No Fault Defense

We handle all aspects of no-fault insurance defense including:

Examinations Under Oath

New York No-Fault Regulations require that claimants and their medical providers appear for examinations under oath scheduled by the insurer/self-insurer in order to answer critical questions related to a no-fault claim including those regarding the facts of the accident, possible material misrepresentation, fraud and the claimant’s treatment. Moreover, as appearing at these examinations is required by the No-Fault Regulations, a failure by a claimant and/or their medical provider to appear may provide a complete defense resulting in a denial of no-fault benefits.

We have helped our insurer clients uncover facts concerning material misrepresentation, staged accidents and fraudulent claims, which has reduced their expenditures on unfounded claims. Additionally, we have pursued declaratory judgments based on these EUOs to obtain determinations regarding no-fault coverage.

Litigation

The Courts in New York City and Long Island are divided between two separate departments, which often issue contradictory case law that directly impacts the handling of cases. It is clear that medical providers and their attorneys are well aware of the differing advantages and disadvantages of each department and take great care to initiate cases in the venue they believe will be most favorable to their client based on the issue at hand.

Insurers and self-insurers need experienced no-fault defense counsel in order to provide the best chance of defense when the odds are already stacked against them. Additionally, due to the large volume of cases filed within the First and Second Department, the process of litigating a claim in the New York City or Long Island courts system can take years, requiring multiple appearances. We have helped our clients litigate thousands of claims throughout the five boroughs and Long Island, successfully defending claims based on a wide variety of defenses.

Arbitration

Intended as a quicker and more relaxed alternative to litigation, medical providers looking to avoid the backlog in the court system have been filing their no-fault claims through the American Arbitration Association. Unlike litigation where there can be a lengthy discovery process, arbitrations move swiftly with a limited window for an insurer to assert and substantiate their defense.

Given the streamlined arbitration process, it is critical that insurers use defense counsel familiar with the arbitration process in order to assess the facts of the case and submit and argue a solid defense within the limited time frame afforded.

Appellate Practice

With an abundance of cases being heard by the Courts, it is an unfortunate reality that not every decision will correctly interpret the facts or law applicable to the case. These incorrect decisions can not only negatively impact the immediate action but can affect future claims by creating “bad case law.” Appealing a decision can be necessary in order to avoid both the immediate and ongoing effects of this bad case law.

Overturning a judicial decision is not easy and may not be the right decision for every case, so it is vital that insurers/self-insurers work with defense counsel that can provide insight into when it is appropriate and cost effective to do so. Knowing when to file an appeal requires a law firm that is experienced in handing no-fault appellate work. Our firm has successfully appealed numerous decisions in both the First and Second Department, giving us vital insight to help our clients make the right decision.

Declaratory Judgments (“DJ”)

When a claimant has violated a policy condition, or when coverage is an issue, an insurer/self-insurer has the right to bring a declaratory judgment action in the Supreme Court seeking a determination as to coverage. These judgments avoid the risks associated with obtaining piecemeal decisions in the lower courts on actions filed by the medical providers.

These actions must be comprehensive and detailed as the failure to list a claimant or medical provider may prevent the application of the declaratory judgment to the medical provider’s lower court case. Therefore, it is imperative that insurers/self-insurers use defense counsel with experience in handling these complex actions. Our firm has successfully litigated numerous DJ actions, building a track record of success which has helped our clients.

No-Fault Subrogation

New York No-Fault Law mandates insurers, self-insurers, and workers’ compensation providers arbitrate disputes for issues involving Loss Transfer (where at least one vehicle weighs more than 6,500 lbs. or is used for transportation of person or property for hire) and Priority of Payment (when insurers, self-insurers and/or compensation providers cannot resolve who is primarily responsible for no-fault benefits).

Through this subrogation, a no-fault insurer/self-insurer may be reimbursed for no-fault benefits paid out on a claim. As the parties involved in subrogation are required to submit all contentions and documentation without the ability to view the evidence submitted by the other party, it is vital to choose a law firm such as ours with experience in this area. We have successfully handled both sides of subrogation claims, giving us the unique insight into this aspect of claims handling.

Coverage Options

Given the multitude of factors than can be involved in handling a no-fault claim, questions will often arise that cannot be clearly answered by a reading of the New York No-Fault Regulations. Contractual or regulatory issues may create questions where a coverage opinion becomes necessary so as to avoid unnecessary expenditures.

Given the dollar amounts at stake, it is imperative that insurers/self-insurers have an experienced and qualified law firm with expertise in the area of New York No-Fault Law that can research the issues and prepare an opinion. The timely and thorough research and coverage provisions we provide to our clients gives them the confidence in knowing they are making the right decisions.