No-Fault Case Law

The court considered the fact that the defendant had previously paid four of the claims involved in the action, and that the remaining six claims were denied because the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). The main issue decided was whether the denial of the remaining six claims due to the plaintiff's failure to appear for the EUOs was valid. The holding of the case was that the defendant had shown prima facie entitlement to summary judgment on the branch of the motion seeking dismissal of the six claims, as the denial of claim forms had been timely mailed and the EUO scheduling letters had also been timely mailed. The court reversed the lower court's order and granted the defendant's motion for summary judgment dismissing the complaint.

The court considered an appeal from an order of the Civil Court that granted the defendant's motion to vacate a judgment entered upon the defendant's failure to appear or answer the complaint, and to compel the plaintiff to accept the defendant's answer. The main issue decided was whether the defendant, in seeking to vacate the default and compel the plaintiff to accept an untimely answer, had shown a reasonable excuse for the default and the existence of a potentially meritorious defense. The holding of the case was that since the defendant failed to demonstrate both a reasonable excuse for its default and a meritorious defense, the defendant's motion to vacate the judgment and compel the plaintiff to accept the answer was denied. Therefore, the order granting the defendant's motion was reversed.

The relevant facts considered by the court in Unitrin Advantage Ins. Co. v Dowd include defendant's failure to appear for an examination under oath (EUO) requested by the insurance company after a claim was made for benefits related to a shoulder surgery performed on a passenger of a vehicle involved in an accident. The main issue decided by the court was whether the failure to appear for the EUO, which was requested in a timely manner, was a breach of a condition precedent to coverage, thus voiding the insurance policy. The holding of the court was that the failure to appear for the EUO constituted a breach of a condition precedent to coverage, and therefore voided the policy ab initio. As a result, the court reversed the lower court's order, denied the defendant's motion for summary judgment, and granted the plaintiff's cross motion for summary judgment.

"]). Defendant, having made a prima facie showing that plaintiff failed to appear at the EUOs as scheduled, was entitled to summary judgment. In opposition, plaintiff failed to raise a triable issue of fact. Therefore, defendant's motion for summary judgment was granted for the first cause of action so much as it sought to recover the assigned first-party no-fault benefits, plus interest, and the second cause of action so much as it sought to recover the first-party no-fault benefits arising from the March 9, 2017 claim. Plaintiff's cross motion for partial summary judgment was denied.

The court considered the Defendant's motion for summary judgment seeking dismissal of the Plaintiff's complaint on the ground that workers' compensation insurance was primary and thus barred the Plaintiff's claim for no-fault benefits. The main issue decided was whether the court had jurisdiction to determine the applicability of the Workers' Compensation Law or if it should be resolved by the Workers' Compensation Board. The court held that it was inappropriate for the courts to express views on the applicability of the Workers' Compensation Law pending determination by the board. Therefore, the court held the Defendant's motion for summary judgment in abeyance pending a determination by the Workers' Compensation Board on the applicability of the law to the case. The parties were ordered to advise the court of the status of any determination by the Workers' Compensation Board by a specified date.

The relevant facts that the court analyzed included the plaintiff's lawsuit against the defendant insurance company to recover unpaid first-party No-Fault benefits for medical services provided to the plaintiff's assignor. The defendant insurance company moved for summary judgment seeking dismissal of the plaintiff's complaint on the ground that the plaintiff failed to attend scheduled Examinations Under Oath (EUO). The main issues decided by the court included the timeliness of the defendant's payment or denial of the claims, the plaintiff's objections to the EUO requests, and the plaintiff's improper pleading of claims for attorneys' fees based on each individual bill in its respective causes of action. The holding of the case was that the defendant's motion for summary judgment was granted to the extent of dismissing most of the plaintiff's causes of action based on the failure to attend scheduled EUOs, such as the second, third, fourth, fifth, sixth, eighth, ninth, tenth, eleventh, thirteenth, fourteenth, seventeenth, eighteenth, nineteenth, twentieth, twenty-first, and twenty-second causes of action. However, the motion was denied regarding the first, seventh, and fifteenth causes of action to recover specific bills for medical services, and the sixteenth cause of action to recover attorneys' fees. The court ordered the first, seventh, and fifteenth causes of action to proceed to trial only on the issue of the amount of statutory interest, and the sixteenth cause of action to proceed to trial for attorneys' fees.

The relevant facts considered in this case were that the plaintiff had commenced an action in 2015 to recover assigned first-party no-fault benefits, and the defendant had failed to appear in the action, resulting in a default judgment. The defendant then served an answer by mail and moved to dismiss the complaint on the grounds of lack of jurisdiction, or in the alternative, to vacate the default judgment, extend the defendant's time to answer, and compel the plaintiff to accept the answer. The main issue decided by the court was whether the defendant's motion to dismiss the complaint for failure to prosecute under CPLR 3216 was valid. The holding of the court was that the defendant failed to satisfy a statutory precondition to dismissal of the complaint, as the motion to dismiss was made before the expiration of one year after the court had deemed the defendant's answer served. Therefore, the court reversed the order and denied the defendant's motion to dismiss the complaint.

. In this proceeding, Allstate Insurance Company, as subrogee of Martin Quirk, sought to confirm an arbitration award in the amount of $24,500. This is for a claim arising out of a motor vehicle accident that occurred on February 20, 2019. The State of New York, also known as Office of General Services of the State of New York, sought to vacate the award on the ground that the arbitrators exceeded their authority. The main issue to be decided in the case was whether Allstate Insurance Company was entitled to recoup the $24,500 it paid to Mr. Quirk under its OBEL coverage. The holding of the case was that the arbitration award was confirmed in favor of Allstate, as they were entitled to recover the $24,500 under Insurance Law. The State did not demonstrate that the arbitrators exceeded their authority, so the award was confirmed.

The court considered the request for post-examination under oath (EUO) additional verification as an issue of fact for trial. Defendant claimed that the request was valid under the no-fault rules as a matter of law and that the court misapprehended the law when it reserved for trial the question of the reasonableness of these additional verification requests. Plaintiff argued that the substance of the additional requests was improper and an abuse of the verification process, placing an improper onus on the provider to supply documents outside the scope of the claim verification process. The court ultimately granted reargument but denied defendant's motion, ruling that the reasonableness of defendant's post-EUO request for additional verification remained an issue of fact for trial. The court also emphasized that its decision did not constitute a substantive ruling on the merit of defendant's Mallela defense, but was based on adherence to claim verification procedures laid out in the no-fault rules.

The court considered the fact that the Plaintiff sued the Defendant insurance company to recover unpaid No-Fault benefits for medical services provided to the Plaintiff's assignor. The Defendant moved for summary judgment dismissing the complaint on the ground that the Plaintiff failed to attend scheduled Examinations Under Oath (EUO). The main issue decided was whether the Defendant established a prima facie case for dismissing the complaint, and the holding was that the Defendant's motion for summary judgment was granted and the Plaintiff's complaint was dismissed. The court found that the Defendant presented admissible evidence of the Plaintiff's failure to attend scheduled EUOs and timely denial of the claims, and the Plaintiff did not present contrary evidence to raise factual issues requiring a trial. Therefore, the court held that the Defendant proved there was no material issue of fact and the controversy could be decided as a matter of law.