No-Fault Case Law

The court considered the relevance of the defendant's verification requests, which sought to gather various documents from the plaintiff to assess whether the plaintiff met the necessary licensing requirements to collect no-fault benefit payments. The main issues addressed were whether the defendant's requests for documentation were justified and whether the plaintiff had grounds for their appeal concerning the denial of their cross-motion for summary judgment and a separate motion to dismiss the defendant's affirmative defenses. Ultimately, the court held that the defendant's motion for summary judgment to dismiss the complaint was valid, the plaintiff's cross-motion was appropriately denied, and the order from the Civil Court was affirmed with costs to the defendant. The court also noted that the plaintiff's amended cross-motion was not addressed in the order on appeal, so the issue was not considered.

The court considered whether the defendant, Lancer Insurance Co., met its burden to demonstrate that proper notices for an examination under oath were mailed to the assignor, Ismael Sejour, and whether Sejour failed to appear. The key issues were whether the notices were properly sent and if the defendant could establish personal knowledge of the mailing procedures. The court found that while the defendant successfully demonstrated Sejour's nonappearance through a certified transcript, it failed to conclusively show that the notices had been properly mailed. Consequently, the motion for summary judgment was granted in part, confirming the assignor's failure to appear at the examination, while leaving the question of proper notice mailing to be resolved at trial.

The court considered several key facts in determining the outcome of the case, particularly regarding the procedural requirements for providing notice for an examination under oath (EUO). The main issue was whether the defendant, Lancer Insurance Co., properly mailed the notices to the assignor, Ismael Sejour, and whether Sejour's failure to appear for the EUO justified granting summary judgment. The court found that while Lancer Insurance Co. had demonstrated the assignor's failure to appear, it failed to establish that proper notice was given, as the evidence presented included boilerplate language lacking personal knowledge and did not satisfactorily prove the mailing procedures. Consequently, the court granted the defendant's motion only to the extent that it recognized the assignor's failure to appear for the EUO, while leaving the question of whether the notices were properly mailed unresolved for trial.

In this case, the Plaintiff, as assignee of a medical treatments provider, sought to recover No-Fault benefits from the Defendant for a treatment rendered. The main issue revolved around the Defendant’s claim that the Assignor had failed to attend two scheduled Examinations Under Oath (EUOs), which the Defendant asserted as grounds for seeking summary judgment. The Court previously denied the Defendant's summary judgment motion, determining that there were issues of fact regarding the Assignor's non-attendance and noting that the Defendant failed to provide sufficient proof that the Assignor did not appear. In the subsequent motion to reargue, the Court found the Defendant's supporting affidavit did not sufficiently demonstrate personal knowledge of the non-appearance, reiterating that mere assertions of absence without presence at the EUO lacked probative value. Ultimately, the Court denied the reargue motion, affirming its earlier decision that the Defendant had not met its burden of proof.

In this case, Dr. Howard M. Rombom, as the assignee of Linda Banks, sought to recover no-fault benefits based on an earlier settlement agreement from 1997, which had been filed as a stipulation of discontinuance but remained unpaid. The trial court initially ruled to vacate a judgment entered in favor of the plaintiff, asserting that the filing of the stipulation in 1998 had terminated the action and deprived the court of jurisdiction. The appellate court found that while the stipulation had been filed, the defendant's failure to pay did not negate the jurisdiction of the court to grant relief under CPLR 5003-a, which allows for the entry of judgment in cases where payments are not made following a settlement agreement. Consequently, the appellate court reversed the lower court's decision to vacate the judgment and remitted the case back to the Civil Court to consider other motions by the defendant.

The court considered the procedural correctness of the plaintiff's submissions and the appropriateness of the defendant's request for additional information to verify the plaintiff's eligibility for no-fault benefits. The main issues decided included whether the defendant could seek verification information regarding the plaintiff's licensing and eligibility before the court and whether the plaintiff's subsequent amended cross-motion for summary judgment was proper. The court held that the defendant's actions were not improper and affirmed the lower court's decision to grant the defendant's summary judgment motion, dismissing the complaint and denying the plaintiff's cross-motion. The decision underscored the importance of compliance with procedural rules and the lack of preclusive effect from a non-final determination in a separate action.

In this case, the court considered the procedural history and substantive adequacy of the claims made by Burke 2 Physical Therapy, P.C. against State Farm Mutual Automobile Insurance Company regarding assigned first-party no-fault benefits. The main issues decided included whether the plaintiff's amended cross-motion for summary judgment was improperly classified as a sur-reply, and whether the defendant's request for verification documents during the claim verification stage was appropriate. The court held that the plaintiff's motions, both initial and amended, failed to establish a triable issue of fact, and that the defendant's request for documents was valid for verifying the plaintiff's eligibility for benefits. Consequently, the court affirmed the lower court's order granting the defendant's summary judgment and denying the plaintiff's cross-motion.

In this case, the court considered the procedural propriety of the plaintiff's submissions and whether the plaintiff had adequately provided the requested verification for no-fault benefits. The main issues involved whether the defendant’s motion for summary judgment should be granted based on the plaintiff's alleged failure to comply with verification requests and whether the Civil Court erred in not considering the plaintiff's amended submissions. The court held that the plaintiff's affidavit did not raise a genuine issue of fact regarding the provision of verification and that the defendant's requests for additional documentation were appropriate. Additionally, the court found that a previous denial in a related declaratory judgment action did not preclude the defendant's summary judgment motion. Ultimately, the court affirmed the order dismissing the complaint and denied the plaintiff's cross-motion for summary judgment.

The court considered several relevant facts, including that the plaintiff, Trinity Medicine, P.C., was seeking first-party no-fault benefits for medical services provided to its assignor due to a motor vehicle accident. The defendant, National General Insurance Company, failed to serve its answer after being served the summons and complaint in December 2020. Upon the plaintiff's attempt to obtain a default judgment, the defendant moved to open its default, claiming a reasonable excuse for the delay due to a clerical oversight and asserting a meritorious defense based on a previous declaratory judgment that indicated no coverage was owed due to the nature of the accident. The main issues were whether the defendant had a reasonable excuse for its default and whether it had a potentially meritorious defense. The court held that the defendant provided a reasonable excuse for its default and demonstrated a potential meritorious defense related to res judicata, affirming the lower court's decision to allow the defendant to file a late answer and denying the plaintiff's motion for summary judgment.

The court considered the case where Quick Health Pharmacy Corp. sought to vacate a master arbitrator's award denying its claim for first-party no-fault benefits of $1,454.70. The initial judgment awarded Quick Health a sum including interest and a specific amount for attorney's fees, but the appellant argued that this fee was inadequate given the circumstances. The main issues decided included whether the awarded attorney's fees complied with regulatory requirements and if they accurately reflected the fees incurred during the arbitration and subsequent court proceedings. The holding reversed the previous judgment, determining that the calculation of attorney's fees was incorrect due to an improper application of a cap, and remitted the matter to the District Court for a new judgment to determine the reasonable attorney's fees entitled to Quick Health without the regulatory cap.