April 3, 2025
State Farm Mut. Auto. Ins. Co. v Lifeline Med. Imaging, P.C. (2025 NY Slip Op 02025)
https://www.beynensonlaw.com/case-law/state-farm-mut-auto-ins-co-v-lifeline-med-imaging-p-c-2025-ny-slip-op-02025/
- Decided
- April 3, 2025
- Citation
- 2025 NY Slip Op 02025
- Posture
- Summary judgment
- Outcome
- Provider prevailed
- Later treatment
- Distinguished in 1 later decision (see Cited by)
- Legal questions
- No-show defense: insurer's proof (see the maps)
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.
Reported in New York Official Reports at State Farm Mut. Auto. Ins. Co. v Lifeline Med. Imaging, P.C. (2025 NY Slip Op 02025)
| State Farm Mut. Auto. Ins. Co. v Lifeline Med. Imaging, P.C. |
| 2025 NY Slip Op 02025 |
| Decided on April 03, 2025 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and subject to revision before publication in the Official Reports. |
Decided and Entered: April 03, 2025
Before: Manzanet-Daniels, J.P., Moulton, Gesmer, Pitt-Burke, Michael, JJ.
Index No. 815415/21|Appeal No. 4041|Case No. 2024-00540|
v
Lifeline Medical Imaging, P.C., Defendant-Appellant.
The Rybak Firm, PLLC, Brooklyn (Maksim Leyvi of counsel), for appellant.
Goldeberg, Miller & Rubin, PC, New York (Harlan R. Schreiber of counsel), for respondents.
Order, Supreme Court, Bronx County (Wilma Guzman, J.), entered July 24, 2023, which granted the motion of plaintiffs State Farm Mutual Automobile Insurance Company, State Farm Indemnity Company, State Farm Guaranty Insurance Company, and State Farm Fire and Casualty Company (collectively State Farm) for summary judgment declaring that State Farm had no obligation to pay bills submitted by defendant Lifeline Medical Imaging, P.C., unanimously reversed, on the law, without costs, the motion denied, and the declaration vacated.
In this action, State Farm sought a declaration that it was not obligated to provide no-fault coverage for various claims submitted by Lifeline, a medical provider. According to State Farm, Lifeline failed to meet a condition precedent to coverage by failing to appear for duly scheduled examinations under oath (EUOs) and by refusing to produce an individual who could provide the information needed to verify Lifeline’s claims. As a result, State Farm maintains, Lifeline’s claim to no-fault benefits is foreclosed.
Supreme Court should have denied the motion as premature, as State Farm failed to offer Lifeline an objective justification for requesting the EUOs, as required by the governing no-fault regulations (see Country-Wide Ins. Co. v Alicea, 214 AD3d 530, 531 [1st Dept 2023]; Country-Wide Ins. Co. v Delacruz, 205 AD3d 473, 473 [1st Dept 2022]). The criteria by which State Farm decided that an EUO was required is essential for Lifeline to oppose State Farm’s summary judgment motion, and those criteria are exclusively within the State Farm’s knowledge and control (see Delacruz, 205 AD3d at 473, citing 11 NYCRR 65-3.5[e]). In addition, despite State Farm’s assertion otherwise, it did not fully respond to Lifeline’s discovery request for a copy of the objective standards relied upon when the EUO was scheduled (see Kemper Independence Ins. Co. v AB Med. Supply, Inc., 187 AD3d 671, 671 [1st Dept. 2020]; American Tr. Ins. Co. v Jaga Med. Servs., P.C., 128 AD3d 441, 441 [1st Dept 2015]; see also Ops Gen Counsel NY Ins Dept No. 02-10-14 [October 2002]; Ops Gen Counsel NY Ins Dept No. 06-12-16 [December 2006]).
Because State Farm’s rationale for requesting the EUOs has yet to be determined, the issue of whether State Farm’s no-coverage defense is subject to preclusion cannot yet be determined.
THIS CONSTITUTES THE DECISION AND ORDER OF THE SUPREME COURT, APPELLATE DIVISION, FIRST DEPARTMENT.
ENTERED: April 3, 2025
Legal questions
A question 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.
Did the insurer prove its IME/EUO no-show defense: mailed, compliant scheduling requests and the claimant’s nonappearance?
This decision: Insurer did not show its requests met the regulatory timing, follow-up or justification requirements
Held summary judgment for the insurer premature because it never gave the provider an objective justification for requesting the EUOs, as the regulations require, and did not fully answer discovery seeking its objective standards.
Of the 165 decisions on this question in the First Department courts and the Court of Appeals, 39 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Country-Wide Ins. Co. v Alicea (2023 NY Slip Op 01474) FollowedAn insurer's EUO nonappearance summary judgment motion is premature without disclosure of its objective justification for requesting the EUO. The insurer obtained a declaration that it owed no benefits and a permanent stay of further actions involving the injured claimant.
- Country-Wide Ins. Co. v Delacruz (2022 NY Slip Op 03068) FollowedThe insurer's EUO nonappearance motion was premature because it withheld the specific objective justification for requesting the EUO. The Appellate Division, First Department, affirmed denial of summary judgment against the providers under CPLR 3212 (f).
- Kemper Independence Ins. Co. v AB Med. Supply, Inc. (2020 NY Slip Op 06209) FollowedThe insurer's summary judgment motion was premature because its objective basis for requesting an EUO was unavailable to the providers.
- American Tr. Ins. Co. v Jaga Med. Servs., P.C. (2015 NY Slip Op 03925) FollowedThe insurer's summary judgment motion based on the claimant's EUO nonappearance was denied because essential discovery remained outstanding.
Cited by
A label shows how the later decision treated this one.
- Integon Natl. Ins. Co. v Salazar-Ochoa (2026 NY Slip Op 50292(U)) DistinguishedAn insurer need not provide coverage for an intentionally caused collision, even to innocent third parties.
Similar decisions
- State Farm Mut. Auto. Ins. Co. v Equinox Physical Therapy, P.C. (2024 NY Slip Op 05193)EUO notices mailed before receipt of the providers' no-fault verification forms are not subject to the 15-day period in 11 NYCRR 65-3.5.
- Flatlands Med., P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50763(U))The provider's objections to the insurer's EUO requests were not heard because it had not responded to the requests.
- LMS Acupuncture, P.C. v State Farm Mut. Automotive Ins. Co. (2019 NY Slip Op 50696(U))An insurer need not state objective reasons for requesting EUOs to obtain summary judgment based on a provider's nonappearance.
- LMS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51655(U))An insurer need not state objective reasons for requesting EUOs to establish prima facie entitlement to summary judgment for nonappearance.
- Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50997(U))The provider failed to show a timely objection to EUO requests and could not challenge their reasonableness in litigation.