No-Fault Case Law

The court considered a dispute between American Transit Insurance Company and Trinity Pain Management of Staten Island, PLLC regarding the determination of a No-Fault insurance master arbitrator. The main issue decided was the proper standard of review for a No-Fault insurance master arbitrator and the Article 75 court scrutiny of a master arbitrator's review. The holding was that the master arbitrator's determination was not arbitrary, capricious, irrational, without a plausible basis, or incorrect as a matter of law, and that the grounds for vacating the arbitration award as specified in CPLR 7511 (b) had not been established. As a result, the court denied the petition of American Transit Insurance Company, dismissed the special proceeding, and confirmed the master arbitration award in its entirety. Respondent was awarded the principal amount, interest, attorney's fees, and return of filing fee as determined in the arbitration. Additionally, Petitioner was ordered to pay Respondent an attorney's fee, and Respondent was awarded the costs and disbursements to be taxed by the Clerk.

The court considered an appeal from two orders of the District Court of Suffolk County, one entered in June 2021 and the other in October 2022, both related to a motion for summary judgment by the defendant to dismiss the complaint. The main issue decided was whether the unpaid portion of first-party no-fault benefits sought to be recovered exceeded the amount permitted by the workers' compensation fee schedule, and whether the only issue at trial shall be whether the defendant properly paid the claim to the fee schedule. The holding of the court was that the branch of the defendant's motion seeking summary judgment dismissing the complaint was granted, as the defendant's affidavits established prima facie that the amount sought to be recovered exceeded the fee schedule, and the plaintiff failed to present evidence to raise a triable issue of fact.

The court considered a motion to reargue, renew, and resettle an order and judgment dated July 20, 2023. The issues decided were whether to add a provision for interest to the order and the amount of attorney's fees awarded. The court held that interest should accrue from August 31, 2020, at the rate of two percent per month, simple, and calculated on a pro-rata basis using a 30-day month. An evidentiary hearing was not necessary to increase the attorney's fee, and the court noted that the defendant was directed to submit an affirmation or affidavit as to the amount of such fees and expenses.

The relevant facts that the court considered were surrounding a construction-related property damage action that was pending in court. The main issue decided was whether or not a justiciable controversy existed for the declaratory judgment sought by Utica Mutual Insurance Company and Utica National Assurance Company. The holding of the case was that the insurance-coverage declaratory judgment action was dismissed and denied, as the court found that the matter in dispute could be determined in the basic negligence action, making the declaratory judgment premature.

The main issues decided in this case were whether the defendant's motion to dismiss the plaintiff's complaint and the plaintiff's cross-motion for summary judgment should be granted. The court considered the fact that the plaintiff had sued the defendant insurance company to recover unpaid No-Fault benefits for medical services provided to the plaintiff's assignor, and that the defendant had previously filed a motion to dismiss which had been denied by the court. The court also took into account the defendant's argument that the plaintiff's claims were barred by collateral estoppel and res judicata, based on a prior default judgment by another court. The court ultimately held that the defendant's motion to dismiss was untimely and denied, and that neither collateral estoppel nor res judicata barred the plaintiff's action. The court also denied the plaintiff's cross-motion for summary judgment, but found that the plaintiff had established the fact that the prescribed statutory billing forms were mailed to and received by the insurance carrier, and that payment of no-fault benefits was overdue. The court ordered the matter to proceed to an immediate trial. The court also warned the plaintiff of the consequences of not taking steps to vacate the prior default judgment.

The court considered whether to vacate a master arbitration award that denied a petitioner's claim for no-fault benefits for medical services rendered to an insured. The main issue in the case was whether the claim for no-fault compensation should retain priority of payment even though the policy was exhausted prior to the underlying arbitration. The court held that the arbitrator did not exceed his power in denying the claim, as an insurer's duties cease upon the payment of the contractual limit on its no-fault policy, and the claim for no-fault compensation should not retain priority of payment after the policy has been exhausted. Therefore, the court affirmed the denial of the petitioner's application to vacate the master arbitration award.

In this case, NYRX Pharmacy Inc. sued Mid-Century Insurance Company for non-payment of medical services rendered to an assignor who was injured in a motor vehicle accident. The insurer claimed that the accident was staged and not covered under the insurance policy. The insurer provided affidavits from the allegedly involved drivers admitting to staging the accident, but the court found these affidavits to be unreliable. The court also found that the insurer did not meet the burden of proof to establish that the accident was, in fact, staged. Consequently, the court denied the insurer's motion to dismiss, holding that there was a triable issue of fact as to whether the accident was staged. The court also ordered the amendment of the insurance company's name in the caption of the case. As a result, the court ruled in favor of the plaintiff and denied the defendant's motion to dismiss.

The court considered the denied motion for attorney's fees by Bay Needle Care Acupuncture, P.C. which sought additional fees related to a no-fault claim. The main issue decided was whether Bay Needle timely sought to submit a proposed judgment and whether they were entitled to additional attorney's fees. The holding of the case was that Supreme Court properly denied Bay Needle's motion for attorney's fees, as they failed to provide an explanation for the lengthy delay in seeking relief and did not submit proof of the fees incurred. The court also exercised its discretion by not awarding additional fees of $2,000 in a case involving a no-fault claim of $2,100, and where Bay Needle's counsel failed to provide contemporaneous documentation of the fees incurred.

The main facts considered were that the plaintiff had commenced an action to recover assigned first-party no-fault benefits, and a stipulation required the plaintiff to provide complete responses to defendant's discovery demands by a certain date, or else the complaint would be dismissed. The defendant moved to dismiss the complaint because the plaintiff had failed to comply with the stipulation, and the Civil Court granted the defendant's motion. The main issue decided was whether the stipulation had become absolute due to the plaintiff's failure to comply with the requirement to provide complete responses to discovery demands, and whether the plaintiff had offered a reasonable excuse for its failure to comply. The holding of the court was that the stipulation had indeed become absolute upon the plaintiff's failure to comply, and the Civil Court properly dismissed the action pursuant to the stipulation. Therefore, the order was affirmed.

The main issue in this case was whether the master arbitrator's award, which upheld the denial of Advanced Recovery Equipment & Supplies, LLC's (Advanced) claims to recover assigned first-party no-fault benefits for services rendered on June 11, 2015, should be vacated. The District Court granted Advanced's petition to vacate the master arbitrator's award, holding that there was no rational basis to support it and remitted the matter to the master arbitrator for a new determination. The appellate court affirmed the judgment, finding that there was no rational basis to support the master arbitrator's determination and thus agreeing with the District Court's decision to vacate the award. Therefore, the main holding of the case was that the master arbitrator's award was properly vacated by the District Court and the matter was remitted for a new determination.