No-Fault Case Law

The court considered an action to recover no-fault insurance benefits under certain contracts of insurance. The plaintiff, Westchester Medical Center, as assignee of Demetrio Recinos (hereinafter WMC), sought recovery from the defendant, Safeco Insurance Company of America, for its failure to pay or deny the claim within the requisite 30-day period. WMC demonstrated its prima facie entitlement to judgment as a matter of law by submitting the necessary billing forms, certified mail receipt, signed return receipt card referencing Recinos and the forms, and an affidavit of its biller. The defendant failed to raise a triable issue of fact in opposition. The Supreme Court correctly granted WMC's cross motion for summary judgment on the first cause of action. The main issue decided was whether WMC was entitled to recover no-fault insurance benefits from Safeco Insurance Company of America, and the court held that WMC was entitled to judgment as a matter of law due to Safeco's failure to pay or deny the claim within the requisite 30-day period.

The plaintiff, Westchester Medical Center, filed a lawsuit to recover no-fault benefits from Liberty Mutual Insurance Company. The plaintiff appealed to the Supreme Court, Nassau County, after the court granted the defendant's cross motion for summary judgment dismissing the second, third, and fourth causes of action. The second and third causes of action involved health services provided to Kevin Kane and Gladys Navarro. The plaintiff demonstrated its entitlement to judgment by proving that necessary billing documents were mailed to and received by the defendant and that payment of the no-fault benefits was overdue. Therefore, the defendant's cross motion for summary judgment was denied, and the Supreme Court erred in awarding summary judgment to the defendant. As it pertains to the fourth cause of action, involving health services to Alyssa Arater, the plaintiff similarly demonstrated its entitlement to judgment, and the Supreme Court should have granted summary judgment in favor of the plaintiff on that cause of action. Therefore, the order was reversed, and the plaintiff's motion for summary judgment was granted. The defendant's cross motion for summary judgment was denied.

The court considered the fact that the defendant, AIU Insurance Company, sought leave to renew and reargue a decision and order granting summary judgment to the plaintiffs, Devonshire Surgical Facility and Carnegie Hill Orthopedic Services. The main issues decided were whether the defendant had established good cause for seeking discovery relating to its defenses and the plaintiffs' corporate structure, and whether there were triable issues of fact concerning the plaintiffs' prima facie case. The court held that the defendant failed to establish good cause for seeking discovery relating to the plaintiffs' alleged fraudulent incorporation, and that the plaintiffs' affidavit supporting their motion for summary judgment was sufficient to lay a foundation for the admission of their business records. Ultimately, the court denied the defendant's motion for leave to renew and reargue.

The relevant facts considered by the court involved a case where the plaintiff was seeking to recover no-fault benefits as an assignee of five individuals, with claims arising out of five separate accidents. The main issue decided was whether the defendant's motion to sever the five causes of action in the complaint into separate actions should be granted. The court held that the particular facts relating to each claim were likely to raise few, if any, common issues of law or fact, and that each claim should be severed into a separate action. The court also found that the defendant's answer, without more, placed at issue the basis for severance, and therefore, the defendant's motion to sever the causes of action should have been granted.

The relevant facts in this case involve an action to recover no-fault insurance medical benefits, in which the plaintiff appealed from an order in the Supreme Court, Nassau County. The order granted the defendant's motion to vacate a judgment entered upon its default in answering, and denied the plaintiff's motion to punish the defendant for contempt. The main issue decided was whether the Supreme Court properly exercised its discretion in granting the defendant's motion to vacate the default judgment pursuant to CPLR 317, and whether it properly denied the plaintiff's motion to punish the defendant for contempt. The holding of the court was that the Supreme Court did exercise its discretion properly in granting the defendant's motion to vacate the default judgment pursuant to CPLR 317 and properly denied the plaintiff's motion to punish the defendant for contempt. Therefore, the order was affirmed with costs.

The relevant facts considered by the court included the denial of plaintiff's motion for summary judgment in an action by a provider to recover first-party no-fault benefits. The main issue decided in this case was whether the defendant proffered sufficient evidence to demonstrate that there was an issue of fact as to whether the injuries sustained by the plaintiff's assignor arose from an insured incident. The holding of the court was that the affidavit submitted by the defendant's investigator was sufficient to demonstrate that the denial of coverage was based on a "founded belief that the alleged injuries do not arise out of an insured incident." As a result, the court reversed the order and denied the plaintiff's motion for summary judgment.

The relevant facts that the court considered in this case were that the plaintiff was an assignee of Joseph Harris and was suing the defendant, State Farm Insurance Company, in a case where no-fault summary judgment motions are common in New York. The main issue that was decided was whether or not the plaintiff had met the necessary prima facie showing for a no-fault plaintiff's summary judgment and if the insurer had preserved a precludable defense or unsatisfied verification requests. The holding of the case was that the court established a four-step analysis for no-fault summary judgment motions, focusing on specific requirements for plaintiff's prima facie case, the insurer's tendered proof of defenses, regulatory compliance review, and timeliness and form requirements for the insurer's denial or verification requests.

The provider sued for unpaid neurological (CPT) testing bills after a December 2002 accident, and at trial it offered claim documents and a notice to admit but called no witnesses. The insurer objected to the notice to admit as improperly served and as seeking admissions on fundamental issues, and objected to the documents for lack of foundation and hearsay. The court considered case law holding that a notice to admit cannot establish the heart of a case, but concluded that the eight individual requests sought admissions of discrete facts such as receipt of bills and non-payment. It found the insurer's reply was late and the notice effective, so the plaintiff established its prima facie case. The insurer presented no evidence, and judgment was awarded to the plaintiff on three causes of action with interest and attorney's fees.

The case involved a proceeding pursuant to CPLR article 75 to permanently stay arbitration. An insured of State Farm was involved in a vehicle accident with a vehicle owned by the City of Long Beach. State Farm sought to recover no-fault benefits from Long Beach's insurer, Specialty National Insurance Company, and initiated arbitration pursuant to Insurance Law § 5105. Long Beach then commenced a proceeding to permanently stay the arbitration. The main issue decided was whether the arbitration proceeding initiated by State Farm was within the applicable limitations period. The court reversed the order of the Supreme Court, denying the petition, as it found that State Farm had initiated the arbitration within three years of the accrual of the claim, which was well before the expiration of the applicable limitations period. Therefore, the court found that the Supreme Court had improperly granted Long Beach's petition based on the statute of limitations.

MVAIC appealed a judgment of $31,980.06 for the plaintiff providers and the denial of its summary judgment motion. The providers showed that the statutory billing forms were mailed and received and that payment was overdue. MVAIC did not pay or deny the claims within 30 days after receiving proof of claim and requested verifications. The Appellate Term held that the 30-day requirement applies to MVAIC under the regulations and does not depend on whether the injured person was deemed a qualified person. MVAIC raised no triable issue, and the judgment was affirmed.