No-Fault Case Law

The plaintiff, Westchester Medical Center, filed a lawsuit to recover no-fault benefits from Liberty Mutual Insurance Company. The plaintiff appealed to the Supreme Court, Nassau County, after the court granted the defendant's cross motion for summary judgment dismissing the second, third, and fourth causes of action. The second and third causes of action involved health services provided to Kevin Kane and Gladys Navarro. The plaintiff demonstrated its entitlement to judgment by proving that necessary billing documents were mailed to and received by the defendant and that payment of the no-fault benefits was overdue. Therefore, the defendant's cross motion for summary judgment was denied, and the Supreme Court erred in awarding summary judgment to the defendant. As it pertains to the fourth cause of action, involving health services to Alyssa Arater, the plaintiff similarly demonstrated its entitlement to judgment, and the Supreme Court should have granted summary judgment in favor of the plaintiff on that cause of action. Therefore, the order was reversed, and the plaintiff's motion for summary judgment was granted. The defendant's cross motion for summary judgment was denied.

The court considered the fact that the defendant, AIU Insurance Company, sought leave to renew and reargue a decision and order granting summary judgment to the plaintiffs, Devonshire Surgical Facility and Carnegie Hill Orthopedic Services. The main issues decided were whether the defendant had established good cause for seeking discovery relating to its defenses and the plaintiffs' corporate structure, and whether there were triable issues of fact concerning the plaintiffs' prima facie case. The court held that the defendant failed to establish good cause for seeking discovery relating to the plaintiffs' alleged fraudulent incorporation, and that the plaintiffs' affidavit supporting their motion for summary judgment was sufficient to lay a foundation for the admission of their business records. Ultimately, the court denied the defendant's motion for leave to renew and reargue.

The relevant facts considered by the court involved a case where the plaintiff was seeking to recover no-fault benefits as an assignee of five individuals, with claims arising out of five separate accidents. The main issue decided was whether the defendant's motion to sever the five causes of action in the complaint into separate actions should be granted. The court held that the particular facts relating to each claim were likely to raise few, if any, common issues of law or fact, and that each claim should be severed into a separate action. The court also found that the defendant's answer, without more, placed at issue the basis for severance, and therefore, the defendant's motion to sever the causes of action should have been granted.

The relevant facts in this case involve an action to recover no-fault insurance medical benefits, in which the plaintiff appealed from an order in the Supreme Court, Nassau County. The order granted the defendant's motion to vacate a judgment entered upon its default in answering, and denied the plaintiff's motion to punish the defendant for contempt. The main issue decided was whether the Supreme Court properly exercised its discretion in granting the defendant's motion to vacate the default judgment pursuant to CPLR 317, and whether it properly denied the plaintiff's motion to punish the defendant for contempt. The holding of the court was that the Supreme Court did exercise its discretion properly in granting the defendant's motion to vacate the default judgment pursuant to CPLR 317 and properly denied the plaintiff's motion to punish the defendant for contempt. Therefore, the order was affirmed with costs.

The relevant facts considered by the court included the denial of plaintiff's motion for summary judgment in an action by a provider to recover first-party no-fault benefits. The main issue decided in this case was whether the defendant proffered sufficient evidence to demonstrate that there was an issue of fact as to whether the injuries sustained by the plaintiff's assignor arose from an insured incident. The holding of the court was that the affidavit submitted by the defendant's investigator was sufficient to demonstrate that the denial of coverage was based on a "founded belief that the alleged injuries do not arise out of an insured incident." As a result, the court reversed the order and denied the plaintiff's motion for summary judgment.

The relevant facts that the court considered in this case were that the plaintiff was an assignee of Joseph Harris and was suing the defendant, State Farm Insurance Company, in a case where no-fault summary judgment motions are common in New York. The main issue that was decided was whether or not the plaintiff had met the necessary prima facie showing for a no-fault plaintiff's summary judgment and if the insurer had preserved a precludable defense or unsatisfied verification requests. The holding of the case was that the court established a four-step analysis for no-fault summary judgment motions, focusing on specific requirements for plaintiff's prima facie case, the insurer's tendered proof of defenses, regulatory compliance review, and timeliness and form requirements for the insurer's denial or verification requests.

The case involved a proceeding pursuant to CPLR article 75 to permanently stay arbitration. An insured of State Farm was involved in a vehicle accident with a vehicle owned by the City of Long Beach. State Farm sought to recover no-fault benefits from Long Beach's insurer, Specialty National Insurance Company, and initiated arbitration pursuant to Insurance Law § 5105. Long Beach then commenced a proceeding to permanently stay the arbitration. The main issue decided was whether the arbitration proceeding initiated by State Farm was within the applicable limitations period. The court reversed the order of the Supreme Court, denying the petition, as it found that State Farm had initiated the arbitration within three years of the accrual of the claim, which was well before the expiration of the applicable limitations period. Therefore, the court found that the Supreme Court had improperly granted Long Beach's petition based on the statute of limitations.

The court considered the appeal of a provider to recover first-party no-fault benefits. Plaintiff moved for summary judgment, but the motion was denied because the affidavit of plaintiff's corporate officer failed to establish personal knowledge of plaintiff's practices and procedures. Defendant argued that the affidavit did not lay a proper foundation for the documents annexed to plaintiff's moving papers, thus failing to establish a prima facie case. The court affirmed the order denying plaintiff's motion for summary judgment, stating that the affidavit submitted was insufficient to establish the officer's personal knowledge and therefore plaintiff failed to make a prima facie showing of entitlement to summary judgment. Therefore, the holding of the case was the denial of plaintiff's motion for summary judgment was properly affirmed.

The court considered the fact that the defendant insurer had admitted receiving the no-fault claims and had made partial payment on the claims. The main issue decided was whether the plaintiff had submitted proof that the claims had been mailed and received, and that they were overdue. The holding of the case was that the defendant insurer was not allowed to argue that the plaintiff had failed to submit the required proof, and that judgment was properly entered in favor of the plaintiff. The court also decided that the defendant waived any objections based on lack of proof of assignment since it did not seek verification of the assignment.

The relevant facts considered by the court in Umed Med., P.C. v State Farm Ins. Co. included an action by a provider to recover first-party no-fault benefits, and whether the insurer raised a triable issue of fact by proffering sufficient evidence to demonstrate a founded belief that the injuries did not arise out of an insured incident, but were staged. The main issue decided was whether the insurer's submission of a sworn affidavit of its special investigator was sufficient to demonstrate a founded belief, despite containing hearsay allegations. The holding of the case was that the branch of the plaintiff's motion seeking summary judgment on its third cause of action should have been denied, as the insurer's evidence was deemed insufficient to require a trial on material issues.