No-Fault Case Law
Matter of American Tr. Ins. Co. v Big Apple Pain Mgt., PLLC (2025 NY Slip Op 05948)
October 29, 2025
The court considered the sequence of events surrounding a motor vehicle accident involving Carlos Nieto and subsequent medical services provided by Big Apple Pain Management, PLLC. Big Apple submitted claims to American Transit Insurance Company for reimbursement, which were denied, prompting Big Apple to seek arbitration. An arbitrator awarded Big Apple the claimed amount, which was later confirmed by a master arbitrator. American Transit then petitioned to vacate this confirmation, resulting in a ruling by the Supreme Court to grant the petition and deny Big Apple's motion. However, on appeal, the court reversed the lower court's decision, determining that American Transit did not present any valid statutory grounds for vacating the master arbitrator's award, leading to the confirmation of that award in favor of Big Apple.
Matter of Oasis Med. & Surgical Wellness v New Jersey Mfrs. Ins. Co. (2025 NY Slip Op 05952)
October 29, 2025
The court considered relevant facts including that Oasis Medical and Surgical Wellness sought no-fault insurance benefits from New Jersey Manufacturers Insurance Company (NJM) for medical services related to a motor vehicle accident in New York, although the care was provided in New Jersey to an insured. NJM denied the claim, leading Oasis to initiate an arbitration in New York, which was dismissed by the arbitrator based on the doctrine of forum non conveniens. Oasis then appealed this dismissal to a master arbitrator, who affirmed the decision. The main issues decided included whether the arbitration award could be vacated on the grounds that the arbitrator exceeded their authority and whether there was sufficient justification for the award. Ultimately, the court held that Oasis failed to provide clear and convincing evidence to vacate the award and affirmed the Supreme Court's order denying the petition.
Matter of South Nassau Community Hosp. v Avis Budget Group, Inc. (2025 NY Slip Op 05954)
October 29, 2025
The court considered relevant facts including the petitioner’s attempt to recover costs for medical services provided following a motor vehicle accident and the respondent’s defenses concerning lack of medical necessity and standing due to absence of an assignment of benefits from the injured party. The main issues decided included whether the arbitrator's decision was arbitrary or capricious and whether the respondent had waived its standing defense. The master arbitrator vacated the initial arbitration award by concluding that the petitioner lacked standing, leading to the petitioner seeking to vacate this decision. Ultimately, the court upheld the master arbitrator's decision, determining that it was not irrational or arbitrary and capricious, thereby affirming the denial of the petition to vacate the award.
American Tr. Ins. Co. v Hackensack Surgery Ctr., LLC (2025 NY Slip Op 05787)
October 22, 2025
In this case, the court examined the plaintiff's pursuit of no-fault insurance benefits under Insurance Law § 5106(c) after the defendant moved to dismiss the complaint for failure to state a cause of action. The initial order from the Supreme Court granted the defendant's motion to dismiss the complaint, with subsequent proceedings addressing the plaintiff's attempt to reargue this decision and the defendant’s request to correct the record to reflect that the dismissal was granted on default. The main issues decided included whether the initial decision should be corrected and if the appeal from the February order should be dismissed as superseded. The court affirmed the March order, concluding that the lower court properly corrected its prior order and that the appeal from the February order was appropriately dismissed since it had been superseded. The court also noted that the plaintiff's arguments made during the appeal were improperly raised for the first time.
Matter of Hereford Ins. Co. v Shelly (2025 NY Slip Op 05681)
October 15, 2025
The court considered relevant facts including that Sarben-Sarpong Shelly and Corey Hargrove were occupants of a vehicle insured by Hereford Insurance Company, which was involved in an accident on June 13, 2018. Hereford had previously filed an action in 2019 against the claimants for a judgment declaring it had no duty to pay claims related to the accident. The court had granted Hereford a default judgment against both claimants, establishing that Hereford was entitled to a permanent stay of any related arbitrations. The main issue decided was whether the claimants could initiate arbitration for uninsured motorist benefits after the earlier ruling had already concluded that Hereford had no duty to pay such claims. The court held that the prior judgment barred the claimants from relitigating the claim for uninsured motorist benefits, affirming the order to permanently stay arbitration.
