State Farm Ins. Co. v. Domotor

In State Farm Ins. Co. v. Domotor, 266 AD2d 219 [1999] the court applied these principles and concluded that once the insurer unequivocally notified its insured that it was denying all no-fault benefits based upon the opinion of its medical expert that she no longer required medical treatment, the insured was excused from her obligation to comply with the conditions precedent to coverage under the PIP Endorsement regarding submission of proofs of loss (266 AD2d at 220-221). The court held that the insured was therefore entitled to arbitrate her claim that she was entitled to such benefits for medical services provided following the issuance of the denial even though the bills for those services were never submitted to the insurer before she demanded arbitration (id.).