No-Fault Case Law
One RX Chemist, Inc. v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51848(U))
November 21, 2025
The court considered the fact that the defendant-insurer's unopposed motion for summary judgment was based on the plaintiff's failure to appear for scheduled examinations under oath (EUOs). It noted that the defendant demonstrated a prima facie case by providing evidence of its standard mailing practices for EUO scheduling letters and an affidavit from its attorney affirming that these procedures were followed in this case. The main issue decided was whether the plaintiff's noncompliance with the EUO requirement justified the dismissal of the complaint for first-party no-fault benefits. Ultimately, the court reversed the lower court's order, granting the defendant's motion for summary judgment and dismissing the plaintiff's complaint, concluding that the defendant had met its burden of proof regarding the EUO issue.
Quazi R. Med. Servs., PC v Nationwide Mut. Ins. Co. (2025 NY Slip Op 51784(U))
November 13, 2025
The court considered that the defendant, Nationwide Mutual Insurance Company, made an unopposed motion for summary judgment in a case involving first-party no-fault benefits, asserting that the plaintiff, Quazi R. Medical Services, failed to appear for scheduled examinations under oath (EUOs). A key issue was whether the defendant's request for verification, which occurred one day past the standard 15-day timeframe set by regulations but prior to the expiration of a 30-day claim denial period, invalidated its requests. The court concluded that the late request did not invalidate the verification requirements and maintained that it merely shortened the timeframe for claim payment or denial. Ultimately, the appellate court reversed the lower court's decision, granted the defendant's motion for summary judgment, and dismissed the complaint, affirming that the plaintiff's failure to comply with the examination requests warranted this outcome.
New York Ctr. for Specialty Surgery v Infinity Ins. Co. (2025 NY Slip Op 51832(U))
November 7, 2025
In this case, the court considered the appeal from an order of the Civil Court that denied Infinity Insurance Company's motion for summary judgment on the grounds that they had not received the claims related to first-party no-fault benefits. The main issue decided was whether the insurance company could establish, prima facie, that they had not received the relevant claims submitted by New York Center for Specialty Surgery as an assignee of Sawyers Franklin. The court found that the affidavit from the defendant's litigation specialist was inadequate as it did not sufficiently detail the practices and procedures for processing incoming mail. Consequently, the court affirmed the lower court's order, thereby allowing the claim to proceed.
John A. Nasrinpay 2 v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51833(U))
November 7, 2025
In this case, the court considered relevant facts surrounding the plaintiff's claim for assigned first-party no-fault benefits, notably that the plaintiff's assignor failed to attend scheduled examinations under oath (EUOs). The main issues decided included whether the defendant's motion for summary judgment, which sought to dismiss the complaint due to the assignor's non-compliance, was justified and whether the plaintiff's cross-motion for summary judgment should have been granted. The court held that the defendant's affidavits were adequate to establish a presumption that the notices for the EUOs were properly mailed, thereby supporting the defendant's case. As a result, the court affirmed the lower court's order dismissing the complaint and denying the plaintiff's cross-motion.
Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC (2025 NY Slip Op 06054)
November 5, 2025
In this case, the court considered the procedural aspects surrounding the arbitration awards related to a no-fault insurance claim involving Bay Ridge Surgi-Center, LLC and American Transit Insurance Company. The main issues included whether Bay Ridge properly substantiated its request for additional attorney's fees under 11 NYCRR 65-4.10(j)(4) and whether a hearing was necessary prior to the court's decision on the fee amount. The court ultimately decided to affirm the lower court's judgment, which had granted Bay Ridge an additional $250 in attorney's fees while confirming the master arbitration award in favor of Bay Ridge. The ruling clarified that Bay Ridge's failure to provide adequate documentation regarding the fees and the lack of a request for a hearing did not warrant revising the awarded amount, thus supporting the discretion of the Supreme Court in determining reasonable attorney's fees.
Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC (2025 NY Slip Op 06055)
November 5, 2025
The court considered the procedural context of a case in which Bay Ridge Surgi-Center, LLC sought to vacate a master arbitration award favorable to it, while also cross-petitioning for additional attorney's fees under a specific regulation (11 NYCRR 65-4.10(j)(4)). The primary issues included the validity of the arbitration award and the assessment of reasonable attorney's fees related to the no-fault insurance claim. Ultimately, the Supreme Court awarded Bay Ridge additional attorney's fees amounting to $1,100, despite Bay Ridge's claim for $4,450, determining that the lower amount was reasonable given the circumstances. The Appellate Division affirmed the Supreme Court's decision, noting that the court acted within its discretion in both adjudicating the fee award and not requiring a hearing before ruling on the matter.
Matter of American Tr. Ins. Co. v Pfeffer (2025 NY Slip Op 06056)
November 5, 2025
In this case, the court considered the arbitration award that was affirmed in favor of Michelle Pfeffer, as well as her request for additional attorney's fees under 11 NYCRR 65-4.10(j)(4). The main issues were whether the Supreme Court properly confirmed the master arbitration award and if it acted within its discretion in granting Pfeffer an additional $500 in attorney's fees without a hearing. The court held that the Supreme Court indeed acted within its discretion, noting that Pfeffer failed to provide sufficient documentation to support a larger fee claim and did not request a hearing regarding the attorney's fees. Consequently, the judgment awarding her the additional fees was affirmed.
Matter of American Tr. Ins. Co. v Scob, LLC (2025 NY Slip Op 06057)
November 5, 2025
The court considered a master arbitration award that had initially favored SCOB, LLC, and subsequent motions related to the recovery of additional attorney's fees following a proceeding brought under CPLR article 75. The main issues decided included whether SCOB was entitled to further attorney's fees in connection with its claim and the amount of those fees. The court held that SCOB was entitled to an award of $1,100 in additional attorney's fees pursuant to 11 NYCRR 65-4.10(j)(4), despite SCOB's request for a higher amount of $4,550. The court determined it had discretion in setting the fee, and SCOB's failure to request a hearing did not impact this decision. Ultimately, the judgment awarding the additional fees was affirmed.
Hereford Ins. Co. v 21 Century Chiropractic Care (2025 NY Slip Op 06022)
October 30, 2025
The court considered multiple relevant facts, including the failure of defendants Cross Bay Orthopedic Surgery and others to provide subscribed transcripts from examinations under oath (EUOs), which are required under the terms of a no-fault insurance policy. The main issues decided were whether the defendants' argument regarding the nature of the subscription failure constituted a violation of a condition precedent to contract performance or coverage, and whether the timing of the insurer's demand for subscriptions was proper. The court ruled that the defendants' arguments were unpreserved for lack of prior assertion in the lower court, and also found that the failure to subscribe the EUO transcripts violated a condition precedent to coverage, voiding the insurance policy ab initio. Consequently, the court affirmed the granting of the plaintiff's summary judgment cross-motion against the defendants.
Matter of American Tr. Ins. Co. v Big Apple Pain Mgt., PLLC (2025 NY Slip Op 05948)
October 29, 2025
The court considered the sequence of events surrounding a motor vehicle accident involving Carlos Nieto and subsequent medical services provided by Big Apple Pain Management, PLLC. Big Apple submitted claims to American Transit Insurance Company for reimbursement, which were denied, prompting Big Apple to seek arbitration. An arbitrator awarded Big Apple the claimed amount, which was later confirmed by a master arbitrator. American Transit then petitioned to vacate this confirmation, resulting in a ruling by the Supreme Court to grant the petition and deny Big Apple's motion. However, on appeal, the court reversed the lower court's decision, determining that American Transit did not present any valid statutory grounds for vacating the master arbitrator's award, leading to the confirmation of that award in favor of Big Apple.