No-Fault Case Law

The main issue that the court decided in this case was whether statutory no-fault interest in a judgment should be recalculated from a simple rate to a compound rate. This case involved a provider seeking to recover assigned first-party no-fault benefits for claims submitted to the insurance company in January 2001, which arose from an accident in November 2000. The defendant had not paid the settlement amount, and a judgment was entered on January 12, 2017, awarding statutory no-fault interest at a simple rate. The court granted the plaintiff's motion to have the interest recalculated pursuant to the pre-2002 regulations, which required no-fault interest to be calculated at a compound rate. The court affirmed the order, holding that the former regulations providing for compound interest should apply to the claims in question.

The critical facts considered by the court in Sunrise Acupuncture, P.C. v Merchants Preferred Ins. Co. were whether the defendant had valid defenses to the claims for medical services billed under CPT codes 99203 and 97039, and whether the defendant had denied certain portions of the claims on the ground of lack of medical necessity. The main issue decided was whether the defendant had established its defense as to the services billed under CPT code 99203, and whether they had properly denied portions of the claims on the ground of lack of medical necessity. The holding of the court was that the defendant had failed to establish its defense as to the services billed under CPT codes 99203 and 97039, and that they were not entitled to summary judgment dismissing the portions of the claims that were denied on the ground of lack of medical necessity. Therefore, the order granting the defendant's motion was reversed, and the claims in question were denied.

The relevant facts in this case were that Success Rehab, PT, P.C., as an assignee, was seeking to recover first-party no-fault benefits from Hereford Insurance Company. The insurer, Hereford, moved for summary judgment to dismiss the complaint, arguing that the assignor failed to appear for scheduled independent medical examinations (IMEs). Success Rehab cross-moved for summary judgment, and the lower court granted their motion, awarding Success Rehab $2,794.24. Hereford appealed, arguing that the assignor had failed to appear for the scheduled IMEs, but the court found that Hereford did not demonstrate its entitlement to summary judgment. However, the court also found that Success Rehab failed to establish its entitlement to summary judgment, as it did not show that Hereford had failed to deny the claims within the requisite 30-day period or that the denials were without merit. As a result, the judgment in favor of Success Rehab was reversed, and their cross-motion for summary judgment was denied.

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to appear for examinations under oath (EUOs). The court considered the fact that the initial EUO request to the plaintiff was sent more than 30 days after the defendant had received the claims at issue, making the requests nullities as to those claims. The court ultimately held that the defendant failed to demonstrate that it was entitled to summary judgment dismissing the complaint based on the plaintiff's failure to appear for EUOs. Therefore, the judgment awarding the plaintiff the principal sum of $1,261.90 was affirmed.

The relevant facts the court considered in this case were that the plaintiff, Sheepshead Bay Oral Surgery, PLLC, was seeking to recover assigned first-party no-fault benefits, and the defendant, Unitirin Direct Ins. Co., moved to dismiss the complaint on the ground that the action was barred by the statute of limitations. The main issue decided by the court was whether the plaintiff's cause of action was timely commenced, as the defendant demonstrated that the cause of action accrued 30 days after the defendant received the plaintiff's claim, and the plaintiff did not rebut that showing. The holding of the court was that the defendant's motion to dismiss the complaint was affirmed, with $25 costs, as the plaintiff's cause of action was not timely commenced and the contention that the defendant should be collaterally estopped from asserting a statute of limitations defense lacked merit. The court also declined to consider the plaintiff's remaining contention, as it was being raised for the first time on appeal.

The court considered a case in which a petitioner sought to vacate an arbitration award issued in relation to an insurance claim being denied. It was determined that the petitioner was not able to establish that the assignor of the respondents was injured in the course of his employment, therefore the claim had been properly denied by the petitioner. The petitioner had failed to provide evidence that the assignor was on duty or carrying a paying passenger at the time of the incident. The Supreme Court was found to have the authority to award attorneys' fees in connection with a "court appeal from a master arbitration award and any further appeals." The matter was remanded for a determination of the amount of fees to which the respondents were entitled. The decision of the Supreme Court was unanimously modified on the law, to remand for a determination of respondents' attorneys' fees pursuant to 11 NYCRR 65-4.10 (j) (4), and otherwise affirmed, without costs.

In the court case, the main issue was that plaintiff no-fault insurers wanted to resolve the question of the fee schedule applicable to reimbursement of licensed acupuncturists who provide services to eligible individuals injured in motor vehicle accidents. Under relevant Insurance Law and regulations, the permissible charge for such services renders the superintended to have not adopted a fee schedule applicable to licensed acupuncturists, requiring consideration of "charges permissible for similar procedures under schedules already adopted or established". The plaintiffs failed to provide admissible evidence to make a prima facie showing of entitlement to judgment on the issue as a matter of law. Additionally, a previously submitted informal opinion letter of the former Insurance Department was considered but did not sufficiently resolve the issue. As a response, the court denied plaintiff's order, concluding that since the superintendent has not adopted a fee schedule, the remaining option would be to pay the provider the prevailing fee in the geographic location of the provider, subject to review by the insurer.

The court considered the facts that a default judgment was taken against the defendant for failing to appear at trial, and that the defendant had attempted to effect a substitution of counsel prior to the trial date. The main issue decided was whether the defendant's failure to comply with the procedural requirements for changing or withdrawing an attorney justified the entry of a default judgment. The court held that the defendant's failure to strictly comply with the procedural requirements did not justify the entry of a default judgment, and that the default judgment was therefore reversed and the defendant's motion to open its default was granted.

The court considered an appeal from an order of the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment. The main issue decided was whether the proof submitted by the defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim forms had been properly mailed. The holding of the court was that the proof submitted by the defendant was indeed sufficient to give rise to such a presumption, and therefore the order granting the defendant's motion for summary judgment was affirmed.

The main issue decided in this case was whether or not the defendant, GEICO Ins. Co., was entitled to summary judgment dismissing the complaint brought by Omphil Care, Inc. as assignee of Rivera, Eugenio. The lower court had denied GEICO's cross motion for summary judgment, but the Appellate Term, Second Department reversed that decision and granted GEICO's cross motion for summary judgment dismissing the complaint. The relevant facts considered by the court were that Omphil Care had failed to appear for scheduled examinations under oath (EUOs). The court found that GEICO had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, and as a result, they were entitled to summary judgment dismissing the complaint.