April 14, 2023
Horizon P.T. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50442(U))
https://www.beynensonlaw.com/case-law/horizon-p-t-care-p-c-v-state-farm-mut-auto-ins-co-2023-ny-slip-op50442u/
- Decided
- April 14, 2023
- Citation
- 2023 NY Slip Op 50442(U)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Followed in 3 later decisions (see Cited by)
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 Horizon P.T. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50442(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
State Farm Mutual Automobile Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Rivkin Radler, LLP (Cheryl F. Korman and Stuart M. Bodoff of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), entered August 2, 2021. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order is affirmed, with $25 costs.
In January 2018, plaintiff Horizon P.T. Care, P.C. (Horizon) commenced this action against defendant State Farm Mutual Automobile Ins. Co. (State Farm) to recover assigned first-party no-fault benefits for services it rendered to its assignor for injuries the assignor allegedly sustained in a motor vehicle accident on March 9, 2015. After issue was joined, Horizon moved for, among other things, summary judgment. State Farm cross-moved for summary judgment dismissing the complaint on the separate grounds that Horizon had failed to appear for duly scheduled examinations under oath (EUOs), and that four of Horizon’s causes of action were barred by a declaratory judgment issued by the Supreme Court, Nassau County, in a December 2015 declaratory judgment action commenced by State Farm against Horizon in regard to the same March 2015 accident. Following Horizon’s default in appearing in the Supreme Court action, judgment was entered in July 2016, which declared that “Horizon . . . has no right to receive payment for the bills submitted to STATE FARM and listed in Exhibit ‘1’ of the . . . summons and verified complaint.” By order entered August 2, 2021, the Civil Court denied Horizon’s motion and granted State Farm’s cross motion for summary judgment dismissing the complaint on the ground that State Farm had established that Horizon failed to appear for duly scheduled EUOs.
State Farm’s cross-moving papers in the Civil Court sufficiently established that the assignor, claims, date of loss and dates of service relevant to Horizon’s first, third, fourth, and seventh causes of action in the case at bar are the same as those referenced in the Supreme Court declaratory judgment action. For the reasons stated in Horizon P.T. Care, P.C. v State Farm [*2]Mut. Auto. Ins. Co. (— Misc 3d —, 2023 NY Slip Op 50295 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2023]), those causes of action were barred under the doctrine of res judicata, thereby obviating any need for this court to independently review them. The Civil Court thus properly granted the branches of State Farm’s cross motion seeking summary judgment dismissing those causes of action, albeit on grounds different from those relied upon by the Civil Court.
With respect to Horizon’s remaining causes of action—the second, fifth, and sixth—contrary to Horizon’s contention, the affidavits of State Farm’s employees were sufficient to give rise to a presumption that the EUO scheduling letters and denial of claim forms as to the claims underlying those causes of action had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Thus, plaintiff has not demonstrated any basis to disturb so much of the order as granted the branches of State Farm’s cross motion seeking summary judgment dismissing those causes of action.
Accordingly, the order is affirmed.
TOUSSAINT, P.J., MUNDY and OTTLEY, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: April 14, 2023
Legal questions (4)
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.
Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?
This decision: The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice
Rejected the provider's contention and held the insurer's employee affidavits sufficient to presume timely mailing of the EUO scheduling letters and denial forms for the remaining causes of action.
Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 809 (this one included) are in the same category.
Is an IME/EUO no-show defense precluded if the insurer did not timely deny the claim on that ground?
This decision: Timely denial required as part of the no-show defense, and the insurer showed it (rules on the question, but another ground decided the case)
For the claims not covered by the declaratory judgment, held the insurer's affidavits raised a presumption that the denial forms were timely mailed, sustaining the EUO no-show dismissal.
Of the 508 decisions on this question in the Second Department courts and the Court of Appeals, 338 (this one included) are in the same category.
Did the insurer prove its IME/EUO no-show defense: mailed, compliant scheduling requests and the claimant’s nonappearance?
This decision: Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected (rules on the question, but another ground decided the case)
For the three causes of action outside the declaratory judgment, held the EUO scheduling letters presumptively timely mailed, leaving the no-show dismissal undisturbed.
Of the 858 decisions on this question in the Second Department courts and the Court of Appeals, 527 (this one included) are in the same category.
Does an insurer’s no-coverage declaratory judgment, or pending declaratory action, bar or stay a no-fault claimant’s action?
This decision: The DJ is given preclusive effect and bars every claim in the action that the court considered (rules on the question, but another ground decided the case)
Held four causes of action, matching the assignor, claims, loss date and service dates in the insurer's default declaratory judgment against the provider, barred by res judicata.
Of the 164 decisions on this question in the Second Department courts and the Court of Appeals, 101 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Horizon P.T. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50295(U)) FollowedThe provider's claims were barred by res judicata because a prior default declaratory judgment adjudicated the same bills.
- St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) FollowedThe insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.
Cited by
A label shows how the later decision treated this one.
- John A. Nasrinpay 2 v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 51833(U)) FollowedThe insurer's employee affidavits supported a presumption that the EUO scheduling letters and denial forms were timely mailed.
- Shafai Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50795(U)) FollowedThe provider's sixth cause of action was barred by res judicata, and its mailing challenge failed on the remaining claims.
- Shafai Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50796(U)) FollowedThe insurer's employee affidavit established a presumption of timely mailing of the EUO scheduling letters and denial forms.
Similar decisions
- New York Wellness PT, P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 50608(U))The insurer failed to prove the assignor's EUO nonappearances through personal knowledge or to establish timely denial after the alleged failures.
- Ahmed Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50276(U))The provider's first, second, third, fourth and sixth causes of action were barred by a prior default declaratory judgment.
- Actual Chiropractic, P.C. v State Farm Ins. (2019 NY Slip Op 50421(U))An insurer need not state objective reasons for requesting EUOs to establish entitlement to summary judgment for nonappearance.
- Bronx Chiropractic Care, P.C. v State Farm Ins. (2019 NY Slip Op 51041(U))The insurer's transfer of claims between offices and the location generating timely EUO letters did not raise a triable issue.
- Heal-Rite, P.T., P.C. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51246(U))The insurer established timely mailing of EUO scheduling letters and denials and sufficient proof of nonappearance.