Blano Med., P.C. v Hereford Ins. Co (2025 NY Slip Op 51540(U))
September 29, 2025
In this case, the defendant, Hereford Insurance Co., abandoned its medical necessity defense at the outset of the trial, opting instead to assert a fee schedule defense, which was not initially addressed in the court’s order. The court considered whether the fee schedule defense was a non-precludable defense that could be raised at any time according to 11 NYCRR § 65-3.8 (g)(1). It found that while there was precedent supporting the notion that fee schedule defenses could be raised without adhering to the 30-Day Denial Rule, the court ultimately disagreed with this interpretation and held that the fee schedule defense is indeed precluded if not properly asserted within the required timeframe. As a result of the defendant's failure to provide a denial based on the fee schedule and not putting forth a valid defense during the trial, the court granted the plaintiff’s motion for a directed verdict in favor of Blano Medical, P.C. for $2,600, plus statutory interest and costs.
21st Century Pharm., Inc. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51577(U))
September 25, 2025
The court considered several relevant facts in this case, including the timeline of the filing of the Notice of Trial and the subsequent motion for summary judgment by the defendant, State Farm. Plaintiff, 21st Century Pharmacy, sought reimbursement for No-Fault benefits totaling $1,529, arguing that the defendant's motion was untimely since it was filed 778 days after the Notice of Trial. The main issues decided centered on whether the defendant demonstrated "good cause" for the delay in filing its summary judgment motion, as required under CPLR § 3212. Ultimately, the court held that the defendant failed to provide a satisfactory explanation for the delay and did not raise its "good cause" arguments until its reply papers, denying the motion for summary judgment and setting the matter for a bench trial.
Brefni Chiropractic Diagnostics, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51518(U))
September 5, 2025
The court considered key facts regarding the scheduling of examinations under oath (EUOs) and the defendant's claims of the plaintiff's failure to appear. It was determined that the defendant, State Farm Mutual Automobile Insurance Company, timely mailed letters scheduling the EUOs and denial of claim forms. The main issue was whether the plaintiff, Brefni Chiropractic Diagnostics, P.C., had indeed failed to appear for the scheduled EUOs, which would be a basis for dismissing the complaint for no-fault benefits. The court concluded that the defendant established a prima facie case of the plaintiff's non-appearance based on an attorney's affirmation without needing to submit EUO transcripts. Consequently, the court reversed the prior order of the Civil Court and granted the defendant's motion for summary judgment, dismissing the complaint.
Matter of Fill Rx NY, Inc. v LM Gen. Ins. Co. (2025 NY Slip Op 04785)
August 27, 2025
The court considered the facts surrounding Fill Rx NY, Inc.'s claim for no-fault insurance benefits against LM General Insurance Company, which totaled $4,151.53 for pharmaceutical products provided to an assignor after a motor vehicle accident. The main issues decided included whether the March 2023 master arbitration award, which confirmed the earlier January 2023 arbitration award denying Fill Rx's claim, should be vacated on grounds of being irrational, arbitrary and capricious, or incorrect as a matter of law. The court held that Fill Rx failed to demonstrate valid grounds for vacating the master arbitration award, as the determinations made by the master arbitrator were supported by evidence and had a rational basis. As a result, the court affirmed the judgment in favor of LM General, dismissing Fill Rx's petition.
Matter of Progressive Ins. Co. v Service (2025 NY Slip Op 04652)
August 13, 2025
In this case, the court considered facts surrounding an accident involving Shante D. Service, who was injured while in a vehicle operated by Artur Nazaryan, a Lyft driver. The vehicle was insured by Hereford Insurance Company, and Progressive Insurance Company also provided coverage for Lyft that included supplementary uninsured motorist (SUM) benefits. Progressive denied coverage and sought to stay arbitration for Service's claim, asserting that she was not an "insured" under their policy because the accident occurred while the vehicle was being used for a prearranged trip, which was categorized as a "for-hire vehicle" and not a "TNC vehicle." The main issue was whether Service qualified as an insured under the SUM endorsement. The court held that Service did not qualify as an insured under the terms of the policy, thereby granting the petition to permanently stay arbitration.