April 9, 2004

Amaze Med. Supply v Allstate Ins. Co. (2004 NY Slip Op 50263(U))

https://www.beynensonlaw.com/case-law/amaze-med-supply-v-allstate-ins-co-2004-ny-slip-op-50263u/

Court: Appellate Term, Second Department
Decided: April 9, 2004
Citation: 2004 NY Slip Op 50263(U)
Posture: Default or vacatur
Outcome: Provider prevailed
Issues: Defaults and vacatur Medical necessity
Legal questions: Vacating a default: excuse and defense · Lack of medical necessity (see the maps)

Cite as

Amaze Med. Supply v Allstate Ins. Co., 2004 NY Slip Op 50263(U) (App Term, 2d Dept, 2d & 11th Jud Dists 2004)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The insurer failed to justify vacating its default because it established neither a reasonable excuse nor a meritorious defense. The Appellate Term, Second Department, reversed the order granting vacatur and denied the insurer's motion, leaving the provider's default judgment intact. The insurer's employee affidavit did not identify who sought an extension of time to answer, the manner of the inquiry or its date. Without supporting facts in evidentiary form, the affidavit did not establish a reasonable excuse. The insurer also relied on a timely denial based on a peer review, but that review was conclusory and lacked a medical rationale for rejecting the claim. Following Amaze Med. Supply Inc. v Eagle Ins. Co., that showing did not establish a meritorious defense.

Reported in New York Official Reports at Amaze Med. Supply v Allstate Ins. Co. (2004 NY Slip Op 50263(U))

[*1]

Amaze Med. Supply v Allstate Ins. Co.

2004 NY Slip Op 50263(U)

Decided on April 9, 2004

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on April 9, 2004

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM : 2nd and 11th JUDICIAL DISTRICTS

PRESENT:PESCE, P.J., GOLIA and RIOS, JJ.
NO. 2003-472 K C

AMAZE MEDICAL SUPPLY INC. a/a/o LESTER STEWART, Appellant,
against
ALLSTATE INSURANCE COMPANY, Respondent.

Appeal by plaintiff from an order of the Civil Court, Kings County

(L. Baily-Schiffman, J.), entered January 31, 2003, which granted defendant’s
motion to vacate the default judgment.

Order unanimously reversed without costs and defendant’s motion to vacate the default judgment denied.

In order to vacate a default judgment, the movant must establish
both a reasonable excuse for defaulting as well as a meritorious defense to the
action (see Titan Realty Corp. v Schlem, 283 AD2d 568 [2001]; Matter of
Gambardella v Ortov Light., 278 AD2d 494 [2000]). While the determination of what constitutes a reasonable excuse lies within the sound discretion of the trial court
(Matter of Gambardella v Ortov Light., 278 AD2d 494, supra), the movant must
submit supporting facts in evidentiary form sufficient to excuse the default (see Incorporated Vil. of Hempstead v Jablonsky, 283 AD2d 553 [2001]; Bravo v New
York City Hous. Auth., 253 AD2d 510 [1998]). In the case at bar, the affidavit [*2]
submitted in support of defendant’s motion was from one of its employees allegedly having personal knowledge of the claim. However, said employee failed to set forth supporting facts in evidentiary form indicating who made the purported inquiry about
an extension of time to answer, whether the inquiry was oral, written or made in
person, and on what date the purported inquiry was made. Accordingly, the
employee’s affidavit was insufficient to establish a reasonable excuse.

Furthermore, while defendant argues that it has a meritorious defense to the action, to wit, the no-fault claim was timely denied based on a peer review, it appears that such review was conclusory in nature and lacked a medical rationale for the claim’s rejection (Amaze Med. Supply Inc. v Eagle Ins. Co., NYLJ,
Dec. 29, 2003 [App Term, 2d & 11th Jud Dists]). Therefore, we are of the opinion
that defendant likewise failed to establish a meritorious defense to the action.

Decision Date: April 09, 2004

Legal questions (2)

Questions of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Vacating a default: excuse and defense

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Did the defaulting party show a reasonable excuse (or lack of notice) and a potentially meritorious defense or claim?

This decision: Relief denied because the party showed neither a reasonable excuse nor a potentially meritorious defense or claim

Reversed vacatur of the default judgment because the employee's affidavit gave no evidentiary details of the claimed extension request and the asserted peer-review denial was conclusory, so neither excuse nor meritorious defense was shown.

Default excusedNo reasonable excuseNo meritorious defenseNeither shownHearing or remittalThis decision

Of the 170 decisions on this question in the Second Department courts and the Court of Appeals, 21 (this one included) are in the same category.

Lack of medical necessity

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Did the insurer’s proof establish lack of medical necessity, and did the provider’s evidence rebut it?

This decision: Insurer's medical-necessity proof failed (conclusory, no factual basis or rationale, inadmissible, not credited) (rules on the question, but another ground decided the case)

Held the insurer showed no meritorious defense for vacating its default because the peer review behind its denial was conclusory and lacked a medical rationale.

Unrebutted, insurer prevailsProvider's rebuttal sufficientInsurer raised triable issueInsurer's proof insufficientTrial error, new trialThis decision

Of the 617 decisions on this question in the Second Department courts and the Court of Appeals, 109 (this one included) are in the same category.

Similar decisions

Amaze Med. Supply, Inc. v Lumbermens Mut. Cas. Co. (2004 NY Slip Op 51110(U))The insurer failed to establish a meritorious defense sufficient to excuse its late answer and defeat a default judgment.
A.B. Med. Servs. PLLC v Allstate Ins. Co. (2006 NY Slip Op 50243(U))The insurer failed to establish a reasonable excuse for its default or a meritorious defense to the providers' claims.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 50447(U))The provider's signed postal ledger and president's affidavit established mailing, and the insurer failed to raise a triable issue of timely denial.
Amaze Med. Supply, Inc. v Allstate Ins. Co. (2008 NY Slip Op 51866(U))The provider failed to establish its prima facie case because its affidavit did not lay a business-records foundation.
Prompt Med. Supply, Inc. v State Farm Mut. Auto Ins. Co. (2019 NY Slip Op 50503(U))The insurer's default was excused based on possible withdrawal and the provider's assurance that no default proceedings would be commenced.