No-Fault Case Law

The court considered a case in which a medical provider was seeking to recover no-fault benefits for services provided to its assignor who was injured in a motor vehicle accident. The insurance company, the defendant, had obtained a default judgment in a declaratory judgment action in Supreme Court, New York County, which declared that the insurer had no duty to pay any no-fault benefits to the provider and its assignor arising out of the accident. The issue in the case was whether the medical provider's action was barred under the doctrine of res judicata due to the declaratory judgment obtained by the insurance company in a separate action. The court held that the medical provider's action was indeed barred by res judicata, and reversed the order denying the insurance company's motion for summary judgment, granting the motion instead.

The court considered the fact that the defendant insurance company appealed from an order of the Civil Court that denied their motion for summary judgment dismissing the complaint of the plaintiff, a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff's assignor failed to appear for duly scheduled examinations under oath (EUOs) and whether the defendant was entitled to summary judgment dismissing the complaint. The holding of the case was that the defendant insurance company was entitled to summary judgment dismissing the complaint, as they were able to demonstrate, as a matter of law, that they had twice duly demanded an EUO from the assignor, and that the assignor twice failed to appear. Consequently, the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint.

The court considered the fact that Restorative Chiropractic Solutions, PC brought a lawsuit against State Farm Mutual Automobile Ins. Co. to recover first-party no-fault benefits for medical services provided to its assignor, Lourdes Clyne. The main issue decided was whether the denials of the claims by State Farm Mutual Automobile Ins. Co. were timely and whether there was material misrepresentation in the procurement of the policy. The court held that while the bills were timely submitted and the denials were timely issued, there was an issue of fact as to whether the misrepresentation about the assignor's residence and garaging of the vehicle was material in the procurement of the insurance policy, indicating that the issues preserved for trial are the basis for the timely denials. The defendant’s motion for summary judgment and plaintiff’s cross motion were both granted.

The relevant facts considered by the court were that Physiodynamics, LLC was seeking to recover assigned first-party no-fault benefits from Allstate Ins. Co. A judgment was entered against Allstate on October 4, 2017 for failing to appear or answer the complaint. Allstate subsequently moved to vacate the default judgment. The main issue decided by the court was whether Allstate had a reasonable excuse for the default and the existence of a meritorious defense, as required by CPLR 5015 (a) (1) for vacating a default judgment. The court held that Allstate did not sufficiently allege a reasonable excuse of law office failure and therefore, their motion to vacate the default judgment should have been denied. The holding of the case was that the order granting Allstate's motion to vacate the default judgment was reversed, and the motion was ultimately denied.

In the case of RX Warehouse Pharm., Inc. v 21st Century Ins. Co., the plaintiff, RX Warehouse Pharmacy, Inc., sought to recover first-party no-fault benefits for services rendered to an injured party involved in a motor vehicle accident. Defendant 21st Century Insurance Company moved for summary judgment, arguing that the issue of providing no-fault coverage had been previously decided in a declaratory judgment action. The Supreme Court had previously granted 21st Century's motion for the entry of a default judgment, which the plaintiff argued was not applicable to them. The Civil Court ultimately denied 21st Century's motion and granted the plaintiff's cross motion for summary judgment, finding that the previous judgment did not conclusively determine a lack of coverage. The main issue decided in this case was whether the previous declaratory judgment action, in which 21st Century had been granted a default judgment, barred the plaintiff from seeking no-fault benefits for the injured party. The holding was that the previous default judgment in the declaratory judgment action did bar the plaintiff from seeking no-fault benefits, and therefore the defendant's motion for summary judgment was granted and the plaintiff's cross motion for summary judgment was denied.

The court considered a dispute over no-fault insurance benefits resulting from a motor vehicle accident. The plaintiff sought to recover $4,748.69 for treatment provided following the accident in April 2011, but the defendant argued that the benefits under the no-fault policy had been exhausted. The main issue decided was the requirement that an insurer pay or deny a verified claim within 30 days of receipt, as well as the insurer's obligation to pay benefits directly to providers of health care services. The holding of the court was that the defendant failed to establish its entitlement to judgment as a matter of law, as it did not submit the no-fault application, verification, any request for verification, or any denial associated with the plaintiff's claim for payment, and therefore there were remaining issues of fact as to when the claim was denied and the basis and efficacy of the denial.

The court considered the fact that the defendant had scheduled independent medical examinations (IMEs) of the plaintiff's assignor, and the assignor failed to appear for the duly scheduled IMEs. The main issue decided was whether the defendant had timely denied the claim based on the assignor's failure to appear for the IMEs, which was considered a condition precedent to the insurer's liability on the policy. The holding of the case was that the defendant had properly scheduled the IMEs and timely denied the claim, and therefore the motion for summary judgment dismissing the complaint was granted.

The relevant facts of the case were that PDG Psychological, P.C. sought to recover assigned first-party no-fault benefits from State Farm Mutual Insurance Co. State Farm moved to dismiss the complaint on the ground of laches, arguing that PDG Psychological, P.C. had delayed in prosecuting the action. The Civil Court granted State Farm's motion, but PDG Psychological, P.C. appealed the decision. The main issue decided by the court was whether the delay in prosecuting the action constituted laches. The holding of the case was that the order granting State Farm's motion to dismiss the complaint on the ground of laches was reversed. The court denied the branch of the motion seeking dismissal on the ground of laches and remitted the matter to the Civil Court for a determination of the remaining branch of State Farm's motion. The court also referenced a previous case, V.S. Med. Servs., P.C. v State Farm Mut. Ins. Co., to support its decision.

The court considered an action by a provider to recover assigned first-party no-fault benefits, including a motion by the defendant to dismiss the complaint on the ground of laches due to the plaintiff's delay in prosecuting the action. The Civil Court granted the defendant's motion, finding that the branch of the motion seeking to toll statutory no-fault interest was moot. On appeal, the Appellate Term reversed the decision, denying the branch of the defendant's motion seeking to dismiss the complaint on the ground of laches and remitting the matter to the Civil Court for a determination of the remaining branch of the defendant's motion. The holding of the case was that the branch of the defendant's motion seeking to dismiss the complaint on the ground of laches was denied, and the matter was remitted to the Civil Court for a determination of the remaining branch of the defendant's motion.

The relevant facts the court considered in this case were that DJS Medical Supplies, Inc. was seeking to recover assigned first-party no-fault benefits from Metropolitan Auto Home and Life Insurance. The defendant moved to dismiss the complaint on the ground of laches, based on the plaintiff's delay in prosecuting the action. The Civil Court granted this branch of the motion and found that the branch seeking to toll statutory no-fault interest was moot. The main issue decided by the court was whether the complaint should be dismissed based on laches. The holding of the court was that the branch of defendant's motion seeking to dismiss the complaint on the ground of laches is denied, and the matter is remitted to the Civil Court for a determination of the remaining branch of the defendant's motion.