No-Fault Case Law

The main issue in this case was whether the plaintiff, Medtech Medical Supply, Inc., as the assignee of Abul Azad, had the standing to maintain an action to recover first-party no-fault benefits for supplies provided to the assignor as a result of a motor vehicle accident that occurred on June 11, 1998. The defendant, Country-Wide Insurance Company, argued that the plaintiff lacked the capacity to maintain the action and collect on the judgment, as the plaintiff had been dissolved by the State of New York in 2001 and had failed to wind up its affairs within a reasonable time. The court considered the provisions of Business Corporation Law §§ 1005 and 1006, which allow a dissolved corporation and its directors, officers, and shareholders to continue to function for the purpose of winding up the affairs of the corporation. The court held that the plaintiff had the capacity to seek entry of judgment and maintain the action as part of the winding up of its business affairs, and that defendant's motion to vacate the judgment and dismiss the complaint should have been denied. The court also found that the basis for vacating the judgment pursuant to CPLR 5015 (a) (4) was improper, and remanded the matter to the Civil Court to determine plaintiff's pending motion.

The relevant facts that the court considered were that the plaintiff, a medical provider, was seeking to recover first-party no-fault benefits on behalf of an assignor who had failed to appear for examinations under oath (EUOs) as required by the insurance company. The main issue decided by the court was whether the assignor's failure to appear at the EUOs constituted a failure to comply with a condition precedent to coverage. The holding of the court was that the defendant's motion for summary judgment dismissing the complaint was granted, as the evidence presented by the defendant, including an affidavit and certified transcripts of the EUOs, demonstrated that the assignor had failed to appear for the EUOs, thereby failing to comply with a condition precedent to coverage. As a result, the order was affirmed by the court.

The case involved Charles Deng Acupuncture, P.C. attempting to recover assigned first-party no-fault benefits from Titan Insurance Co. The dispute arose over whether Deng Acupuncture had appeared for examinations under oath (EUOs) as required. The judgment dismissed the complaint after a nonjury trial that focused on this issue. The court held that transcripts of "bust" statements by the defendant's attorney regarding Deng Acupuncture's nonappearances at EUOs should not have been admitted as evidence. As a result, the court found that the defendant did not sustain its burden of proving that the plaintiff had failed to appear for the EUOs, and reversed the judgment, remitting the matter to the Civil Court for the entry of a judgment in favor of the plaintiff in the sum of $2,226.41, following a calculation of statutory no-fault interest and an assessment of attorney's fees.

The main issues decided in this case were whether the EUO scheduling letters were properly mailed to the plaintiff's assignor and whether the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs). The relevant facts considered by the court included the timely mailing of the EUO scheduling letters by the defendant and the failure of the plaintiff to appear for the EUOs as scheduled. The court found that the letters had been properly mailed to the plaintiff's assignor based on the matching address on the NF-3 forms provided to the defendant. As a result, the court held that the defendant had established a prima facie case that the letters had been properly mailed and that the plaintiff's opposition papers failed to rebut this showing. Therefore, the defendant's motion for summary judgment dismissing the complaint was granted and the order denying the motion was reversed.

The court considered the case of American Transit Insurance Company against Jose A Marte Lopez and several medical provider defendants. American Transit brought this action for a declaratory judgment that it is not required to pay no-fault benefits to Lopez or to Lopez's medical provider assignees, based on Lopez's failure to appear for independent medical examinations (IMEs) scheduled under the terms of the no-fault insurance policy. American Transit moved for summary judgment against the remaining answering defendants, arguing that it complied with procedural and timeliness requirements for no-fault claims and was entitled to a declaratory judgment. The court ultimately denied American Transit's motion for summary judgment, as it found that American Transit had not provided evidence that it timely requested the IME at issue, which was required to obtain the requested declaratory judgment. The court also noted that the arguments made by American Transit had previously been rejected in similar cases, and the recent decisions of the Appellate Division, First Department further supported the denial of American Transit's motion for summary judgment.

The court considered whether the plaintiff provided the defendant with an MRI diagnostic test and film for payment pursuant to the no-fault insurance regulations and fee schedule. The main issue was the defendant's motion for summary judgment, which was based on the grounds that the plaintiff's claim was premature as responses were outstanding to verification requests. The court ultimately held in favor of the defendant, granting their motion and dismissing the matter without prejudice as premature. The court found that the defendant's motion for summary judgment was justified based on the plaintiff's refusal to provide the MRI films until they received a $5 fee, while the defendant's response aiming to promote litigation and delay payment. Therefore, the court granted the defendant's motion and denied the plaintiff's cross motion.

The court considered the fact that plaintiff was seeking to recover assigned first-party no-fault benefits for medical services provided to defendant's insured as a result of a car accident that occurred in 2013. Plaintiff filed a motion for summary judgment, and defendant cross-moved to dismiss the complaint. The court denied both motions on the basis of defective notice/papers, as both parties had issues with timing and signature of relevant documents. The main issue decided was whether the court should disregard procedural irregularities and grant plaintiff's motion for summary judgment. The court held that it did not improvidently exercise its discretion in denying plaintiff’s motion "for defective papers," and affirmed the lower court's decision.

The court reviewed evidence provided by State Farm Mutual Automobile Insurance Company which showed that certain medical providers and individual defendants violated specific conditions preceding coverage and had a founded belief that the alleged injuries did not arise from a car accident claim. The court agreed that these parties did not take part in Examinations Under Oath and therefore could not make a claim for the alleged accident. The court agreed with State Farm that they did not have to pay any claims related to the accident. Although State Farm was not able to perform discovery on the claimants, the evidence they provided in the complaint and affidavits was deemed admissible and supported their argument. The court also acknowledged their argument that the policy was procured online to an Albany address 22 days before the collision, which called into question the legitimacy of the claims.

The main issue in the case was whether the insurance policy issued by American Transit Insurance Company was void ab initio, and whether the medical provider defendants were entitled to no-fault insurance benefits arising from the motor vehicle accident. The court found that the insurer failed to establish prima facie that it was entitled to summary judgment based on the insured's failure to appear for an independent medical examination (IME), as its motion papers did not demonstrate that it complied with New York State no-fault regulations governing the timeframes for scheduling IMEs. Specifically, the insurer did not establish that it timely requested the IMEs under the applicable regulations, and therefore, the court reversed the order granting the insurer's motion, denied the motion, and remanded the matter for further proceedings consistent with its decision. The court found that the insurer did not meet its burden of proof and compliance with the regulations, and therefore, was not entitled to summary judgment declaring the insurance policy void and denying benefits to the medical provider defendants.

The relevant facts of this case involve American Transit Insurance Company seeking a declaration that it is not obligated to pay no-fault benefits to Erika Rivera, who was involved in a vehicle collision and assigned the right to collect no-fault benefits to various treating medical providers. American Transit denied the providers' applications for no-fault benefits and brought the action for declaratory judgment. The main issue decided was whether American Transit complied with the procedural and timeliness requirements of 11 NYCRR § 65-3.5 regarding the handling of no-fault claims. The court's holding was that American Transit failed to establish that it satisfied the timeliness requirements for requesting an independent medical examination and rescheduling it, and that its motion for default judgment and summary judgment was denied. Additionally, the court ordered American Transit to respond to the discovery requests from Global Surgery and Safe Anesthesia within 30 days, and if it fails to serve a renewed motion within 60 days, the action will be administratively dismissed.