No-Fault Case Law
State Farm Mut. Auto. Ins. Co. v Amtrust N. Am., Inc. (2024 NY Slip Op 00646)
February 7, 2024
State Farm Mutual Automobile Insurance Company sought to recover damages for unjust enrichment. The company had provided payments for medical services on behalf of individuals who had been injured in a motor vehicle accident while traveling in a vehicle insured by State Farm. It was discovered that the injured individuals had applied for and been directed to receive workers' compensation benefits by a different insurer. State Farm demanded that the defendant reimburse it for the full amount of no-fault benefits paid out. The Supreme Court initially granted the defendant's motion to dismiss the complaint, arguing that the Workers' Compensation Board had primary jurisdiction over the coverage dispute. However, the Appellate Division reversed this decision, stating that the matter should be referred to the Workers' Compensation Board.
Matter of New Millennium Pain & Spine Medicine, P.C. v Garrison Prop. & Cas. Ins. Co. (2024 NY Slip Op 00599)
February 6, 2024
The court considered two separate applications to vacate master arbitration awards denying no-fault benefits for medical services rendered to insured individuals. The court explained that it would not set aside an arbitrator's award for errors of law or fact. New Millennium argued that the insurer took a 20% wage offset twice, first when issuing payment against gross wages, and second when taken against the no-fault personal injury protection limit of liability. However, the court found this argument unavailing because Insurance Law § 5102(b) allows an insurer to deduct from first-party benefits. The court also determined that New Millennium was not the prevailing party and was therefore not entitled to attorneys' fees. Ultimately, the court unanimously affirmed both orders denying the applications to vacate the master arbitration awards.
Biotech Surgical Supply, Inc. v Country Wide Ins. Co. (2024 NY Slip Op 50118(U))
January 26, 2024
The relevant facts considered by the court in this case were that a provider was seeking to recover assigned first-party no-fault benefits for a claim arising from an accident that occurred in 1999. The case was settled in 2003, and a judgment was entered in 2017 awarding statutory no-fault interest from the date of the settlement. The main issue decided by the court was whether the accrual of statutory no-fault interest should be tolled from the date of the settlement to the date the plaintiff filed a motion to recalculate the interest. The holding of the court was that the Civil Court erred in tolling the accrual of interest, and the matter was remitted to the Civil Court for the entry of a new judgment in accordance with the decision and order.
Metro Med. Diagnostics, P.C. v Country Wide Ins. Co. (2024 NY Slip Op 50119(U))
January 26, 2024
The relevant facts that the court considered were that the plaintiff, Metro Medical Diagnostics, P.C. sought to recover no-fault benefits for a claim arising from a 2000 accident that was settled in 2010, but the defendant failed to pay the settlement amount. A judgment was entered in 2017, awarding the plaintiff statutory no-fault interest from the date of the settlement at a simple rate. The main issue decided was whether the Civil Court erred in tolling the accrual of statutory no-fault interest from the date of the settlement to the date of the original judgment. The holding of the case was that the Civil Court did indeed err in tolling the accrual of interest, and as a result, the judgment was reversed, and the matter was remitted to the Civil Court for the entry of a new judgment in accordance with the decision and order.
New Life Acupuncture, P.C. v Country Wide Ins. Co. (2024 NY Slip Op 50120(U))
January 26, 2024
The relevant facts of the case included an action by a provider to recover assigned first-party no-fault benefits for a claim submitted to the defendant on May 4, 2000, arising from an accident that occurred on November 15, 1999. The case was settled on July 31, 2008, but the defendant did not pay the settlement amount, leading to a judgment being entered on March 22, 2017, awarding statutory no-fault interest at a simple 2% per month rate. Plaintiff moved to have the interest recalculated pursuant to the pre-2002 regulations, which required no-fault interest to be calculated at a compound rate. The main issue decided was whether the interest in the judgment should be recalculated from a simple rate to a compound rate, and the holding of the court was that the plaintiff's motion to recalculate the interest from a simple rate to a compound rate should have been granted. The court stated that the claim involved was governed by former regulations providing for compound interest, and the order of the Civil Court, denying the plaintiff's motion, was reversed.
