No-Fault Case Law

The relevant facts in the case were that Bruce Campbell, Jr. was driving a vehicle insured by Metropolitan Property and Casualty Insurance Company. After the vehicle stalled, Campbell pushed it to a safer spot, turned on its hazard flashers, locked the doors, and walked home. Approximately 15 minutes later, he returned in another vehicle and attempted to jump start the disabled car. Campbell then locked the vehicle again and went to a friend's home in order to get someone to tow the disabled vehicle. When he was heading back to the vehicle, he was informed that two snowmobiles had collided with the disabled car and Robert J. Trentini, who was operating one of those snowmobiles, was injured. The main issue was whether the disabled vehicle was considered in "use or operation" at the time of the accident, thus permitting Trentini to recover no-fault benefits. The court decided that because Campbell was involved in an "on-going activity relating to the vehicle," the vehicle was in use at the time of the accident, and therefore, Trentini was entitled to no-fault benefits.

The plaintiff sued his insurer for no-fault lost wage benefits and moved for summary judgment on the theory that the insurer failed to pay or deny within 30 days. The Supreme Court denied that part of the motion. The Appellate Division held that the plaintiff did not make a prima facie showing because he did not demonstrate the absence of triable issues about the insurer's compliance with the regulations governing payment or denial. The order was affirmed insofar as appealed from.

Hospital plaintiffs sued as assignees to recover no-fault medical payments, and the Supreme Court granted summary judgment of $10,265.76 and $4,864.02 to two of them. On appeal the Appellate Division found that the plaintiffs made a prima facie showing of entitlement to judgment. The insurer failed to raise a triable issue of fact in opposition. The appeal from the decision was dismissed and the order and judgment were affirmed.

The main issues considered in this case were whether attorney Amos Weinberg rightfully represented all of the plaintiffs involved in the action to recover first-party no-fault benefits from defendant Countrywide Insurance Company, as well as whether Dr. Abraham had the authority to act on behalf of the other plaintiffs. The court found that both attorney Amos Weinberg and Dr. Jamil Abraham engaged in sanctionable conduct and that their actions were considered completely without merit in law and could not be supported by a reasonable argument for an extension or modification of existing law. The court found that Weinberg abdicated his responsibility as an officer of the court and permitted a number of meritless and baseless actions to go forward while Abraham covered up important information regarding the bankruptcy and death of one of the plaintiffs. As a result, the court dismissed their claims and awarded sanctions against both parties. Both Weinberg and Abraham each had to pay $3,000 along with paying for the defendant's legal fees, with Weinberg submitting his payment to the Lawyers' Fund for Client Protection and Abraham depositing the same with the clerk of the court for transmittal to the Commissioner of Taxation and Finance.

An insurer that paid no-fault benefits submitted a subrogation claim under Insurance Law 5105 against a self-insured owner of the other vehicle, and obtained arbitration awards after the owner failed to appear. The Supreme Court confirmed the awards and denied the owner's cross motion to vacate. The Appellate Division found that the court had personal jurisdiction because the affidavit of service was unrebutted. It nonetheless vacated the awards because the notice of intention to arbitrate was sent to the owner's Arkansas headquarters rather than its known local representative, as 11 NYCRR 65.10 requires, and there was no proof of certified-mail notice of the hearings. The order was reversed, the motion to confirm denied, and the awards vacated.

The court considered the fact that the plaintiff was seeking first-party no-fault benefits for health services provided to two individuals injured in an automobile accident, and that the defendant denied the claims for payment. The main issue decided was whether the defendant's denial of the claims was valid, as the plaintiff argued the claims were not timely denied as required by Insurance Law. The holding of the case was that the court affirmed the lower court's decision to deny the plaintiff's motion for summary judgment, as the defendant was able to rebut the plaintiff's prima facie case by showing that the plaintiff did not submit completed proof of claim and did not timely respond to requests for verification. The defendant also raised an additional issue of fact regarding fraud in the claim, further supporting the denial of the motion for summary judgment.

The plaintiff provider sued to recover $3,486.96 in first-party no-fault benefits for medical and chiropractic services, and the Civil Court denied its summary judgment motion. The insurer had asked for an examination under oath, but the regulation in effect in 2001 contained no provision requiring one. The court therefore held that the request did not toll the 30-day period to pay or deny, so the insurer's denial of certain claims was untimely. For other bills, the provider's billing manager submitted an affidavit and a postmarked receipt showing the claim forms were mailed, which sufficed despite the insurer's denial of receipt. The Appellate Term reversed, granted summary judgment to the plaintiff, and remanded for calculation of statutory interest and attorney's fees.

The plaintiff providers sued for first-party no-fault benefits for medical and chiropractic services and appealed the denial of summary judgment. Some claims had been denied late, and one set of bills was denied because the assignor failed to appear for an examination under oath. Because the 2001 regulation did not require an examination under oath, the request did not toll the 30-day period, and the denial was untimely. For further bills, the billing manager's affidavit and postmarked receipt established mailing despite the insurer's claimed non-receipt. The Appellate Term reversed, granted summary judgment of $4,710.04, and remanded for interest and attorney's fees.

The plaintiff commenced an action for first-party no-fault benefits, and the defendant's attorney served an answer late. The Civil Court granted the defendant's motion to compel the plaintiff to accept the late answer. The Appellate Term held that the attorney's affirmation, which blamed the home office for slow forwarding of the papers, lacked personal knowledge and did not show a reasonable excuse. The purported stipulation extending the time to answer was unsigned by plaintiff's counsel and not binding, and no affidavit of merit was submitted. The order was reversed and the motion to compel acceptance of the late answer was denied.

The court considered the defendant insurer's motion for summary judgment to dismiss the complaint in a lawsuit to recover payments for medical services rendered under No-Fault. The main issues decided were the validity of the complaint, the authorization of the individual physicians named as plaintiffs, and the obstruction of discovery by one of the plaintiffs. The court held that the verification of the complaint was defective, but that the defendant failed to act with due diligence to treat it as a nullity. It was also held that the causes of action pertaining to Drs. Schur, Casson, and Choi should be dismissed due to lack of authorization by their counsel. Additionally, the court granted the motion to dismiss the causes of action asserted by Dr. Abraham due to willful obstruction of discovery.