Legal Questions

Each page takes one question of New York no-fault law: its leading authorities, whether the courts agree on it, a map of the decisions by court and date, and every decision in our case-law database that rules on it.

• Is an IME/EUO no-show defense precluded if the insurer did not timely deny the claim on that ground?The departments are split · 495 decisions
• On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?Settled statewide by the Court of Appeals · 1,038 decisions
• What must a no-fault claimant prove at trial to make out its prima facie case for overdue benefits?Settled at the Appellate Division, no conflicting department · 109 decisions
• Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?Settled statewide by the Court of Appeals · 1,476 decisions
• Did the insurer prove its IME/EUO no-show defense: mailed, compliant scheduling requests and the claimant’s nonappearance?Settled at the Appellate Division, no conflicting department · 997 decisions
• Did the insurer’s proof establish lack of medical necessity, and did the provider’s evidence rebut it?Settled at the Appellate Division, no conflicting department · 686 decisions
• Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?Settled statewide by the Court of Appeals · 406 decisions
• On the merits, when may a no-fault insurer withhold payment because unlicensed persons own or control the provider (Mallela)?Settled statewide by the Court of Appeals · 74 decisions
• May the insurer raise and investigate a Mallela (fraudulent incorporation) defense, or is it precluded, waived or denied discovery?Settled at the Appellate Division, no conflicting department · 159 decisions
• Did the insurer prove that the amount billed exceeded the applicable workers’ compensation fee schedule?Settled at the Appellate Division, no conflicting department · 330 decisions
• Against MVAIC, was the claimant shown to be a qualified, covered person meeting article 52’s conditions?The departments are split · 267 decisions
• Did the insurer show the claimed injuries did not arise from a covered accident (staged, intentional, or unrelated)?Settled statewide by the Court of Appeals · 241 decisions
• Does an insurer’s no-coverage declaratory judgment, or pending declaratory action, bar or stay a no-fault claimant’s action?Settled at the Appellate Division, no conflicting department · 162 decisions
• Which limitations period governs a first-party no-fault claim against an insurer, self-insurer or MVAIC: six or three years?Settled statewide by the Court of Appeals · 66 decisions