No-Fault Case Law
Medical Imaging of Bronx, P.C., Inc. v MVAIC (2026 NY Slip Op 26160)
October 1, 2026
The provider failed to justify the four-month delay between another insurer's denials and submission of its claims to MVAIC. The parties stipulated that MVAIC timely denied the claims under the 45-day rule and limited trial to reasonable justification under 11 NYCRR 65-3.3 (e). The provider's witness could not recall or document when the referring physician was contacted about other coverage. Cover letters describing prior submission to another insurer did not explain the subsequent delay, and the provider did not respond to MVAIC's invitation to supply justification. General public policy considerations could not displace the filing requirements. The Appellate Term, First Department, reversed the judgment after nonjury trial and directed judgment dismissing the complaint.
Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2026 NY Slip Op 26164)
September 24, 2026
The provider failed to raise a factual issue concerning compliance with verification requests within 120 days. The Civil Court, Kings County, granted the insurer's summary judgment motion, dismissed the complaint with prejudice, and denied the provider's cross motion as moot. Under 11 NYCRR 65-3.5 (o), the insurer established nonreceipt of requested documents, while the provider supplied neither proof of compliance nor reasonable justification. Its owner's affidavit gave inconsistent mailing addresses and lacked corroborating documents. Government Employees Ins. Co. v Mayzenberg did not bar requests investigating licensing eligibility under 11 NYCRR 65-3.16 (a) (12): the denial rested on noncompliance with verification, without a conclusive finding of professional misconduct. The court declined to consider an amended cross motion served 18 months after the insurer's opposition and reply.
Matter of Hartford Fire Ins. Co. v Villanueva (2026 NY Slip Op 05393)
September 23, 2026
The claimant failed to offer a reasonable excuse for defaulting in opposition to the insurer's petition to stay UM arbitration. After the claimant missed a court-ordered deadline for written opposition, Supreme Court permanently stayed arbitration of the alleged hit-and-run claim. Relief under CPLR 5015 (a) (1) required both a reasonable excuse and a potentially meritorious defense. Conclusory assertions that missing medical records and a purported police report hampered opposition were insufficient because the claimant did not explain efforts to obtain them. The Appellate Division, Second Department, affirmed the order, insofar as appealed from, denying vacatur and found it unnecessary to consider a potentially meritorious defense.
Matter of Nostrand Drugs Rx, Inc. v Church Mut. Ins. Co. (2026 NY Slip Op 05400)
September 23, 2026
The provider's petition to vacate a master arbitration award was denied because it showed no statutory ground for vacatur. The Appellate Division, Second Department, affirmed the denial of the CPLR article 75 petition challenging an award rejecting reimbursement for prescription medications. The court relied on CPLR 7511's narrow grounds for vacatur and the insufficiency of mere legal errors; remaining contentions were unpreserved or unnecessary to reach.
RVA Leasing Corp. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 51527(U))
September 22, 2026
The insurer established timely mailing of the provider's EUO notices, nonappearance and an objective basis for the EUOs. The Appellate Term, First Department, reversed the order, insofar as appealed from, and granted the insurer's motion for summary judgment dismissing the no-fault complaint. The insurer's attorney described the office's standard mailing practices and procedures and represented under penalty of perjury, with personal knowledge, that those procedures were followed. This adequately proved mailing of the scheduling letters, and the provider failed to appear at the initial and follow-up EUOs. The provider raised no factual issue, and the insurer supplied a specific objective justification under 11 NYCRR 65-3.5 (e).
RVA Leasing Corp. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 51528(U))
September 22, 2026
The provider's failure to attend the initial and follow-up EUOs violated a condition precedent to coverage. The Appellate Term, First Department, reversed the order and granted the insurer's unopposed motion for summary judgment dismissing the no-fault complaint. The insurer established that it timely and properly mailed the EUO scheduling notices and that the provider failed to appear. The provider's challenge to the reasonableness of the EUO requests was raised for the first time on appeal and was therefore unpreserved for review.
NR Motion PT, P.C. v Allstate Ins. (2026 NY Slip Op 51460(U))
September 3, 2026
The insurer failed to establish its intoxication exclusion or fee-schedule defense through competent, admissible evidence. The Civil Court, Kings County, denied its summary judgment motion in full. Under Westchester Med. Ctr. v Government Empls. Ins. Co., the insurer had to prove intoxication or impairment and that the injuries resulted from operating a vehicle in that condition. Unauthenticated medical records and a police report lacked an admissible foundation under CPLR 4518 or another evidentiary rule, and the assignor's EUO testimony disputed intoxication. The insurer also supplied no competent proof that the charges exceeded the applicable fee schedule. The court made no finding of intoxication or causation and left both defenses for proof at trial.
Citimed Surgery Ctr. LLC v Allstate Ins. Co. (2026 NY Slip Op 51435(U))
August 24, 2026
The defendant insurer established that a separate company issued the assignor's policy and that it was not a proper party. The Civil Court, New York County, granted summary judgment under CPLR 3212 (b) and dismissed the provider's no-fault reimbursement complaint. The defendant's records search located no policy covering the assignor, while a claims representative for the separate issuing insurer identified the relevant policy and claim number. The provider's conclusory assertions concerning the issuer's identity and the companies' relationship raised no triable issue. Whether the defendant received the bills or issued a lack-of-coverage denial was immaterial to the jurisdictional issue presented.
Medical Supply Depot Group Corp v State Farm Mut. Auto. Ins. Co. PI/BI Claims (2026 NY Slip Op 51339(U))
August 20, 2026
Post-EUO verification requests continue tolling when the EUO fails to supply information necessary to verify the claim. The insurer submitted the EUO transcript and an SIU affidavit establishing that necessary information remained outstanding. Following Nationwide Affinity Ins. Co. of Am. v Gepp and 11 NYCRR 65-3.5 (c), the Civil Court, Kings County, rejected the provider's arguments that the completed EUO ended tolling and that the written request eight days later was untimely. The provider did not respond within 120 days; its later statement of intent to supply verification did not constitute a response. The insurer was entitled to deny the claim, and the court granted its CPLR 3212 summary judgment motion in its entirety and denied the provider's cross motion.
Baldwin Med. Servs., P.C. v Maya Assur. Co (2026 NY Slip Op 51329(U))
August 19, 2026
The insurer failed to establish timely, proper mailing of its initial verification request, defeating summary judgment for nonresponse. The Civil Court, Bronx County, denied the insurer's motion under CPLR 3212. The adjuster's affidavit described mailing procedures for the follow-up request but omitted the processing steps for the initial request; conflicting mailing dates also raised a factual issue. Although 11 NYCRR 65-3.5 (o) permits denial after 120 days without verification or reasonable justification, the insurer did not establish tolling. The court found requests for signed claim and assignment forms reasonable and rejected the provider's demand for separate copies to it and counsel under 11 NYCRR 65-3.6 (b). Timely, proper mailing remained for trial; if proven, the action was premature.