No-Fault Case Law
Aviyon Med. Rehabilitation, P.C. v Allstate Ins. Co. (2004 NY Slip Op 50819(U))
August 2, 2004
The relevant facts of this case are that Aviyon Medical Rehabilitation, P.C. brought an action against Allstate Insurance Company for its failure to pay the total amount due on assigned no-fault claims, leaving an unpaid balance of $105,218.78. Allstate Insurance Company moved to sever and dismiss the claims, arguing that the claims did not arise from a series of transactions or occurrences and that joinder would cause prejudice and lead to jury confusion. The main issues decided by the court were whether the claims should be severed and dismissed, and whether the court had subject matter jurisdiction. The holding of the court was that defendant's motion to sever and dismiss the claims was denied, and the court retained subject matter jurisdiction over the case. The court based its decision on the liberal joinder policy to prevent multiplicity of suits and the absence of logistical difficulties in preparing a defense to the claims.
563 Grand Med. P.C. v New York State Ins. Dept. (2004 NY Slip Op 24415)
July 30, 2004
The relevant facts the court considered in this case were the provisions of the New York State No-Fault law governing optional arbitration procedures, and the complaints by the plaintiffs that these provisions violated the Due Process Clauses of the United States and New York Constitutions. The main issue decided was whether the no-fault arbitration regulations violated procedural due process, as claimed by the plaintiffs, and whether they were facially unconstitutional. The holding of the case was in favor of the defendants, stating that the regulations governing arbitration procedures did not violate procedural due process, and the court dismissed the claims by the plaintiffs that the regulations were unconstitutional.
Palladium Car & Limo Serv. Corp. v Liberty Mut. Ins. Co. (2004 NY Slip Op 50987(U))
July 22, 2004
The court considered the plaintiff's motion for summary judgment on the grounds that they were entitled to No-Fault benefits for transportation services provided to a patient who was injured in a motor vehicle accident. The plaintiff claimed that they provided necessary transportation services to the patient and were owed a balance of $950 after being reimbursed $700 by the defendant. The main issue decided was whether the plaintiff had established a prima facie case of entitlement to No-Fault benefits, which required proof of claim and amount of loss, along with a valid assignment. The court held that the plaintiff had failed to establish a valid assignment for the right to collect payment from the defendant, therefore failing to establish a prima facie case of entitlement to judgment as a matter of law, and consequently, denied the motion for summary judgment.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 50833(U))
July 21, 2004
The court considered the facts of a case in which a medical supply company sued an insurance company to recover first-party no-fault benefits for medical supplies furnished to the company's assignor. The main issues decided were whether the insurance company was justified in denying the claim for medical supplies and whether the denial was timely for other claims. The court held that the insurance company failed to provide sufficient evidence to defeat the medical supply company's motion for summary judgment, and that the insurance company had also failed to deny certain claims within the required time frame, thereby precluding the defense of medical necessity. As a result, the court granted the medical supply company's motion for partial summary judgment in the principal sum of $2,365 and remanded the matter for the calculation of statutory interest and assessment of attorney's fees.
S & M Supply Inc. v Dollar Rent A Car Sys. Inc. (2004 NY Slip Op 24284)
July 21, 2004
A medical supply provider as assignee sought a default judgment for first-party no-fault benefits against a rental car company that failed to appear. The Civil Court denied the motion with leave to renew, finding no prima facie showing of liability. The Appellate Term explained that proof of claim consists of the statutory forms or their equivalent, and that CPLR 3215 (f) requires proof of the facts constituting the claim and the amount due. The provider's billing manager averred that billing for medical equipment followed the Workers' Compensation fee schedules, whereas the governing regulation limits such charges to 150 percent of documented cost. That averment raised an issue as to the amount due, so the claim was not for a sum certain, and the denial was affirmed with leave to renew.
State Farm Mut. v Katehis (2004 NY Slip Op 50854(U))
July 16, 2004
The respondent demanded arbitration of an uninsured motorist claim arising from an October 2000 hit-and-run accident, and the insurer petitioned for a permanent stay on the ground of untimely notice. The court found the petition itself timely under CPLR 7503 (c) and General Construction Law § 25 (a). The respondent first contacted the insurer about thirty months after the accident, and although he showed efforts to identify the offending vehicle, he had counsel throughout and no reasonable excuse for not giving notice earlier. The court also held the insurer's denial of coverage was made as soon as reasonably possible. It granted the permanent stay.
Hospital for Joint Diseases v Hertz Corp. (2004 NY Slip Op 06024)
July 12, 2004
A hospital as assignee sued to recover no-fault medical payments, and the Supreme Court denied its summary judgment motion and denied the defendants' cross motion to dismiss. The Appellate Division found that the hospital established prima facie entitlement to summary judgment. The defendants submitted no evidentiary proof that the injury and treatment were not causally related to the motor vehicle accident, so they neither established their own entitlement to dismissal nor raised a triable issue. The court reversed and granted the hospital's motion, affirmed the denial of the cross motion, and held the defendants' remaining arguments unpreserved.
Hospital for Joint Diseases v Hertz Corp. (2004 NY Slip Op 06025)
July 12, 2004
A hospital as assignee sued to recover no-fault medical payments, and the Supreme Court denied its motion for summary judgment. The hospital established prima facie entitlement to judgment. The defendants claimed they timely denied the claim but provided no evidentiary support, and they offered no proof that the injury and treatment were unrelated to the accident. The Appellate Division concluded that the defendants failed to raise a triable issue of fact. It reversed and granted the motion.
Rose v Hartford Ins. Co. (2004 NY Slip Op 06034)
July 12, 2004
The plaintiffs sued for a declaration that the defendant insurer had to defend and indemnify its insureds in an underlying personal injury action and for related coverage. The Supreme Court, among other things, directed on its own that the period in which one plaintiff could submit an uninsured motorist claim to the insurer would run from service of its order with notice of entry. The insurer appealed that portion, and the Appellate Division treated the notice of appeal as an application for leave and granted leave. It held that under the circumstances the Supreme Court properly set the period to run from service of the order and affirmed insofar as appealed from.
Matter of New York Cent. Mut. Fire Ins. Co. v Czumaj (2004 NY Slip Op 05880)
July 9, 2004
The main facts considered in the case were that the respondent submitted claims for no-fault insurance benefits for injuries he sustained in a motor vehicle accident in September 1995. Petitioner denied his claims, and respondent served a demand for arbitration through Federal Express overnight mail, to which petitioner sought a permanent stay of arbitration on the grounds that the service was jurisdictionally defective due to the method of mailing. The court decided that the service of the demand for arbitration by Federal Express mail was not jurisdictionally defective, and that the demand was properly served within the statute of limitations. The main issue was therefore whether the petitioner's participation in a prior arbitration proceeding, or lack thereof, constituted a waiver of their right to seek a stay of arbitration. The holding was that the issue was a threshold question requiring a trial forthwith to determine whether the claim was time-barred or not.