No-Fault Case Law
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.
Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51513(U))
August 8, 2025
In this case, the court considered the procedural aspects of the defendant's motion to open its default and compel the plaintiff to accept an amended answer regarding a claim for assigned first-party no-fault benefits. The main issues addressed were whether the defendant's default should be opened and whether the plaintiff should be compelled to accept the defendant’s amended answer. The court found that the Civil Court acted within its discretion in granting the defendant's requests as there were no compelling reasons against such actions. The holding affirmed the lower court's order, thereby allowing the defendant to proceed with the amended answer and opening the default.
Matter of Liberty Mut. Ins. Co. v McCormack (2025 NY Slip Op 04571)
August 6, 2025
The court considered the proceedings initiated by Liberty Mutual Insurance Company to permanently stay arbitration of a claim filed by Kerio McCormack for supplemental uninsured motorist (SUM) benefits. The main issue was whether McCormack qualified as an insured under the SUM endorsement of the relevant insurance policy, as Liberty Mutual argued that he did not. McCormack opposed the stay, asserting that there existed a triable issue of fact regarding his status as an insured, specifically whether he was occupying a vehicle insured by Liberty Mutual during the incident in question. The court ultimately held that the Supreme Court should not have granted Liberty Mutual's request to stay arbitration without first conducting a framed-issue hearing to resolve the factual dispute regarding McCormack's eligibility for SUM coverage. Consequently, the order was reversed with directions for further proceedings.
Shamrock Med., P.C. v Personal Serv. Ins. Co. (2025 NY Slip Op 51175(U))
July 18, 2025
In this case, the court considered the procedural posture of the appeal concerning a no-fault benefits dispute, where Shamrock Medical, P.C., as the assignee of Rexford Bishop, sought to recover benefits from Personal Service Insurance Company. The primary issue resolved was whether the order of the Civil Court, which granted the defendant’s motion to dismiss the complaint in part by setting a traverse hearing, was appealable. The holding determined that no appeal lies as of right from such an order, leading to the dismissal of the appeal. The court referenced relevant case law to support its decision and concluded that leave to appeal was not warranted.
LVOV Acupuncture, P.C. v Personal Serv. Ins. Co. (2025 NY Slip Op 51176(U))
July 18, 2025
In this case, the court considered the appeal by Personal Service Insurance Company regarding a prior order that granted a motion to dismiss the complaint only to the extent of setting the matter down for a traverse hearing. The main issues involved whether the dismissal of the complaint should be upheld or if the traverse hearing was warranted based on the evidence presented. Ultimately, the court held that the appeal was dismissed, reaffirming the lower court's decision to set the matter for a traverse hearing rather than fully dismissing the complaint. This decision aligns with the precedent established in a related case, indicating the court's commitment to examining the necessary facts before a final resolution.
Hand By Hand PT, P.C. v Personal Serv. Ins. Co. (2025 NY Slip Op 51177(U))
July 18, 2025
In this case, the court considered the appeal from a Civil Court order that partially granted the defendant's motion to dismiss the complaint filed by a medical provider seeking to recover assigned no-fault benefits. The main issue was whether the dismissal of the complaint should proceed in full or if a traverse hearing was necessary to evaluate the facts presented. The court ultimately held that the appeal was dismissed, affirming the lower court's decision to set the matter down for a traverse hearing rather than granting a complete dismissal of the complaint. This decision aligns with precedents established in similar cases involving insurance disputes over no-fault benefits.