No-Fault Case Law

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.

The court considered the facts that First Care Medical Equipment, LLC was seeking to recover no-fault benefits for supplies provided to Sophia Brooks, who was allegedly injured in an accident. Encompass Insurance had previously obtained a declaratory judgment in a separate action in the Supreme Court, which declared that they were not obligated to provide any coverage, reimbursements, or pay any invoices to First Care. Encompass then moved in the Civil Court for summary judgment dismissing First Care's complaint, arguing that the Civil Court action was barred by the declaratory judgment. First Care opposed the motion and cross-moved for summary judgment. The main issue decided was whether the Civil Court action was barred by the doctrine of res judicata, and the holding was that the action was not barred by res judicata based on the declaratory judgment, and thus Encompass's motion for summary judgment was properly denied.

The main issue decided in this case is whether or not to grant the defendant's motion for leave to reargue or renew plaintiff's prior motion seeking to preclude the defendant from offering evidence at trial. The court considered the fact that the defendant had been unable to perfect their appeal due to missing paperwork, and had been granted a stay pending appeal. The court ultimately held that the branch of the defendant's motion seeking to vacate the order granting plaintiff's motion to preclude defendant from offering evidence at trial was granted, and the plaintiff's motion was denied. The court found that while the defendant had violated the stay, vacatur was appropriate in the interest of substantial justice. Therefore, the order denying the defendant's motion was reversed.

The court considered a provider's claim for first-party no-fault benefits, specifically the issue of severance of the first cause of action, seeking to recover for services rendered to Yolanda Deleon, from the remaining causes of action following five accidents and multiple defenses interposed in the answer. The main issue decided was whether to grant severance of the claims, an exercise of judicial discretion that should not be disturbed on appeal in the absence of a showing of prejudice to a substantial right. The court held that the denial of defendant's motion for severance was not an improvident exercise of discretion, as the resolution of the claim for services rendered to Yolanda Deleon will involve different questions of fact and law from the claims for services rendered to the other assignors. Therefore, the order denying defendant's motion for severance was affirmed.

Facts: New York Center for Specialty Surgery (Specialty Surgery) sought payment from State Farm Insurance Company for manipulation under anesthesia (MUA) procedures performed on Jennifer Barrera, which State Farm deemed medically unnecessary. A bench trial was held, and the parties stipulated to the timeliness of claims and denials, as well as the expertise of the chiropractor who performed the procedures. After reviewing the treatment records and bills, the court found justification for each MUA procedure based on the patient's medical and treatment history. Issues: The main issue in this case was whether the MUA procedures performed by Specialty Surgery on Jennifer Barrera were medically justified and exceeded the scope of chiropractic practice, and if State Farm was obligated to pay for the procedures. Decision: The court held that the MUA procedures were justified based on the patient's medical history and the National Academy of Manipulation Under Anesthesia Physicians (NAMUA) protocols, which recommend such procedures for patients experiencing intractable pain that interferes with their lifestyle. The court also found that the procedures did not exceed the scope of chiropractic practice, as the manipulation of the patient's spine was within the scope of chiropractic treatment. Therefore, the court directed the clerk to enter judgment in favor of Specialty Surgery in each of the three matters, ordering State Farm to pay for the MUA procedures.