No-Fault Case Law

In this case, the court considered relevant facts pertaining to the failure of the plaintiff, a chiropractic provider seeking to recover no-fault benefits, to appear for duly scheduled examinations under oath (EUOs). The main issue was whether the plaintiff's absence justified the defendant's motion for summary judgment, which sought to dismiss the complaint on these grounds. The court found that the attorney's affirmation regarding the plaintiff's failure to appear was sufficient evidence to establish this absence, noting that the attorney was present and prepared to conduct the EUOs. The court determined that there was no merit to the plaintiff's contention that the attorney's memory of the events was questionable. As a result, the court affirmed the lower court's order granting the defendant's motion to dismiss the complaint.

In this case, the court considered the facts surrounding a provider's attempt to recover assigned first-party no-fault benefits after the defendant, Progressive Insurance Co., moved for summary judgment on the grounds that the plaintiff's assignor had materially misrepresented where the insured vehicle was garaged. The main issues involved whether the defendant had timely denied the claims based on these misrepresentations, which could affect its ability to assert this defense in court. The court determined that the defendant's failure to establish timely denial of the claims meant that it could not rely on the misrepresentation defense, ultimately leading to a reversal of the lower court's order and a denial of the defendant's motion for summary judgment. The decision underscored the importance of timely denial in asserting defenses related to misrepresentation.

In this case, the court considered the relevant fact that the plaintiff, a chiropractic provider seeking to recover no-fault insurance benefits, failed to appear for scheduled examinations under oath (EUOs). The main issue was whether the defendant, State Farm Insurance Company, was entitled to summary judgment dismissing the complaint due to the plaintiff's absence during these EUOs. The court found that the attorney representing the defendant provided adequate affirmation confirming that the plaintiff did not appear, thus validating the defendant's claim. Consequently, the court affirmed the lower court's order granting summary judgment to State Farm, rejecting the plaintiff's argument regarding the attorney's recollection of events as without merit.

In this case, Integral Medical Supply Corp. sought to recover assigned first-party no-fault benefits from Progressive Insurance Co., which had moved for summary judgment to dismiss the complaint based on allegations that the assignor misrepresented the location where the vehicle was garaged. The court noted that a defense based on misrepresentation is subject to preclusion if the insurer fails to demonstrate that it timely denied the claim on that basis. The court found that Progressive Insurance Co. did not timely deny the claims, thus failing to meet its burden of proof regarding the defense. Consequently, the court reversed the lower court's order and denied the insurance company's motion for summary judgment, allowing the case to proceed.

The court considered the defendant’s argument that the plaintiff, Burke Physical Therapy, failed to timely respond to verification requests as mandated by 11 NYCRR §65-3.5(o). The main issues were whether the plaintiff provided the requested verification within the required timeframe and whether any reasonable justification for the delay was offered. The court found that the plaintiff’s affidavits, which merely stated that documentation was mailed without corroborating evidence, were insufficient to raise a triable issue of fact. As a result, the court granted the defendant's cross-motion for summary judgment and dismissed the plaintiff's case with prejudice, affirming that the plaintiff did not comply with the necessary verification procedures.

The court considered the facts surrounding a no-fault insurance settlement that was agreed upon in December 2001, but not paid by the insurance company until a judgment was entered in February 2017, which awarded statutory no-fault interest based on a simple rate. The appellant argued that the interest should be recalculated at a compound rate, citing statutory provisions and prior case law. A major issue involved the delay in entering the judgment, which the lower court cited as a reason to deny the compound interest and toll the accrual of that interest. The appellate court held that the lower court erred in tolling the statutory no-fault interest and ruled that the plaintiff was entitled to compound interest as a result of the settlement, remanding the case for the entry of a new judgment that reflected this decision. The appellate court emphasized that the insurance company did not deny the settlement agreement and failed to challenge the previous judgment.

The court considered several key facts, including that the claimants asserted they were passengers in a vehicle involved in an accident on January 9, 2022, and intended to submit no-fault insurance claims. However, the claimants did not respond to the lawsuit, leading the court to grant a default judgment against them. The plaintiff, Unitrin Safeguard Insurance Company, provided evidence that the injuries did not arise from the accident, which included an investigator's affidavit detailing the incident and testimony from occupants of the other vehicle who described the accident as minimal and indicated no visible injuries or damage. The main issues decided included whether the claims were valid based on the circumstances of the accident and the credibility of the claimants’ accounts, ultimately concluding that the claimants' lack of a plausible and supported claim negated any duty to pay. The court held that the plaintiff had no obligation to cover the no-fault claims submitted by the medical providers, confirming the summary judgment in favor of the plaintiff.

In this case, the court considered the issue of whether separate arbitral awards could be treated as a single award for the purposes of establishing subject matter jurisdiction under Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii). The relevant facts included four distinct arbitral awards issued in favor of the defendant, Comfort Choice Chiropractic, for chiropractic services provided to a single individual, each award being less than the $5,000 threshold required for de novo review in court. The main issue was whether the court could aggregate these separate awards to meet the jurisdictional threshold. The court held that the plain language of the statutes did not allow for such aggregation, stating that each award must independently meet the $5,000 requirement. Consequently, the court reversed the lower court's order, dismissed the complaint due to lack of jurisdiction, and granted an award of reasonable attorney's fees to the defendant.

The court considered the arbitration award issued in favor of Comfort Choice Chiropractic, P.C. on February 11, 2022, and the subsequent proceeding initiated by American Transit Insurance Company to vacate that award. The main issues decided included Comfort Choice's request for attorney's fees in connection with enforcing the arbitration award, as specified under 11 NYCRR 65-4.10(j)(4). The Appellate Division reversed the lower court's decision that denied Comfort Choice's cross-motion for attorney's fees and granted that request, ordering the case be remitted to the Supreme Court for a determination of the reasonable attorney's fees owed to Comfort Choice. The ruling reinforced the entitlement to attorney's fees under the specified regulation when a valid claim for no-fault benefits is overdue.

In this case, Burke 2 Physical Therapy, P.C. appealed a Civil Court order that dismissed its complaint seeking no-fault benefits from State Farm Mutual Automobile Insurance Company. The court considered the legitimacy of State Farm's verification requests, which aimed to determine the provider's eligibility for benefits based on licensing requirements, as established by prior case law. The main issues were whether State Farm's requests for documentation were proper and whether the plaintiff's cross-motion for summary judgment and separate motion to dismiss affirmative defenses should have been granted. Ultimately, the court held that State Farm's verification requests were appropriate and affirmed the dismissal of the plaintiff's complaint, denying the plaintiff’s motions as lacking merit.