No-Fault Case Law

The relevant facts considered by the court were that Quality Health Supply Corp. was seeking to recover $1,176.95 in assigned first-party no-fault benefits for durable medical products it sold to its assignor in June 2015. The main issue in the case was whether the plaintiff was properly licensed at the time it sold the durable medical products to its assignor. The court held that the evidence presented by the defendant, including a Freedom of Information Law (FOIL) request, was insufficient to establish that the plaintiff did not have a Department of Consumer Affairs license for the relevant time period. As a result, the court reversed the judgment and remitted the matter to the Civil Court for the entry of a judgment in favor of the plaintiff in the principal sum of $1,176.95.

The court considered a dispute over a claim made by an injured individual, Mostafa Hekal, in a motor vehicle accident. Hekal sought no-fault benefits through Hereford Insurance Company, who initially denied the claim. Hekal then submitted the claim to the Motor Vehicle Accident Indemnification Corporation (MVAIC), who also denied the claim based on coverage by AutoTeam Inc. The arbitrator determined that Hereford was responsible for processing the claim since they were the first to receive it, but the court found that Hereford's policy did not cover the vehicle involved in the accident. The court held that the arbitrator's decision was arbitrary and capricious, and vacated the awards made in favor of Hereford and MVAIC. The cross-petitions of MVAIC and Corona Medical were denied, and the court entered judgment accordingly. The main issue decided by the court was whether Hereford Insurance Company was liable for processing the claim for no-fault benefits, and the court held that there was no basis in the record to find that coverage by Hereford existed. The court also found that both the petition and the cross-petitions were denied, and vacated and set aside the awards.

The relevant facts the court considered included the history of the lawsuit, which was initially filed in 2003 to recover unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor in 2002. The case became "inactive" in 2007, and the defendant filed a motion to dismiss the complaint in 2017, citing abandonment and laches. The main issues decided by the court were whether the plaintiff's complaint should be dismissed as abandoned or barred by laches and whether interest accruing should be stayed. The holding of the case was that the defendant's motion to dismiss on the grounds of abandonment was denied, but their motion to fix the accrual of interest was granted. The court further ordered that, in the event the plaintiff prevails on its claims, interest shall accrue from the filing date of the notice of trial.

The relevant facts of this case include Solution Bridge, Inc.’s action to recover assigned first-party no-fault benefits. GEICO Ins. Co. moved for summary judgment to dismiss the complaint on the grounds that the action was barred by a declaratory judgment entered in the Supreme Court, Nassau County, or that Solution Bridge, Inc. had failed to appear for duly scheduled examinations under oath (EUOs). The main issue decided was whether GEICO Ins. Co. was entitled to summary judgment dismissing the complaint. The holding of the court was that the order denying the motion and cross motion was reversed, and GEICO Ins. Co.'s motion for summary judgment dismissing the complaint was granted.

The court considered the fact that the defendant had properly scheduled independent medical examinations (IMEs) for the plaintiff's assignor, but the assignor failed to appear for those scheduled IMEs. The main issue decided was whether the plaintiff's assignor failed to appear for duly scheduled IMEs and whether the amounts sought by the plaintiff exceeded the amounts permitted by the workers' compensation fee schedule. The holding of the case was that the defendant was entitled to summary judgment dismissing the complaint, as the plaintiff failed to raise a triable issue of fact in opposition to the defendant's motion or challenge the implicit findings in the defendant's favor. Therefore, the order denying the defendant's motion for summary judgment was reversed, and defendant's motion for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court in this case included an action to recover assigned first-party no-fault benefits and a direction from the Civil Court for defendant to establish its fee schedule defense. The main issue decided in this case was the appeal from a "decision and order" of the Civil Court, which awarded the plaintiff the sum of $164.01. The holding of the court was that the appeal was dismissed, as the paper in question was not appealable as of right and did not decide a motion made upon notice. Additionally, the court declined to grant leave to appeal and stated that no appeal lies from a decision, leading to the dismissal of the appeal.

The court considered the fact that the plaintiff, a medical provider, was seeking to recover assigned first-party no-fault benefits for medical services rendered, totaling $6,947.81. The defendant insurer moved for summary judgment to dismiss the complaint based on the plaintiff's assignor's failure to appear for orthopedic independent medical examinations (IME's) on two occasions. The main issue decided was whether the defendant's scheduling of the orthopedic IME's complied with the regulation prescribing a statutory 30-calendar-day time frame for timely holding of IME's, and whether the plaintiff had submitted proof of mailing of the prescribed statutory billing forms. The court held that the defendant had failed to demonstrate a prima facie entitlement for summary judgment, as they did not schedule the IME's in a timely manner, and that the plaintiff had also failed to demonstrate a prima facie entitlement for summary judgment, as they had not submitted evidence of mailing of the billing forms. The court also found that the defendant had failed to establish that the prior decisions raised by the defendant under the doctrine of res judicata were a disposition on the merits for the same litigation between the same parties, so they were not a bar to the plaintiff's claims. Therefore, the motion by defendant for summary judgment dismissing plaintiff's complaint was denied, and the plaintiff's cross-motion for summary judgment in the total sum of $6,947.81 was also denied.

The court considered a motion brought by Kemper Independence Insurance Company for a declaration that it is not required to pay no-fault benefits to certain medical providers, as the claimants who assigned their rights under a no-fault insurance policy failed to appear for examinations under oath (EUO). Kemper argued that the defendants breached their obligations under the no-fault policy by failing to appear for scheduled EUOs, while the defendants contended that Kemper's refusal to provide a specific justification for the EUO requests excused their refusal to appear. The court disagreed with Kemper, stating that the insurer must provide a specific objective justification for seeking an EUO during the claims-verification process and that the categorical refusal by Kemper to provide the reasons for requesting an EUO rendered their second request to appear for an EUO unreasonable, thus not forming a basis to deny the benefits claim. The court also ruled that an insurer's obligation to maintain internal standards should be treated as distinct from an insurer's obligation to provide an explanation for a given EUO request. Therefore, the motion of Kemper for summary judgment against the defendant was denied.

The court considered the dispute over unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor Allen on specific dates in 2019. The main issue was whether the services provided were medically necessary and if the insurer had timely denied the claim. The court held that the insurer had timely denied the claim, precluding them from offering evidence of their defense to non-payment and that the plaintiff failed to raise factual issues requiring a trial. As a result, the court granted the insurer's motions for summary judgment and dismissed the plaintiff's complaints in both actions.

The relevant facts in this case involved 27 actions brought by Queens Neurology, P.C. seeking to recover assigned first-party no-fault benefits. The plaintiff corporation was dissolved in 2009 and in 2017, it sought to consolidate the various actions and to substitute a new attorney as its representative. The main issue before the court was whether the plaintiff, as a dissolved corporation, could continue to bring the actions without timely substitution of its attorney. The court found that as a dissolved corporation, the plaintiff was required to be substituted pursuant to CPLR 1017 and had not sought substitution within a reasonable time. Therefore, the court vacated the denial of the plaintiff's motion seeking to substitute a new attorney and vacated the findings that the plaintiff was no longer winding up its affairs, had failed to timely be substituted, and had no standing to bring the motion. The holding of the court was to modify the order, insofar as appealed from, by granting the plaintiff's motion to substitute a new attorney, and by vacating the findings regarding the plaintiff's affairs, timeliness of substitution, and standing to bring the motion.