Pommells v. Perez
4 N.Y.3d 566 (N.Y. 2005) Cited 2,060 timesHolding that a plaintiff's claim survived summary judgment when her doctor stated that she had suffered severe and permanent injuries and that opinion was supported by measurements of loss of range of motion and an MRI revealing herniated discs
Central General Hospital v. Chubb Group of Insurance
90 N.Y.2d 195 (N.Y. 1997) Cited 536 timesHolding that an insurer may assert a defense based upon the "fact or founded belief that the alleged injury does not arise out of an insured incident."
Presbyterian Hospital v. Maryland Casualty Co.
90 N.Y.2d 274 (N.Y. 1997) Cited 489 timesStating no-fault's prompt payment of uncontested first party benefits "is part of the price paid to eliminate common law contested actions"
State Farm Ins. v. Mallela
4 N.Y.3d 313 (N.Y. 2005) Cited 274 times 1 Legal AnalysesHolding that "unlicensed or fraudulently licensed providers" are "ineligible for reimbursement" under New York's no-fault law
Matter of Medical Society of the State v. Serio
100 N.Y.2d 854 (N.Y. 2003) Cited 249 timesHolding that a provision in New York Insurance Law providing that “[t]he superintendent shall have the power to prescribe and from time to time withdraw or amend, in writing, regulations, not inconsistent with the provisions of [the Insurance Law] ... does not cede to the executive branch fundamental legislative or policymaking authority, which remains at all times with the Legislature”
Nicole v. Defontaine-Stratton
231 A.D.2d 412 (N.Y. App. Div. 1996) Cited 192 timesSeptember 12, 1996. Order, Supreme Court, Bronx County (Luis Gonzalez, J.), entered August 21, 1995, which granted defendant Rev. Jame s B. Defontaine-Stratton's motion for summary judgment and dismissed the complaint as against him, is unanimously reversed, on the law, without costs, the motion is denied and the complaint is reinstated. Before: Milonas, J. P., Ellerin, Kupferman, Tom and Mazzarelli, JJ. In order to establish a prima facie case, plaintiff must establish that she has suffered a "serious
Walton v. Lumbermens Mut. Co.
88 N.Y.2d 211 (N.Y. 1996) Cited 92 times 2 Legal AnalysesHolding that the legislative purpose of New York's No-Fault Laws is "to establish a quick, sure and efficient system for obtaining compensation for economic loss suffered as a result of such accidents"
Country-Wide Insurance Co. v. Harnett
431 U.S. 934 (1977) Cited 44 timesUpholding the constitutionality of no-fault compulsory arbitration prior to this amendment
Clemens v. Apple
65 N.Y.2d 746 (N.Y. 1985) Cited 73 timesEmphasizing that the parties against whom preclusion was sought "freely chose the arbitration forum, although a judicial forum was, and remained, available at the time arbitration was sought"
Auto One Ins. Co. v. Hillside Chiropractic, P.C.
126 A.D.3d 423 (N.Y. App. Div. 2015) Cited 4 timesIn Auto One Ins. Co., the arbitrator failed to independently assess the affirmation without reference to the statutorily prescribed rule of evidence.
Section 65-3.5 - Claim procedure
N.Y. Comp. Codes R. & Regs. tit. 11 § 65-3.5 Cited 662 timesRequiring insurer procedures to include "supervisory review of all such determinations"
Section 65-3.8 - Payment or denial of claim (30-day rule)
N.Y. Comp. Codes R. & Regs. tit. 11 § 65-3.8 Cited 618 times 1 Legal Analyses(a) (1) No-fault benefits are overdue if not paid within 30 calendar days after the insurer receives proof of claim, which shall include verification of all of the relevant information requested pursuant to section 65-3.5 of this Subpart. In the case of an examination under oath or a medical examination, the verification is deemed to have been received by the insurer on the day the examination was performed. (2) An insurer shall defer payment of OBEL benefits for claims submitted by or on behalf