No-Fault Case Law

The court considered the fact that the plaintiff, Bento Ortho, Inc., was seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment dismissing the complaint should be granted, and whether the plaintiff's cross motion for summary judgment should be denied. The court held that there was an issue of fact as to whether the plaintiff's claims were timely denied, due to a significant discrepancy between the date the bills were sent and the date they were received by the defendant. As a result, the court modified the order by denying the defendant's motion for summary judgment dismissing the complaint.

The case involved a dispute between V.S. Care Acupuncture, P.C. (V.S.) and Country-Wide Ins. Co. regarding a claim for no-fault benefits for treatment rendered to Morris Collins. Country-Wide denied the claim on the grounds that Collins did not appear for independent medical examinations and that V.S. failed to appear at scheduled examinations under oath. Country-Wide also contended that V.S. was fraudulently incorporated. The original arbitration ruled in favor of V.S., finding that Country-Wide had not met its burden of proof regarding the fraudulent incorporation defense. On appeal to a master arbitrator, the master arbitrator found that the original arbitrator had committed an error of law in rejecting the fraudulent incorporation defense. The court held that the master arbitrator's determination was without a rational basis and vacated the master arbitrator's award, confirming the original arbitrator's award in favor of V.S. The court also remitted the matter back to the Supreme Court for a determination of the amount of an additional attorney's fee to be awarded to V.S.

The Supreme Court vacated a master arbitrator’s award in favor of V.S. Care Acupuncture, P.C. in the amount of $3,650, plus statutory interest, attorney's fees, and costs and disbursements. Country-Wide Ins. Co. then appealed this decision. V.S. Care Acupuncture, P.C. had filed a claim for no-fault benefits for treatment it provided, that the carrier Country-Wide Ins. Co. denied. The arbitrator denied V.S.'s claim, finding that the evidence established that V.S. was fraudulently incorporated in violation of (State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]). The Supreme Court granted the petition, vacated the master arbitrator's award, and entered a judgment in favor of V.S. in the amount of the claim for no-fault benefits plus statutory interest, attorneys' fees, and costs and disbursements. Upon appeal, the judgment was reversed, the original award was reinstated, and V.S. failed to demonstrate any grounds for vacating the master arbitrator's award.

The case involves Bay Needle Care Acupuncture, an assignee of a claim for no-fault benefits for treatment rendered to Kareem Edgar, and Country-Wide Ins. Co. Country-Wide denied the claim, leading to the arbitration. The original arbitrator found in favor of Bay Needle and Country-Wide appealed, resulting in the master arbitrator vacating the award and remitting the matter for a new hearing. Bay Needle petitioned to vacate the master arbitrator's award and the Supreme Court granted the petition, vacated the master arbitrator's award, confirmed the original arbitrator's award in favor of Bay Needle, and entered judgment accordingly. The main issue was whether the master arbitrator exceeded their power in vacating the original arbitrator's award. The holding was that the master arbitrator did exceed his power in vacating the original arbitrator's award, and the original arbitrator's award was confirmed in favor of Bay Needle. Additionally, Bay Needle was entitled to an attorney's fee for this appeal and the matter was to be remitted to the Supreme Court for that purpose.

The main issue in this case was whether a matter was entitled to preclusive effect, and if the prior determination involving the same parties was sufficient for this. The court found that Acuhealth failed to establish that the issue for collateral estoppel was identical to an issue decided in the prior proceeding. Additionally, Acuhealth failed to demonstrate any additional ground for vacating the master arbitrator's award. The court also held that an arbitrator's rulings are largely unreviewable, and that courts have a limited ability to vacate an arbitrator's award unless the error claimed is so irrational as to require vacatur. The court found that the petition to vacate the arbitrator's award should have been denied, and the award should have been confirmed, thus reversed the original judgment in favor of the petitioner and awarded in favor of Country-Wide Ins. Co.

The relevant facts from the case involve a dispute between Acuhealth Acupuncture, P.C. and Country-Wide Ins. Co. over a denied claim for no-fault benefits. The original arbitrator found in favor of Acuhealth, but the master arbitrator vacated the award and issued a new award in favor of Country-Wide based on a defense that Acuhealth was fraudulently incorporated. Acuhealth then petitioned the Supreme Court pursuant to CPLR article 75 to vacate the master arbitrator's award. The main issue decided was whether the master arbitrator acted within his discretionary authority and correctly vacated the original arbitrator's award. The holding of the case was that the master arbitrator exceeded his power by rejecting the original arbitrator's discretionary authority and passing upon factual questions concerning the validity of the defense, and thus the Supreme Court's determination to vacate the master arbitrator's award and confirm the original arbitrator's award in favor of Acuhealth was affirmed. Additionally, the court remitted the case for the determination of an additional attorney's fee to be awarded to Acuhealth.

The appellate term affirmed the denial of Allstate Insurance Company's petition to vacate a master arbitration award in favor of Victoria Brown. Allstate failed to demonstrate the existence of any statutory grounds for vacating the award, as the master arbitrator found that the decision was rational and not arbitrary or capricious. The arbitrator's rejection of Allstate's IME no show defense was based on evidence, including proof of mailing the IME notices and the claimant's previous appearances at IMEs. Additionally, Allstate did not dispute that the parties had agreed to limit the issue before the arbitrator to the IME no show defense. Therefore, the court held that there were no grounds for vacating the award, and affirmed the judgment in favor of Victoria Brown.

The petitioner's assignor underwent acupuncture treatments and initiated a no-fault arbitration proceeding against the respondent insurer. An arbitrator decided in favor of the petitioner, awarding them a sum of money. The petitioner contested the attorney's fee award to a master arbitrator. The court decided that the master arbitrator's decision to affirm the award was not arbitrary and capricious. This is because the award had a rational basis. The master arbitrator decided that the petitioner's attorney failed to submit proper documentation to establish an hourly rate, thus justifying the affirmation of the attorney's fee. The court agreed with the Supreme Court's denial of the petition. The petitioner failed to demonstrate their entitlement to an attorney's fee.

The court considered the fact that the plaintiff, Actual Chiropractic, P.C., as Assignee of Wilson Santiago, had failed to appear for duly scheduled examinations under oath (EUOs) after the defendant, State Farm Insurance, had requested them. The main issue decided was whether the defendant was required to set forth objective reasons for requesting the EUOs in order to establish its entitlement to summary judgment. The holding of the case was that the defendant was not required to set forth objective reasons for requesting the EUOs in order to establish its entitlement to summary judgment. This was because an insurer only needs to demonstrate, as a matter of law, that it twice duly demanded an EUO from the provider, the provider twice failed to appear, and the insurer issued a timely denial of the claim. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The main issue in this case was whether the defendant-insurer's motion for summary judgment dismissing the underlying first-party no-fault action should be granted. The court considered whether the defendant had submitted competent evidence of the assignor's nonappearance at scheduled independent medical examinations (IMEs). The holding of the court was that the defendant's motion for summary judgment was properly denied, as the evidence submitted by the defendant, including a conclusory affirmation of the IME doctor and an affidavit from the IME scheduling vendor, lacked probative value and did not establish personal knowledge of the assignor's nonappearance. Therefore, the court affirmed the order of the Civil Court of the City of New York, denying the defendant's motion for summary judgment.