No-Fault Case Law
Chiropractic Assoc. of Richmond Hill, P.C. v Nationwide Gen. Ins. Co. (2025 NY Slip Op 50506(U))
April 4, 2025
The court considered the Civil Court's order denying Nationwide General Insurance Company's motion for summary judgment, which sought to dismiss a complaint for first-party no-fault benefits claimed by Chiropractic Associates of Richmond Hill, P.C. The primary issue was whether the insurer had adequately demonstrated that the policy limits had been exhausted prior to receiving the claims from the provider. The court ruled that the defendant failed to prove this exhaustion as a matter of law, thus not meeting the required standard for summary judgment. Ultimately, the appellate court affirmed the lower court's order, confirming that the defendant had not made a prima facie showing of entitlement to dismiss the complaint.
State Farm Mut. Auto. Ins. Co. v Lifeline Med. Imaging, P.C. (2025 NY Slip Op 02025)
April 3, 2025
In this case, the court considered relevant facts regarding State Farm's obligation to provide no-fault coverage for claims submitted by Lifeline Medical Imaging, P.C. State Farm argued that Lifeline failed to comply with a condition precedent for coverage by not attending scheduled examinations under oath (EUOs) and not supplying a necessary individual for information verification. The main issues decided concerned whether State Farm provided an objective justification for requiring the EUOs, as mandated by no-fault regulations, and whether State Farm had adequately responded to Lifeline's discovery requests regarding the standards used for scheduling the EUOs. The holding of the court was that State Farm's motion for summary judgment was denied as premature, and the declaration that it had no obligation to pay Lifeline's claims was vacated, as the criteria for the EUO request remained undetermined.
Medical Supply of NY Corp. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50412(U))
April 1, 2025
In this case, the court considered the admissibility of the Kuperman Affidavit, which was contested by the defendant on the grounds that it lacked a proper notarial signature, as it simply contained the word "February" scripted above the signature line instead of the notary's actual name. The main issues included whether the affidavit could still be considered valid despite this technical defect and whether the defendant was prejudiced by its admissibility. The court ultimately held that while the Kuperman Affidavit was defective in form, the defect was not fatal and could be rehabilitated per CPLR § 2001, since the defendant had not demonstrated substantial prejudice or a deprivation of a substantial right. Consequently, the court ruled the affidavit admissible and found that the plaintiff had established a triable issue regarding the outstanding verification requests, while also granting summary judgment to the defendant for having timely issued its denials.
Nationwide Gen. Ins. Co. v Gaines (2025 NY Slip Op 01896)
April 1, 2025
In this case, the court considered the fact that the injured claimant failed to attend two independently scheduled medical examinations (IMEs) that were properly noticed by the insurance company. The main issues decided were whether the insurer was obligated to pay no-fault benefits despite the claimant's absence from the IMEs and if the notices were timely under the applicable regulations. The court held that the plaintiffs were entitled to summary judgment, determining that the claimant's failure to attend the properly noticed IMEs foreclosed any obligation for the insurer to provide coverage for the associated medical claims. The decision emphasized that failure to attend these examinations constituted a coverage defense applicable to all claims, rather than on a bill-by-bill basis.
MAZ Chiropractic, P.C. v State Farm Ins. Co. (2025 NY Slip Op 50492(U))
March 28, 2025
In this case, the court considered relevant facts pertaining to the failure of the plaintiff, a chiropractic provider seeking to recover no-fault benefits, to appear for duly scheduled examinations under oath (EUOs). The main issue was whether the plaintiff's absence justified the defendant's motion for summary judgment, which sought to dismiss the complaint on these grounds. The court found that the attorney's affirmation regarding the plaintiff's failure to appear was sufficient evidence to establish this absence, noting that the attorney was present and prepared to conduct the EUOs. The court determined that there was no merit to the plaintiff's contention that the attorney's memory of the events was questionable. As a result, the court affirmed the lower court's order granting the defendant's motion to dismiss the complaint.
Integral Med. Supply Corp. v Progressive Ins. Co. (2025 NY Slip Op 50493(U))
March 28, 2025
In this case, the court considered the facts surrounding a provider's attempt to recover assigned first-party no-fault benefits after the defendant, Progressive Insurance Co., moved for summary judgment on the grounds that the plaintiff's assignor had materially misrepresented where the insured vehicle was garaged. The main issues involved whether the defendant had timely denied the claims based on these misrepresentations, which could affect its ability to assert this defense in court. The court determined that the defendant's failure to establish timely denial of the claims meant that it could not rely on the misrepresentation defense, ultimately leading to a reversal of the lower court's order and a denial of the defendant's motion for summary judgment. The decision underscored the importance of timely denial in asserting defenses related to misrepresentation.
MAZ Chiropractic, P.C. v State Farm Ins. Co. (2025 NY Slip Op 50492(U))
March 28, 2025
In this case, the court considered the relevant fact that the plaintiff, a chiropractic provider seeking to recover no-fault insurance benefits, failed to appear for scheduled examinations under oath (EUOs). The main issue was whether the defendant, State Farm Insurance Company, was entitled to summary judgment dismissing the complaint due to the plaintiff's absence during these EUOs. The court found that the attorney representing the defendant provided adequate affirmation confirming that the plaintiff did not appear, thus validating the defendant's claim. Consequently, the court affirmed the lower court's order granting summary judgment to State Farm, rejecting the plaintiff's argument regarding the attorney's recollection of events as without merit.
Integral Med. Supply Corp. v Progressive Ins. Co. (2025 NY Slip Op 50493(U))
March 28, 2025
In this case, Integral Medical Supply Corp. sought to recover assigned first-party no-fault benefits from Progressive Insurance Co., which had moved for summary judgment to dismiss the complaint based on allegations that the assignor misrepresented the location where the vehicle was garaged. The court noted that a defense based on misrepresentation is subject to preclusion if the insurer fails to demonstrate that it timely denied the claim on that basis. The court found that Progressive Insurance Co. did not timely deny the claims, thus failing to meet its burden of proof regarding the defense. Consequently, the court reversed the lower court's order and denied the insurance company's motion for summary judgment, allowing the case to proceed.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2025 NY Slip Op 50376(U))
March 24, 2025
The court considered the defendant’s argument that the plaintiff, Burke Physical Therapy, failed to timely respond to verification requests as mandated by 11 NYCRR §65-3.5(o). The main issues were whether the plaintiff provided the requested verification within the required timeframe and whether any reasonable justification for the delay was offered. The court found that the plaintiff’s affidavits, which merely stated that documentation was mailed without corroborating evidence, were insufficient to raise a triable issue of fact. As a result, the court granted the defendant's cross-motion for summary judgment and dismissed the plaintiff's case with prejudice, affirming that the plaintiff did not comply with the necessary verification procedures.
Berenblit v Country Wide Ins. Co. (2025 NY Slip Op 50487(U))
March 21, 2025
The court considered the facts surrounding a no-fault insurance settlement that was agreed upon in December 2001, but not paid by the insurance company until a judgment was entered in February 2017, which awarded statutory no-fault interest based on a simple rate. The appellant argued that the interest should be recalculated at a compound rate, citing statutory provisions and prior case law. A major issue involved the delay in entering the judgment, which the lower court cited as a reason to deny the compound interest and toll the accrual of that interest. The appellate court held that the lower court erred in tolling the statutory no-fault interest and ruled that the plaintiff was entitled to compound interest as a result of the settlement, remanding the case for the entry of a new judgment that reflected this decision. The appellate court emphasized that the insurance company did not deny the settlement agreement and failed to challenge the previous judgment.