Country-Wide Ins. Co. v Yao Jian Ping (2024 NY Slip Op 24033)
January 22, 2024
The relevant facts the court considered in this case include the commencement of the action by Country-Wide Insurance Company against Yao Jian Ping following an arbitration award in defendant's favor in excess of $5,000. Defendant made a motion to dismiss the action, which was initially denied and affirmed on appeal. A notice of trial was filed and granted by the court, after which additional discovery was directed. Defendant also sought to amend the answer but was denied. Finally, a nonjury trial was held, during which plaintiff's and defendant's exhibits were submitted and evidence was presented. Defendant rested with both plaintiff and defendant moving for a directed verdict in their favor, and the court reserved decision.
The main issue was whether the plaintiff was entitled to an adjudication de novo of a no-fault insurance claim pursuant to Insurance Law § 5106(c) following the master arbitrator's award in defendant's favor. The legal issues involved the procedural history of the case, the jurisdiction of the Civil Court, and whether the defendant should be allowed to amend the answer.
The holding in this case was not provided in the given text.
Time to Care Pharm. Inc. v American Tr. Ins. Co. (2024 NY Slip Op 50126(U))
January 17, 2024
The court considered the petition for an order confirming the Master Arbitration Award that affirmed the Arbitration Award below. The main issue decided was whether the Master Arbitration Award should be confirmed in favor of the petitioner, Time to Care Pharmacy Inc., against the respondent, American Transit Insurance Co. The holding of the case was that the unopposed petition for confirmation of the Master Arbitration Award was granted, and the Arbitration Award was confirmed in favor of the petitioner for specific sums, including interest, attorney fees, and arbitration filing fees. The court determined that the Master Arbitrator found that the lower arbitrator's decision was based on a review and evaluation of the record and had a rational and plausible basis in the evidence, and therefore affirmed the lower arbitration award in its entirety. The court also agreed with the findings of the Master Arbitrator and found that the record demonstrated a rational basis for the initial arbitrator's decision and that the award was justified.
Matter of Lam Quan, MD, PC v GEICO Gen. Ins. Co. (2024 NY Slip Op 00174)
January 16, 2024
The appellate Division, First Department, considered a case where petitioner-Appellant, Lam Quan, MD, PC, attempted to vacate a master arbitrator's award that affirmed a lower arbitrator's decision, which denied the petitioner's claims against GEICO General Insurance Company. The main issue was whether there were grounds to vacate the initial arbitration award, and the court unanimously affirmed the denial of the petition, stating that the initial arbitration decision was reached in a rational manner and was not arbitrary, capricious, or incorrect as a matter of law. The court emphasized that the fact that the arbitrator followed First Department precedent rather than Second Department precedent did not warrant reversal. Additionally, the court ruled that Quan's argument regarding the wage offset and attorneys' fees were unpreserved and unavailing. The holding of the court was the affirmance of the denial of the petition, without costs.
John T. Mather Mem. Hosp. v American Tr. Ins. Co. (2024 NY Slip Op 24009)
January 12, 2024
The court in the present case considered a special proceeding pursuant to CPLR 7502 and 7510 for confirmation of a No-Fault Insurance master arbitration award in favor of John T. Mather Memorial Hospital, a medical provider, against American Transit Insurance Company. The main issues decided were whether the master arbitration award should be confirmed, whether an attorney's fee should be awarded to the petitioner, and whether the respondent was entitled to costs and disbursements. The court held that the master arbitration award in favor of the hospital was confirmed, and the hospital was awarded the principal amount, interest, attorney's fees, and return of the filing fee as determined in the arbitration hearing. The court denied the hospital's request for an attorney's fee in connection with the petition to confirm, and awarded costs and disbursements to the respondent. The court also clarified that the purpose of the Article 75 proceeding was to obtain a judgment for the hospital to levy upon the respondent's assets to enforce the award, rather than being in the nature of an appeal.
JSJ Anesthesia Pain Mgt., PLLC v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 50064(U))
January 12, 2024
The court considered an appeal from an order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint on the grounds that the policy limits had been exhausted and denying the plaintiff's cross-motion for summary judgment. The main issue was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the order was modified to deny the defendant's motion for summary judgment dismissing the complaint. Therefore, the order was affirmed without costs.