No-Fault Case Law

Nationwide Gen. Ins. Co. v South (2024 NY Slip Op 00028)

The court considered the motion for summary judgment brought by the plaintiffs, Nationwide General Insurance Company, to determine whether they were obligated to pay no-fault benefits to the defendants, ARS Medical Equipment Corp., Ideal Care Pharmacy, Inc., and Rosar Medical Equipment Corp. The main issue decided by the court was whether the plaintiffs had a valid basis to deny coverage based on the investigation undertaken by their investigator and the examination under oath testimony of the driver of the vehicle involved in the accident. The court held that the plaintiffs demonstrated a "founded belief" that the accident was not covered by no-fault insurance and that they were entitled to deny coverage pursuant to regulations and provisions of the policy voiding coverage based on fraud. Additionally, the court found that the claimants' failure to appear for two properly noticed and scheduled EUOs was a violation of a condition precedent to coverage and a valid basis to deny the defendants' claims. In conclusion, the court reversed the lower court's decision, granted the plaintiffs' motion for summary judgment, and declared that the plaintiffs were not obligated to pay no-fault benefits to the defendants.
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Art of Healing Medicine, P.C. v Allstate Ins. Co. (2023 NY Slip Op 51471(U))

The relevant facts the court considered were that a judgment had been entered on May 3, 2022 upon the defendant's failure to answer the complaint, and the defendant subsequently moved to vacate the default judgment and compel the plaintiff to accept its answer. The main issue decided was whether the defendant had a reasonable excuse for its default and whether it had a potentially meritorious defense to the action. The holding of the case was that the defendant's claim of not receiving the summons and complaint, as well as a COVID-19-related staff reduction, were insufficient to constitute a reasonable excuse for the default, and therefore, the motion to vacate the default judgment and compel the plaintiff to accept defendant's answer was denied.
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Matter of Country-Wide Ins. Co. v WJW Med. Prods., Inc. (2023 NY Slip Op 06472)

The court considered the denial of respondent WJW Medical Products, Inc.'s motion for attorney's fees in connection with a no-fault insurance arbitration award. The main issue was whether WJW should be granted attorney's fees under 11 NYCRR 65-4.6(d). The holding of the case was that the Supreme Court's denial of WJW's motion for attorney's fees was reversed, and the matter was remanded for a recalculation of fees in accordance with the statute. Additionally, the court declined to award interest for the three-month period of WJW's delay in filing a notice of entry, as it exceeded the allotted time and was deemed unreasonable. The court also decided that WJW was not entitled to attorney's fees for prosecuting the appeal, as a party is not entitled to "fees on fees" when applying for attorney's fees.
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American Tr. Ins. Co. v Trinity Pain Mgt. of Staten Is., PLLC (2023 NY Slip Op 51337(U))

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.
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Metro Pain Specialists, P.C. v Mid-Century Ins. Co. (2023 NY Slip Op 51394(U))

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.
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American Tr. Ins. Co. v Nexray Med. Imaging P.C. (2023 NY Slip Op 51311(U))

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.
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Utica Mut. Ins. Co. v Crystal Curtain Wall Sys. Corp. (2023 NY Slip Op 23362)

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.
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Renelique v Foremost Signature Ins. Co. (2023 NY Slip Op 51226(U))

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.
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Matter of New Millennium Pain & Spine Medicine, P.C. v Progressive Cas. Ins. Co. (2023 NY Slip Op 05369)

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.
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NYRX Pharm. Inc. v Mid-Century Ins. Co. (2023 NY Slip Op51094(U))

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.
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