No-Fault Case Law

The case of American Tr. Ins. Co. v Espinal involved a motion for summary judgment in a case where the plaintiff sought a declaration that they were not obligated to pay no-fault benefits to the defendant, Samuel O. Espinal. The defendant had timely filed opposition to the summary judgment motion in accordance with CPLR 2214 (b). However, the motion court had granted the plaintiff's motion on the ground that the defendant failed to submit opposition papers, without considering the merits of the motion. Therefore, the main issue decided was whether the matter should be remanded for the motion court to consider the merits of the summary judgment motion. The holding of the Appellate Division, First Department was that the matter should be remanded for further proceedings for the motion court to consider the merits of the summary judgment motion in the first instance.

The court considered an appeal from an order of the Civil Court that granted the defendant's motion for summary judgment dismissing the complaint in a case where a provider sought to recover assigned first-party no-fault benefits. The main issue was whether the plaintiff's affidavit submitted in opposition to the defendant's motion was sufficient to rebut the defendant's showing of a lack of medical necessity for the services at issue. The holding of the court was that the plaintiff's affidavit was insufficient to rebut the defendant's prima facie showing of a lack of medical necessity for the services at issue, and therefore affirmed the order granting the defendant's motion for summary judgment.

The relevant facts the court considered were that the plaintiff, Country-Wide Insurance Company, sought a declaratory judgment that it was not liable to pay no-fault benefits to medical-provider assignees due to the failure of the driver, Saquan Ware, to appear for scheduled independent medical examinations (IMEs). Country-Wide had requested the IMEs within the appropriate time frames as required by regulations and Ware had failed to appear for the examinations as scheduled. The main issue decided was whether Country-Wide timely requested Ware to appear for the IMEs, and the holding of the case was that Country-Wide had established that Ware failed twice to appear for properly scheduled IMEs, therefore voiding his insurance coverage ab initio and relieving Country-Wide from liability to pay the no-fault benefits. As a result, Country-Wide's motion for summary judgment was granted.

The relevant facts in this case involved a plaintiff suing an insurance company to recover unpaid first-party no-fault benefits for medical services provided to their assignor. The insurance company moved for summary judgment on the grounds that the assignor failed to appear for two independent medical examinations (IME). The main issue decided by the court was whether the insurance company had timely denied the plaintiff's claims based on the assignor's failure to attend the IMEs, which was a condition precedent to the insurer's liability on the policy. The court held that the insurance company presented sufficient evidence to demonstrate that it timely denied the plaintiff's claims based on the assignor's failure to attend the IMEs, and the plaintiff failed to raise factual issues requiring a trial. As a result, the court granted the insurance company's motion for summary judgment and dismissed the plaintiff's complaint.

The court considered a personal injury protection insurance claim in which the plaintiff sued the defendant for unpaid medical services provided to an individual injured in a car accident. The defendant moved for summary judgment, arguing that the plaintiff failed to provide additional documentary verification within the required time frame. In response, the plaintiff cross-moved for summary judgment on its claims against the defendant. The main issue decided by the court was whether the plaintiff's failure to provide requested verification within the required time frame warranted the dismissal of the plaintiff’s complaint and whether the defendant properly advised the plaintiff of the consequences for noncompliance. The court held that the defendant failed to establish its entitlement to summary judgment as there was a disputed issue of fact regarding the plaintiff's eligibility to receive insurance benefit payments. As a result, the court denied both the defendant’s motion for summary judgment and the plaintiff’s cross-motion.

The relevant facts the court considered included an action by a medical supplies provider to recover assigned first-party no-fault benefits. The defendant had granted the motion for summary judgment dismissing the complaint on the grounds that the plaintiff's assignor had failed to appear for scheduled independent medical examinations. The main issue decided by the court was whether the defendant had properly mailed the denial of claim forms in duplicate and whether the affirmation of the plaintiff's counsel in opposition to the defendant's motion was sufficient to raise a triable issue of fact. The holding of the case was that the defendant had properly mailed the denial of claim forms and that the affirmation of the plaintiff's counsel was insufficient to raise a triable issue of fact. Therefore, the court affirmed the order granting the defendant's motion for summary judgment.

The court considered the appeal from a judgment of the Civil Court of the City of New York, Kings County, which awarded the plaintiff, Adelaida Physical Therapy, P.C., the principal sum of $4,181.20 after a nonjury trial in a case involving a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the judgment should be reversed and the matter remitted to the Civil Court for the entry of a judgment in favor of the defendant, Lancer Insurance Co., dismissing the complaint. The holding of the court was that, for the reasons stated in a related case (JCC Med. P.C., as Assignee of Damis, Magalie v Lancer Ins. Co.), the judgment was reversed and the matter was remitted to the Civil Court for the entry of a judgment in favor of the defendant, dismissing the complaint.

The main issue in this case was whether the provider, New Way Medical Supply Corp., was entitled to recover assigned first-party no-fault benefits from Lancer Insurance Co. After a nonjury trial, the Civil Court of the City of New York, Kings County, entered a judgment in favor of New Way Medical Supply Corp., awarding them the principal sum of $3,048.40. However, on appeal, the Appellate Term, Second Department, reversed the judgment and remitted the matter to the Civil Court for the entry of a judgment in favor of Lancer Insurance Co., dismissing the complaint. The court's decision was based on the same reasoning as another related case, JCC Med. P.C., as Assignee of Damis, Magalie v Lancer Ins. Co. The holding of the case was that the judgment in favor of New Way Medical Supply Corp. was reversed, and the matter was remitted to the Civil Court for the entry of a judgment in favor of Lancer Insurance Co., dismissing the complaint.

The main issue decided in this case was whether the defendant, Lancer Insurance Co., timely mailed the examination under oath (EUO) scheduling letters and the denial of claim forms to the plaintiff, JCC Medical, P.C., in a first-party no-fault benefits claim. The court found that defendant established that the EUO scheduling letters were timely mailed to the plaintiff by first class mail, and despite not being mailed by certified mail, return receipt requested, their timeliness was established. Additionally, the testimony of the defendant's no-fault claims examiner was deemed sufficient to establish that the denial of claim forms were also timely mailed to the plaintiff. Based on these findings, the court reversed the judgment and remitted the matter to the Civil Court to enter a judgment in favor of the defendant dismissing the complaint.

The relevant facts considered by the court were that the plaintiff, Wellmax Products Corp, was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co as an assignee of Stephanie Crespo. The main issue decided was whether the verification requested by the defendant remained outstanding. The court held that after a nonjury trial, in which the testimony proffered by the defendant's witness was found to be credible, the Civil Court dismissed the complaint. The Appellate Term, Second Department affirmed the judgment, stating that the determination of a trier of fact as to issues of credibility is given substantial deference, and as the record supported the Civil Court's determination based on the assessment of the credibility of the witness, there was no basis to disturb the finding.