No-Fault Case Law

The court considered the fact that a claim for first-party no-fault benefits was submitted by the plaintiff and the statute of limitations for first-party no-fault claims is six years. The main issue decided was whether the plaintiff should be granted leave to amend to add a new party, Knightbrook Insurance Company, to the action and remove Grange Mutual Casualty Ins. Co. as a defendant. The court held that the plaintiff's motion to amend should be denied because the amendment to add a party fell outside of the statute of limitations, and the plaintiff failed to demonstrate notice to, nor that the statutory prerequisites have been met with the new party. The court also held that the plaintiff failed to satisfy the three-part test for the application of the relation-back doctrine, and did not establish diligent efforts were made to ascertain the unknown party's identity prior to the expiration of the statute of limitations. Therefore, the Motion to Amend was denied.

The court considered the facts of several no-fault insurance cases filed by plaintiffs against the New York State Insurance Fund (Defendant) and found that default judgments had been entered against the Defendant in each case. The main issue decided was whether the court had subject matter jurisdiction to entertain the plaintiffs' actions against the Defendant. The court granted the Defendant's motions to vacate the default judgments and to dismiss the breach of contract matters against the Defendant without prejudice, stating that the Civil Court did not have subject matter jurisdiction to render the judgments. Furthermore, the court denied the Defendant's application for sanctions against the Plaintiffs' counsel and enjoined the Plaintiffs and their counsel from commencing any future similar actions or proceedings seeking relief from the Defendant in the Civil Court without a determination from the Appellate Term.

The court considered the facts of the case, which involved a pharmacy seeking reimbursement of No-Fault benefits from an insurance company. The insurance company had previously filed a declaratory action in the New York Supreme Court and obtained an order declaring that they had no obligation to cover the No-Fault claims for the pharmacy. The main issue before the court was whether the pharmacy's action seeking reimbursement was barred by res judicata and collateral estoppel, based on the order issued by the Supreme Court. The court held that the insurance company's motion to dismiss the action was granted, as they had properly preserved their defenses, a declaratory judgment order was issued regarding the claim, and that order had preclusive effect given the identity of issues and parties. Therefore, the court dismissed the pharmacy's complaint with prejudice.

The court considered the facts of the case to be about a dispute over unpaid first party No-Fault benefits for medical services provided to the plaintiff's assignor, as well as other charges, totaling $2,330.56. The main issues related to the timing of requested Examinations Under Oath (EUO), with the defendant seeking dismissal of the plaintiff's complaint due to the plaintiff's failure to attend scheduled EUOs. The court held that an EUO request letter constitutes "additional verification" and must be sent within fifteen business days of receipt of claims, and that transmission of an EUO request letter within thirty calendar days of receiving a claim for No Fault benefits tolls an insurer's time to pay or deny such claim, as long as the delay does not exceed the thirty days. The court ultimately granted the defendant's motion for summary judgment, dismissing the plaintiff's complaint, and denied the plaintiff's cross-motion for summary judgment.

The court considered the facts that New Millennium Medical Imaging, P.C. (New Millennium) sought to recover no-fault benefits for medical services provided to assignors injured in an automobile accident on August 13, 2011. However, Repwest Insurance Company (Repwest) had commenced a declaratory judgment action alleging no duty to pay benefits relating to an accident on August 12, 2011. The main issue decided was whether res judicata barred New Millennium's action in the Civil Court after Repwest obtained a default judgment in the Supreme Court, New York County. The holding was that res judicata applied, barring the instant action, as the evidence established that the assignors sought coverage for injuries arising from an August 12, 2011 accident, and not from any accident on August 13, 2011. Therefore, the trial court's order was reversed and Repwest's motion for summary judgment dismissing the complaint was granted.

