No-Fault Case Law

The court considered the issue of whether State Farm Mutual Automobile Insurance Company had failed to establish that the arbitrator's award for its compulsory arbitration of a no-fault claim was not based on the evidence and was arbitrary and capricious. The court also considered the issue of whether State Farm had failed to establish that the arbitrator exceeded his power or so imperfectly executed it regarding its uninsured motorist claim. The court held that State Farm failed to establish either of these claims and therefore, its petition to vacate the awards was properly denied. Additionally, the court did not address Travelers Insurance Company's cross petition to confirm the awards, as it had not been cross-appealed.

The main issues in the case were whether the plaintiff was entitled to recover for medical services provided to its assignor under the No-Fault Law, and whether the defendant's denial of the claims based on an affirmed peer review report submitted by its doctor was justified. The court considered the claim forms, denial of the claims, and the affirmed peer review report in making its decision. The court held that the plaintiff's prima facie showing was opposed by the affirmed medical report, which raised a triable issue of fact. It was determined that the defense of lack of medical necessity could be based on a sufficiently detailed peer review report, as implicitly provided by Insurance Regulation 11 NYCRR 65-3.8 (b) (4), and that the defendant's timely denial of the plaintiff's no-fault benefits claim was justified based on the file-based peer review. Therefore, the order denying the plaintiff's motion for summary judgment was affirmed.

The court considered a case in which a medical supply company was seeking first-party no-fault insurance benefits from an insurance company. The insurance company objected to the claim on the basis that the prices of the medical equipment provided exceeded the prevailing rates in the geographic location. The main issue decided was whether the regulation permitting reference to prevailing fees in the geographic location applied, or whether the 150 percent limitation on fees under the Insurance Department regulation was applicable. The court held that the 150 percent rule was an applicable fee schedule within the contemplation of the regulation, and that it represented a legislative determination to help contain the no-fault premium. Therefore, the court reversed the order denying the medical supply company's motion for summary judgment, granted the motion, and remanded the matter to the lower court for the calculation of statutory interest and an assessment of attorney's fees.

The court considered the fact that this was a case to recover first-party no-fault insurance benefits, where the defendant insurer objected to the plaintiff's claim for medical equipment on the grounds that the supplier's prices exceeded the prevailing rates for such equipment in its geographical location. The main issue decided was whether the defendant insurer's objection to the claim was valid and whether the plaintiff's motion for summary judgment should be granted. The court held that as the defendant preserved no other proper defense to the action, the plaintiff's motion for summary judgment should have been granted. The matter was remanded to the court below for the calculation of statutory interest and an assessment of attorney's fees.

The relevant facts considered by the court include service of summons being made in Suffolk County, which was followed by a notice of motion being sent to the defendant at a Nassau County address. The court also considered several previous cases involving similar situations. The main issues decided were the validity of serving the summons outside Nassau County due to the defendant's offices being located within Nassau County, and whether there was a jurisdictional basis for service. The holding of the case was that service upon the defendant in Suffolk County was prohibited under UDCA 403 and 404 because the defendant had offices in Nassau County. Therefore, the case was dismissed without prejudice to be renewed upon service authorized by UDCA 403.

The plaintiffs in the case sought to recover $4,643.74 in first-party no-fault benefits. They sought summary judgment on their claims. They argued that they were not obligated to prove the medical necessity of the treatments for their motion for summary judgment. Defendants argued that plaintiffs needed to prove medical necessity. The court decided that no-fault benefits claimants do not have to prove the medical necessity of treatment at the claim stage or for their motion for summary judgment. The court also held that the defendant had waived nearly all objections and defenses related to the adequacy of proof of the claims and to their propriety. An assessment of statutory interest and attorney's fees was ordered for the portion of the claim for which summary judgment was sought, and the case was remanded for further proceedings.

The relevant facts in the case were that Bruce Campbell, Jr. was driving a vehicle insured by Metropolitan Property and Casualty Insurance Company. After the vehicle stalled, Campbell pushed it to a safer spot, turned on its hazard flashers, locked the doors, and walked home. Approximately 15 minutes later, he returned in another vehicle and attempted to jump start the disabled car. Campbell then locked the vehicle again and went to a friend's home in order to get someone to tow the disabled vehicle. When he was heading back to the vehicle, he was informed that two snowmobiles had collided with the disabled car and Robert J. Trentini, who was operating one of those snowmobiles, was injured. The main issue was whether the disabled vehicle was considered in "use or operation" at the time of the accident, thus permitting Trentini to recover no-fault benefits. The court decided that because Campbell was involved in an "on-going activity relating to the vehicle," the vehicle was in use at the time of the accident, and therefore, Trentini was entitled to no-fault benefits.

The main issues considered in this case were whether attorney Amos Weinberg rightfully represented all of the plaintiffs involved in the action to recover first-party no-fault benefits from defendant Countrywide Insurance Company, as well as whether Dr. Abraham had the authority to act on behalf of the other plaintiffs. The court found that both attorney Amos Weinberg and Dr. Jamil Abraham engaged in sanctionable conduct and that their actions were considered completely without merit in law and could not be supported by a reasonable argument for an extension or modification of existing law. The court found that Weinberg abdicated his responsibility as an officer of the court and permitted a number of meritless and baseless actions to go forward while Abraham covered up important information regarding the bankruptcy and death of one of the plaintiffs. As a result, the court dismissed their claims and awarded sanctions against both parties. Both Weinberg and Abraham each had to pay $3,000 along with paying for the defendant's legal fees, with Weinberg submitting his payment to the Lawyers' Fund for Client Protection and Abraham depositing the same with the clerk of the court for transmittal to the Commissioner of Taxation and Finance.

The court considered the fact that the plaintiff was seeking first-party no-fault benefits for health services provided to two individuals injured in an automobile accident, and that the defendant denied the claims for payment. The main issue decided was whether the defendant's denial of the claims was valid, as the plaintiff argued the claims were not timely denied as required by Insurance Law. The holding of the case was that the court affirmed the lower court's decision to deny the plaintiff's motion for summary judgment, as the defendant was able to rebut the plaintiff's prima facie case by showing that the plaintiff did not submit completed proof of claim and did not timely respond to requests for verification. The defendant also raised an additional issue of fact regarding fraud in the claim, further supporting the denial of the motion for summary judgment.

The court considered the defendant insurer's motion for summary judgment to dismiss the complaint in a lawsuit to recover payments for medical services rendered under No-Fault. The main issues decided were the validity of the complaint, the authorization of the individual physicians named as plaintiffs, and the obstruction of discovery by one of the plaintiffs. The court held that the verification of the complaint was defective, but that the defendant failed to act with due diligence to treat it as a nullity. It was also held that the causes of action pertaining to Drs. Schur, Casson, and Choi should be dismissed due to lack of authorization by their counsel. Additionally, the court granted the motion to dismiss the causes of action asserted by Dr. Abraham due to willful obstruction of discovery.