No-Fault Case Law
November 20, 2023
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.
Matter of New Millennium Pain & Spine Medicine, P.C. v Progressive Cas. Ins. Co. (2023 NY Slip Op 05369)
October 24, 2023
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.
October 11, 2023
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.
October 10, 2023
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.
October 6, 2023
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.
October 5, 2023
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.
September 22, 2023
The relevant facts considered by the court in this case included a provider's attempt to recover assigned first-party no-fault benefits, and a motion for summary judgment granted by the defendant on the grounds that the plaintiff's claim was submitted more than 45 days after the subject service had been rendered. The main issue decided was whether the plaintiff's claim was submitted in a timely manner, and whether there was a triable issue of fact as to that issue. The holding of the case was that while the defendant had made a prima facie showing that the plaintiff did not timely submit the claim, the affidavit submitted by the plaintiff in opposition to the motion was sufficient to raise a triable issue of fact. Therefore, the defendant's motion for summary judgment dismissing the complaint was denied and the plaintiff's cross-motion for summary judgment was properly denied.
September 22, 2023
The court considered the case of Heaven & Earth Acupuncture, P.C. appealing the order of the Civil Court which granted the insurance company's motion for summary judgment dismissing the complaint and denied plaintiff's cross-motion for summary judgment. The main issue decided was whether the insurance company had paid the limits of the policy in accordance with regulations and therefore was entitled to summary judgment dismissing the complaint. The holding of the court was that the insurance company failed to prove that it had made any payments under the policy and therefore did not make a prima facie showing of entitlement to summary judgment. The court also held that the plaintiff's cross-motion for summary judgment was properly denied as the affidavit submitted by the plaintiff failed to establish that the claims had not been timely denied or that the insurance company had issued timely denial of claim forms that were without merit as a matter of law. Ultimately, the court modified the order by providing that defendant's motion for summary judgment dismissing the complaint is denied.
September 22, 2023
The main issue in the case was whether the plaintiff, Absolute Medical Supplies, Inc., had submitted their claim for first-party no-fault benefits in a timely manner. The defendant, Unitrin Advantage Insurance Company, argued that the claim was submitted more than 45 days after the service was rendered, and therefore should be dismissed. The court considered the timing of the claim submission and whether there was a triable issue of fact. The holding of the case was that while the defendant had initially made a prima facie showing that the claim was not timely, the plaintiff's opposition raised a triable issue of fact. As a result, the court denied the defendant's motion for summary judgment dismissing the complaint and affirmed the order with modification.
September 11, 2023
The court considered the facts surrounding the plaintiff's lawsuit against the defendant insurance company for $2,114.99 in unpaid No-Fault benefits for medical services provided to the plaintiff's assignor after an automobile accident. The main issue in the case was whether the defendant's motion for summary judgment to dismiss the complaint on the ground that the plaintiff failed to provide additional documentary verification within 120 days was valid. The court held that the defendant's motion for summary judgment was denied, as the defendant failed to establish good cause for investigating the plaintiff's alleged noncompliance with licensing and incorporation statutes through admissible evidence. Additionally, the court denied the plaintiff's cross-motion for summary judgment, as the requested verification was still outstanding, and factual issues existed as to the plaintiff's eligibility to receive No Fault benefit payments.