No-Fault Case Law

The court considered whether American Transit Insurance Company was obligated to pay no-fault insurance benefits to Albert Hayes, who was a passenger in a vehicle involved in a collision covered by American Transit's insurance policy. Hayes applied for benefits, which American Transit denied, and the company sought a declaratory judgment that it was not required to pay benefits to Hayes or the medical providers that were his assignees. American Transit sought summary judgment against the answering defendants and default judgment against the non-appearing defendants, but the motion was denied. The court held that American Transit failed to demonstrate compliance with the procedural and timeliness requirements related to the handling of no-fault claims and was therefore not entitled to summary or default judgment in its favor.

The court considered the fact that the plaintiff was awarded no-fault benefits in the amount of $4,590.72, and that the defendant's independent medical examination (IME) no-show defense was not established. The main issue was whether the plaintiff was entitled to attorneys' fees pursuant to the standard fee provision or the hourly rate fee provision contained in Insurance Department Regulations. The court held that the standard fee provision contained in the regulations applies in this case, as the specifically enumerated policy issues on the denial of claim form did not include the assignor's failure to attend an IME. The court also ruled that the opinion letters issued by the Department of Financial Services did not interpret the counsel fees regulation at issue, and did not explicitly state that the failure of the assignor to appear for an IME constitutes a "policy violation" triggering additional attorneys' fees under the regulations. Therefore, the court affirmed the order granting the defendant's motion to vacate so much of the judgment as awarded plaintiff attorneys' fees pursuant to the regulations.

The court considered an appeal from an order of the Civil Court of the City of New York, Queens County, in which the order granted the defendant's motion to dismiss the complaint on the ground of laches. The main issue decided was whether the delay in prosecuting the action by the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, warranted the dismissal of the complaint on the ground of laches. The holding of the court was that the order was reversed, the branch of defendant's motion seeking to dismiss the complaint on the ground of laches was denied, and the matter was remitted to the Civil Court for a determination of the remaining branches of defendant's motion. The court's decision was based on the reasons stated in a similar case, Rockaway Med. & Diagnostic, P.C., as Assignee of Ramon Ortiz v State Farm Mut. Ins. Co., and the justices all concurred with the decision.

The case involved a dispute over first-party no-fault benefits for acupuncture services provided after a motor vehicle accident. The plaintiff was granted summary judgment in the Civil Court, but the defendant later obtained a declaratory judgment in Supreme Court denying the plaintiff's right to no-fault benefits. The defendant then moved to vacate the judgment in Civil Court based on the Supreme Court's ruling, and the Civil Court granted the motion. However, the Appellate Term of the Supreme Court reversed the decision, ruling that the Supreme Court did not have the authority to vacate the judgment issued by the Civil Court. Therefore, the decision to vacate the judgment in Civil Court was in error, and the defendant's motion was denied.

The relevant facts of the case included a provider seeking to recover first-party no-fault benefits, with a default judgment entered against the defendant for failing to appear or answer the complaint. The defendant moved to vacate the default judgment, claiming it had not received the summons and complaint and had a potentially meritorious defense. The court considered whether the defendant had a reasonable excuse for the default and a potentially meritorious defense. The court held that the defendant failed to demonstrate a reasonable excuse for the default and therefore denied the defendant's motion to vacate the default judgment. Additionally, the court held that the plaintiff's cross motion seeking costs and sanctions was improperly granted, as the defendant's behavior was not found to be frivolous. The judgment awarding costs to the plaintiff was reversed, while the remainder of the order was affirmed.

The relevant facts the court considered in this case were that the master arbitrator's award was challenged by Global Liberty Insurance Company of New York due to the respondent's assignor's failure to attend scheduled independent medical exams. The main issue decided by the court was whether the master arbitrator's award was arbitrary and ignored established precedent that the petitioner's no-fault policy was void ab initio due to the assignor's failure to attend medical exams. The holding of the case was that the master arbitrator's award was indeed arbitrary and that it irrationally ignored the well-established precedent, and as a result, the court unanimously reversed the order and granted the petition to vacate the master arbitrator's award.

The court considered the fact that the plaintiff had served the summons and complaint on the defendant on October 31, 2016, and a default judgment was entered on March 13, 2017 based on defendant's failure to answer the complaint. The defendant moved to vacate the default judgment in December 2017, arguing that it had timely answered the complaint with the wrong index number. Defendant contended that it had potentially meritorious defenses to the action, as the provided services lacked medical necessity and the limits of the insurance policy had been exhausted. However, the plaintiff rejected the defendant's answer because it contained the wrong index number, and the defendant did not submit a new answer with the corrected index number until December 13, 2017. The main issue decided by the court was whether the defendant had a reasonable excuse for its default, as well as a potentially meritorious defense. The court held that a defendant seeking to vacate a default judgment must demonstrate both a reasonable excuse for the default and a potentially meritorious defense to the action. The court found that the defendant failed to demonstrate a reasonable excuse for its default, as it had waited a year after its initial answer was rejected before serving a new answer bearing the correct index number. Therefore, the court affirmed the order denying the defendant's motion to vacate the default judgment.

The court considered the evidence presented by both the plaintiff and the defendant in a first-party no-fault action. The defendant, an insurance company, submitted a peer review report from its physician, which concluded that the medical supplies provided to the plaintiff's assignor were not medically necessary. The report stated that the assignor was already receiving other therapies for her injuries and that the equipment in question was either unnecessary or redundant. The plaintiff's opposition, which consisted of an attorney's affirmation, prescription, and claim forms, did not include medical evidence or other competent proof of medical necessity. The main issue decided by the court was whether the defendant insurer was entitled to judgment as a matter of law dismissing the complaint. The court held that the defendant had made a prima facie showing of entitlement to judgment as a matter of law based on the evidence presented. As a result, the court reversed the lower court's order and granted the defendant's motion for summary judgment, ultimately dismissing the complaint. In summary, the court considered the evidence of medical necessity presented by both parties, ultimately holding that the defendant had made a prima facie showing of entitlement to judgment as a matter of law, and therefore dismissing the complaint.

The court considered the case of Medcare Supply, Inc. v. Global Liberty Insurance, in which Medcare Supply was seeking to recover first-party no-fault benefits from Global Liberty Insurance. The main issue decided was whether Global Liberty Insurance had properly scheduled independent medical examinations (IMEs) and whether Medcare's assignor had failed to appear for these examinations. The court held that defendant's moving papers demonstrated timely mailing of the IME scheduling letters and denial of claim form, as well as the assignor's failure to appear for the scheduled IMEs. In contrast, Medcare failed to raise a triable issue of fact in opposition to defendant's motion, and consequently, the order was reversed, and the defendant's cross motion for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court were that this was an action by a provider to recover assigned first-party no-fault benefits, and the defendant moved to dismiss the complaint for lack of personal jurisdiction, stating that it does not conduct business in the State of New York. Plaintiff's opposition papers consisted only of an affidavit of its owner attesting to mailing policies and procedures and the affirmation of its counsel, who had no personal knowledge of the underlying facts. The main issue decided was whether the plaintiff had established a jurisdictional basis for the service, as the burden shifted to plaintiff to establish this after the defendant's prima facie showing that the court lacked personal jurisdiction. The court held that plaintiff failed to meet its burden and did not produce evidence showing a jurisdictional basis for the service, and accordingly, the order to dismiss the complaint for lack of personal jurisdiction was affirmed.