No-Fault Case Law

The court considered an appeal from an order denying the defendant's motion to sever the first cause of action, seeking to recover services rendered to Hajar Abada, from the remaining causes of action and granting the plaintiff's cross-motion for summary judgment. The main issue decided was whether the defendant's motion to sever the first cause of action should have been granted. The holding of the court was that the defendant's appeal did not present any argument with respect to the portion of the order granting summary judgment upon the first cause of action, and therefore failed to establish a basis to disturb that portion of the order. As a result, the court affirmed the order insofar as it was appealed from.

The court considered a motion by the defendant to sever the first cause of action, seeking to recover upon a claim for services rendered to Hajar Abada, from the remaining causes of action, and a cross motion by the plaintiff for summary judgment. The main issue decided was whether the defendant's motion to sever the first cause of action should be granted. The court's holding was that the motion to sever the first cause of action from the remaining causes of action should be denied, and the branch of plaintiff's cross motion for summary judgment upon the first cause of action should be granted. The plaintiff's contention that its motion should have been granted was deemed moot. The court affirmed the order, with costs.

The main issue in this case was whether the Civil Court erred in failing to decide the branch of defendant's motion seeking summary judgment dismissing the complaint on the ground that the coverage limits of the insurance policy had been exhausted. In the underlying action, the provider was seeking to recover assigned first-party no-fault benefits, while the insurance company moved for summary judgment on the grounds that it never received the claims at issue and that the coverage limits available under the insurance policy had already been exhausted. The Civil Court denied both the branch of defendant's motion seeking summary judgment on the ground that defendant had never received the claims at issue, and plaintiff's cross motion, stating that there was an issue of fact with respect to defendant's defense that it had not received the claims at issue. The Appellate Term, Second Department dismissed the appeal, noting that no appeal lies from an order or portion thereof which fails to determine a motion or branch thereof. The holding of the case was that the appeal was dismissed and the branch of defendant's motion seeking summary judgment dismissing the complaint on the ground that the coverage limits available under the subject insurance policy had already been exhausted remained pending and undecided.

The court considered the fact that Milky Way Acupuncture, P.C. had filed a lawsuit in 2015 to recover first-party no-fault benefits that had been assigned to them. Nationwide Ins. had moved for summary judgment to dismiss the complaint on the basis that Milky Way Acupuncture, P.C. had failed to submit the bills at issue to them. The main issue decided was whether or not Milky Way Acupuncture, P.C. had properly submitted the claims to Nationwide Ins. The holding of the case was that the order of the Civil Court, which had granted defendant's motion for summary judgment dismissing the complaint, was affirmed. The court determined that Milky Way Acupuncture, P.C. had failed to demonstrate that the claim forms had been mailed to Nationwide Ins., and the affidavit submitted in support of their motion for leave to renew failed to establish the identity of the insurance carrier to whom the claim forms had been resubmitted. Therefore, the appeal was dismissed and the order was affirmed.

The relevant facts considered by the court in this case were that Pro-Align Chiropractic, P.C. was seeking to recover first-party no-fault benefits as an assignee of Kethelyne Jean-Louis. The main issue decided was whether the defendant, Integon National Ins. Co., had timely mailed the IME scheduling letters and denial of claim forms, and whether the plaintiff's assignor had failed to appear for the scheduled IMEs. The holding of the court was that the defendant's proof sufficiently established that they had timely mailed the IME scheduling letters and denial of claim forms, and that the plaintiff's assignor had indeed failed to appear for the scheduled IMEs. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered whether personal jurisdiction had been obtained over the defendant, a Pennsylvania insurance company, in a case brought by a medical provider to recover no-fault benefits. The defendant argued that it was not subject to jurisdiction in New York, as it was not licensed to do business in New York, did not have offices or representatives in New York, and did not own or possess property in New York. The plaintiff argued that the defendant had transacted business in New York by issuing policies to New York drivers and establishing a relationship with defense counsel in New York. The court held that the defendant made a prima facie showing that personal jurisdiction had not been obtained over it, and the plaintiff's evidence was insufficient to demonstrate that jurisdiction existed. Therefore, the court reversed the judgment, vacated the order, granted the defendant's motion for summary judgment, and denied the plaintiff's cross motion for summary judgment.

The court considered whether personal jurisdiction had been obtained over the defendant in an action by a provider to recover assigned first-party no-fault benefits. In multiple affidavits in support of the motion to dismiss the complaint, defendant's employees asserted that defendant is a Pennsylvania company, which is not licensed to do business in New York and does not conduct business within the state. Plaintiff cross-moved for summary judgment and opposed the motion with an affirmation by its counsel, alleging that defendant had transacted business in New York, subjecting it to jurisdiction in New York. The court held that defendant made a prima facie showing that personal jurisdiction had not been obtained over it, and that the affirmation of plaintiff's attorney was insufficient to demonstrate that personal jurisdiction over defendant existed under the Civil Court's long-arm statute. The court affirmed the order granting defendant's motion to dismiss the complaint and directed counsel for the respective parties to show cause why sanctions and costs should not be imposed.

The main issue in Restoration Chiropractic, P.C. v 21st Century Ins. Co. was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The court considered the fact that the plaintiff's assignor had failed to appear for scheduled examinations under oath (EUOs), and the defendant argued that this failure was grounds for dismissal of the complaint. However, the court held that the defendant's follow-up scheduling letter for the EUOs was untimely, as it was mailed more than 10 days after the assignor's failure to appear for the first scheduled EUO. As a result, the court reversed the order and denied the defendant's motion for summary judgment dismissing the complaint.

In the case of MUA Chiropractic Healthcare, PLLC v State Farm Mut. Auto. Ins. Co., the main issue before the court was whether 11 NYCRR 65-3.8 (g) (1) (ii) was inconsistent with the express dictates of the Insurance Law and therefore constitutionally void. The court held that the regulation was inconsistent with the legislative statute which establishes the legal doctrine that defenses to claims not raised within 30 days after receipt of a no-fault claim are precluded. The court found that the regulation, which removed the fee schedule defense from the statutory preclusion rule, was an unconstitutional overreach and deemed it invalid. As a result, the defendant's fee schedule defense became nonviable 30 days after the claim was received without denial or demand for further verification. Thus, the defendant's motion to dismiss was denied as moot, and the plaintiff's cross motion seeking summary judgment was granted.

The court considered a motion by the defendant to reargue a previous decision denying the defendant's motion for summary judgment. The defendant argued that the court had misapplied the law when it denied the motion based on the plaintiff's failure to attend scheduled Examinations Under Oath (EUO). The defendant asserted that a previous Supreme Court Order had made a final determination on this issue, precluding the plaintiff's cause of action to recover no-fault benefits. The court granted the defendant's motion to reargue, vacated its previous decision, and issued a new decision in its place. The court acknowledged that it had erred in finding that the Supreme Court Order did not have a preclusive effect and held that the doctrine of res judicata bars the plaintiff's action to recover no-fault benefits. The main issue decided by the court was whether the previous Supreme Court Order made a final determination with res judicata effect, precluding the plaintiff's action to recover no-fault benefits. The court held that the Supreme Court Order did have a preclusive effect and that the doctrine of res judicata applied, barring the plaintiff's action. Therefore, the court vacated its previous decision and issued a new decision in favor of the defendant.