgment and dismissed the case.

The relevant facts in this case include the plaintiffs, providers seeking to recover first-party no-fault benefits, filing a motion for summary judgment. In opposition, the defendant argued that the plaintiffs had not established a foundation for the admission of the documents submitted as business records. The District Court denied the motion, citing insufficiency of the affidavit provided by the plaintiffs' billing manager. The main issue decided in this case was whether the plaintiffs had made a prima facie showing of their entitlement to summary judgment. The court held that the affidavit submitted by the plaintiffs' billing manager failed to establish that the documents annexed to the moving papers were admissible under CPLR 4518. The holding of the case was that the plaintiffs' motion for summary judgment was properly denied, as they had failed to make a prima facie showing of their entitlement to summary judgment. The court did not reach any other issues in light of their decision.

The court considered the fact that Careplus Medical Supply, Inc. was seeking to recover assigned first-party no-fault benefits from Allstate Insurance Company. Careplus moved for summary judgment, but Allstate argued that Careplus did not make a prima facie showing of entitlement to judgment. The court denied Careplus's motion, stating that the affidavit by Careplus's billing manager did not establish a prima facie case because it did not demonstrate that the documents annexed to Careplus's motion were admissible as business records. The main issue decided was whether Careplus made a prima facie showing of entitlement to summary judgment, and the court held that Careplus failed to do so, as the affidavit submitted by Careplus's billing manager did not establish the admissibility of the documents annexed to Careplus's moving papers. Therefore, the denial of Careplus's motion for summary judgment was affirmed.