Appellate Division, Fourth Department
Feb 11, 2026
2026 NY Slip Op 00748
Provider prevailed
The insurer's repeated discovery failures were willful, contumacious, and in bad faith, warranting a default judgment on the no-fault claim. In an injured claimant's action for unpaid lost-wage benefits, the insurer repeatedly supplied incomplete responses despite consenting to a conditional preclusion order requiring completion within 60 days. The Appellate Division, Fourth Department, affirmed the order striking the answer and entering default judgment under CPLR 3126, and denying the insurer's CPLR 3103 protective-order cross motion. The claimant established misconduct, shifting the burden to the insurer to offer a reasonable excuse. The insurer offered only a relevance objection, which failed because the demands sought evidence of potential bias by its IME physicians.
Appellate Division, Fourth Department
Dec 23, 2022
2022 NY Slip Op 07343
Insurer prevailed
A prima facie tort claim requires an allegation that disinterested malevolence was the defendant's sole motivation. The Appellate Division, Fourth Department, reversed the order denying the insurers' CPLR 3211 (a) (7) motion and dismissed the provider's complaint. After a prior dismissal without prejudice, the provider again asserted prima facie tort and sought punitive damages. Additional allegations and opposition materials did not cure the defect: alleging malicious conduct and disinterested malice did not allege that disinterested malevolence was the insurers' sole motivation. Following Burns Jackson Miller Summit & Spitzer v Lindner, the court found the pleading insufficient and did not address the insurers' remaining contentions.
Appellate Division, Fourth Department
Oct 9, 2020
2020 NY Slip Op 05626
Provider prevailed
A compulsory SUM arbitration award must have evidentiary support and cannot be arbitrary and capricious. The injured claimant sought confirmation after recovering damages from the other driver, while the insurer sought vacatur under CPLR 7511 (b) (1) (iii). The arbitrator credited treating physicians' accident-causation opinions and objective evidence over conflicting IME opinions concerning spinal injuries. Judicial review accepted the arbitrator's credibility determinations despite conflicting evidence. The Appellate Division, Fourth Department, affirmed the judgment confirming the award because the findings were rational and supported by the record; it dismissed the separate order appeal as subsumed in the judgment and the payment-into-court appeal as abandoned.
Appellate Division, Fourth Department
Feb 7, 2020
2020 NY Slip Op 00971
Insurer prevailed
The insurers' successive summary judgment motion was entertained because an intervening appeal clarified the proof required for EUO nonappearance. The prior appeal made the defense subject to preclusion and found the original timely-denial proof conclusory and unsupported by denial forms. The second motion supplied detailed affidavits and the forms, meeting the insurers' burden without a triable response. The provider's hope that discovery would uncover opposing evidence was insufficient under CPLR 3212 (f). The Appellate Division, Fourth Department, reversed, granted summary judgment declaring no obligation to pay or reimburse the subject claims, and dismissed the provider's CPLR 3124 discovery cross motion as moot.
Appellate Division, Fourth Department
Feb 7, 2020
2020 NY Slip Op 00972
Insurer prevailed
The insurers justified renewal with previously known denial evidence after intervening precedent made EUO nonappearance subject to preclusion. Earlier summary judgment motions sought declarations of no payment obligation based on the providers' EUO defaults. Under CPLR 2221 (e) (2) and (3), Nationwide Affinity Ins. Co. of Am. v Jamaica Wellness Med., P.C. supplied reasonable justification for not previously submitting evidence of timely, proper denials: it first imposed that requirement in the department, contrary to another department's precedent. The insurers met their summary judgment burden, and the providers raised no factual issue. The Appellate Division, Fourth Department, reversed, granted renewal and summary judgment, and declared no obligation to pay the subject claims.
Appellate Division, Fourth Department
Jan 31, 2020
2020 NY Slip Op 00789
Split result
The provider's prima facie tort complaint was properly dismissed, but dismissal should have been without prejudice under CPLR 205 (a). As assignee of no-fault claims, the provider asserted a single prima facie tort cause of action and sought, among other relief, punitive damages. The insurer moved under CPLR 3211 (a) (7). The Appellate Division, Fourth Department, upheld dismissal for the reasons stated in Greater Buffalo Acc. & Injury Chiropractic, P.C. v Geico Cas. Co., which involved an identical complaint against the insurer. It declined to consider documents not considered on the motion below and modified the order to make dismissal without prejudice, otherwise affirming.
