No-Fault Case Law

The court considered a case where the claimant sought supplemental underinsured motorist (SUM) benefits from Transcontinental Insurance Company (CNA) after being injured as a passenger in a van insured by CNA. The claimant fractured her femur in an accident involving the van, and CNA argued that the injury was not caused by the accident but rather by a subsequent fall on ice. The main issue was whether the claimant's injury was proximately caused by the insured vehicle, which would determine her eligibility for SUM benefits. The court held that the claimant's injuries were indeed proximately caused by the collision involving the van, and therefore she was entitled to proceed to arbitration for her SUM claim. The court found that CNA had not met its burden of proving that the injury was not caused by the insured vehicle, and directed the parties to proceed to arbitration.

The court considered the prima facie evidence submitted by A.B. Medical Services PLLC to establish their entitlement to partial summary judgment. The main issue decided was whether the insurance company, Liberty Mutual, had provided timely payment or denial of claims. The holding of the court was to reverse the order denying partial summary judgment and to grant the motion by A.B. Medical Services PLLC for partial summary judgment in the sum of $4,410.22. The matter was also remanded to the court below for the calculation of statutory interest and an assessment of attorney's fees due thereon pursuant to Insurance Law § 5106(a) and the regulations promulgated thereunder, and for further proceedings on its remaining claims. The appeal by plaintiffs Lvov Acupuncture P.C. and Somun Acupuncture P.C. was unanimously dismissed. The court also noted discrepancies in the NF-10 "Denial of Claim" form submitted by both parties, and one judge dissented, stating that the case should be remanded for further investigation due to the disturbing discrepancies found.

Nyack Hospital appealed an order denying its motion for summary judgment on its claim for statutory interest and an attorney's fee, and granting the defendant, Encompass Insurance Company, summary judgment dismissing the complaint. Nyack Hospital had made evidentiary proof that the prescribed billing forms were mailed and received and that payment of no-fault benefits was overdue when made. Encompass Insurance Company waived any defense based on the lack of a valid assignment, and letters from the company stating that payment was delayed pending investigation did not toll the 30-day statutory period for paying or denying the claim. The court held that the hospital was entitled to summary judgment on its claim for statutory interest and an attorney's fee, reversing the order of the lower court and remitting the matter to calculate the amount due to the hospital.

The relevant facts the court considered in this case were related to a dispute over first party no-fault benefits for medical services rendered to patients of the plaintiff health care providers. The main issue was whether the plaintiff providers were entitled to summary judgment for unpaid claims, and whether the insurance company could require the patients to submit to examinations under oath. The court held that the plaintiff providers were entitled to summary judgment in the amount demanded in the complaint, as they had submitted claims and payment was overdue. The court also held that the insurance company could not require the patients to submit to examinations under oath, as the insurance policy did not contain the necessary endorsement authorizing such examinations. Therefore, the insurance company could not rely on revised regulations to argue that the plaintiffs had vitiated coverage by failing to comply with a condition precedent, and the decision was in favor of the plaintiffs.

The relevant facts considered by the court in this case include the plaintiff, First Help Acupuncture, P.C., seeking to recover first-party No-Fault benefits in the amount of $3,000.00 for healthcare services allegedly rendered to its assignor, Zach Glot. The main issue is whether the plaintiff has made out a prima facie case for summary judgment by submitting sufficient evidence in admissible form, and whether the affidavit of the plaintiff's employee and the affirmation of the plaintiff's attorney laid a proper foundation for admissibility of plaintiff's exhibits. The holding of the court was that the plaintiff's motion for summary judgment was denied, as the plaintiff had failed to make out its prima facie case due to deficiencies in the supporting affidavit, and therefore was not entitled to summary judgment. The court also noted that the plaintiff's attorney's affirmation lacked probative value and was insufficient to support an award of summary judgment.

The court considered the motion brought seeking partial summary judgment in the principal sum of $4,575.44 based on some claims made by plaintiff health care provider A.B. Medical Services PLLC. The main issue decided was whether the plaintiff had established a prima facie entitlement to summary judgment by proof that it submitted claims setting forth the fact and the amounts of the losses it sustained, and that payment of no-fault benefits was overdue. The holding of the court was that plaintiff A.B. Medical Services PLLC is awarded partial summary judgment in the principal amount of $4,575.44, and the case is remanded for the calculation of statutory interest and attorney's fees thereon, as well as for all further proceedings on the remaining claims. The appeal as taken by the other plaintiffs was dismissed since they lack an interest in the specific sums in controversy upon the appeal.

The court considered whether the plaintiffs, A.B. Medical Services PLLC, D.A.V. Chiropractic P.C., and Daniel Kim's Acupuncture P.C., were entitled to summary judgment in their case against Encompass Insurance for failing to pay their no-fault benefits claims within the 30-day period. The court held that the plaintiffs established a prima facie entitlement to summary judgment, as it was uncontroverted that the defendant failed to pay or deny the claims within the required timeframe, precluding them from raising most defenses. The court also determined that the defendant's failure to seek verification of the assignments and to allege any deficiency in the assignments constituted a waiver of any defenses. However, the defendant could still assert a lack of coverage defense on the ground that the alleged injuries were not causally related to the accident, but their submissions were insufficient to demonstrate the insurer's defense was based on a "founded belief." Therefore, the motion for summary judgment by the plaintiffs was granted, and the matter was remanded for the calculation of statutory interest and attorney's fees. The appeal with respect to Somun Acupuncture P.C. was dismissed.

The court considered the fact that the plaintiff, a New York resident, had been involved in an accident in Queens and sought to recover under the uninsured motorist endorsement of his automobile policy issued in Virginia. The main issue decided was whether the plaintiff was required to prove "serious injury" as defined by New York law, as the policy was issued in Virginia. The holding of the case was that the law of New York should be applied, and the plaintiff was required to demonstrate that he sustained a "serious injury." The court affirmed the denial of the plaintiff's motion to dismiss certain affirmative defenses, stating that the New York courts should apply the "serious injury" requirement, as strong policy considerations underlie it and the accident location and situs of the loss or injury were in New York.

The court considered the fact that plaintiff provided medical services to its assignor and submitted claims to the defendant insurer seeking first-party no-fault benefits. The main issue decided was whether the defendant insurer was obligated to pay or deny a claim when the plaintiff and its assignor failed to respond to timely requests for additional verification. The holding of the court was that the defendant insurer established its entitlement to summary judgment dismissing the complaint, as it was not obligated to pay or deny a claim until requested verifications were provided. The court found that the plaintiff and its assignor failed to respond to the defendant's timely requests for additional verification, making any claim for payment premature. Therefore, the defendant was not required to respond to the plaintiff's claims, and the claim for payment was not valid.

The court considered the plaintiff's action to recover first-party no-fault benefits for medical services rendered to its assignor, as well as the defendant's motion for summary judgment on the grounds that the claims were not overdue and the action was premature. The main issues decided were whether the defendant failed to pay or deny the claims within the statutory 30-day period as required by Insurance Law section 5106(a), and whether the defendant's verification requests were timely sent to the plaintiff. The court held that the defendant's motion for summary judgment was denied, and that the plaintiff's cross-motion for summary judgment was granted, awarding judgment in favor of the plaintiff in the amount of $759.00, together with statutory interest and attorney's fees.