The court considered that the plaintiff, Alsaad Medical, P.C., sought payment of no-fault benefits for medical treatments for assignor Patronita Colon-Chavez under the defendant's insurance policy. The plaintiff had treated Colon-Chavez for injuries sustained in a motor vehicle accident and sought payment of $200.68 for the services provided. The defendant, State Farm Mutual Automobile Insurance Co., moved for summary judgment and dismissal of the action on the grounds that the plaintiff failed to appear for two scheduled Examinations Under Oath (EUOs) and, therefore, its claims for medical services were appropriately denied. The plaintiff argued that the EUO notices were defective and that its submissions, objecting to the EUOs, obviated the need to appear. In its decision, the court granted the defendant's motion for summary judgment and dismissed the action, while denying the plaintiff's cross-motion for summary judgment on the grounds that more than 30 days had elapsed since submitting its claims and the defendant had failed to pay them. The court also noted that pursuant to the No-Fault Law, entitlement to no-fault benefits requires compliance with all conditions precedent, including the timely submission of written proof of claim. Therefore, the defendant was authorized to deny the claim due to the plaintiff's failure to comply with these requirements.

The court considered the fact that the plaintiff, Burke 2 Physical Therapy, P.C., submitted bills for treatment to the defendant, State Farm Mutual Automobile Insurance Co., after the insured, Sang, was in a motor vehicle accident. Despite acknowledging receipt of the claims, State Farm issued several verification requests and denials of the claims. The main issue decided was whether State Farm's verification requests were proper, timely, and justified, and if Burke was in compliance with providing the requested verification. The court held that State Farm's verification requests were proper, timely, and justified, and that Burke failed to comply with providing the requested verification, leading to the dismissal of the plaintiff's complaint and the grant of State Farm's motion for summary judgment.

The relevant facts considered by the court included the filing of a summons and complaint by a provider to recover assigned first-party no-fault benefits in Civil Court, Kings County, which indicated that the matter was to be heard in Civil Court, Queens County. The defendant served an answer and allegedly filed it in Queens County. The plaintiff then moved for a default judgment, which was granted, and a judgment was entered. The defendant then moved to vacate the default judgment and dismiss the complaint, arguing that the Civil Court, Kings County, did not have jurisdiction over the matter. The Civil Court granted the motion, vacated the default judgment, and dismissed the plaintiff's complaint as "fatally defective." The main issue decided by the court was whether dismissal of the complaint was the proper remedy upon the vacatur of the default judgment, or if the plaintiff should have been permitted to correct its error pursuant to CPLR 2001. The holding of the court was that the plaintiff's argument that it should have been afforded an opportunity to amend the complaint pursuant to CPLR 2001 was unpreserved for appellate review, as the plaintiff failed to raise the issue in opposition to the defendant's motion. Therefore, the order, insofar as appealed from, was affirmed.

The relevant facts considered in this case were that State Farm Mutual Automobile Insurance Company submitted evidence of the defendants' defaults after proper service, as well as an affidavit of its no-faults claims representative setting forth the basis for its claims seeking a declaration of noncoverage in connection with a June 1, 2018 accident. By failing to answer the complaint, the defaulting defendants were deemed to have admitted the allegations, including that the accident was intentional and staged. Also, State Farm's claims representative's affidavit and red flags raised by defendant Walton's testimony supported the company's belief. The main issue decided was whether the company was entitled to a declaration that it was not obligated to defend or indemnify the owner of the insured vehicle, or the driver, or to provide no-fault coverage to any of the claimants in connection with the accident. The holding of the case was that the motion for a default judgment was granted in its entirety and it was declared that State Farm was not obligated to provide coverage for the accident.

The relevant facts that the court considered in this case included the circumstances surrounding responses to verification requests regarding MRI films sent in response to claims for no-fault benefits. Defendant in the case moved for summary judgment to dismiss the complaint, arguing that the action was premature as plaintiff had not provided the MRI films demanded. The issue decided by the court was whether the toll on the insurer's time to pay or deny a claim ends when the provider responds that the films will be sent only after the insurer reimburses the provider for the reproduction costs of those films. The court's holding was that the action was in fact premature, and the plaintiff had not complied with the verification requests to provide MRI films, and the insurer was not required to pay the reproduction costs to receive the films. Therefore, the action was dismissed as premature.