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December 2, 2022

Healthwise Med. Assoc., P.C. v Nationwide Ins. (2022 NY Slip Op 51251(U))

https://www.beynensonlaw.com/case-law/healthwise-med-assoc-p-c-v-nationwide-ins-2022-ny-slip-op51251u/

Court
Appellate Term, Second Department
Decided
December 2, 2022
Citation
2022 NY Slip Op 51251(U)
Posture
Summary judgment
Outcome
Insurer prevailed
Later treatment
Contrasted (cf., but see) in 1 later decision (see Cited by)
Issues
Declaratory judgment, res judicata
Legal questions
Effect of insurer's declaratory judgment (see the maps)
Cite as
Healthwise Med. Assoc., P.C. v Nationwide Ins., 2022 NY Slip Op 51251(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022)

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 provider's claims were barred by a prior no-coverage declaration obtained by the appearing insurer, which proved it was the proper insurer. The provider sued a different named insurer, but the proper insurer voluntarily appeared, asserting that it had been incorrectly sued. It had already obtained an unopposed declaration in the Supreme Court, Nassau County, that it owed the provider and assignor no coverage for the loss. The Appellate Term, Second Department, added the appearing insurer to the caption and affirmed summary judgment dismissing the complaint, denial of the provider's cross motion and denial as moot of its separate motion to dismiss affirmative defenses. Res judicata applied because recovery would impair rights established by the declaration, and sufficient evidence identified the proper insurer.

Reported in New York Official Reports at Healthwise Med. Assoc., P.C. v Nationwide Ins. (2022 NY Slip Op 51251(U))

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

Healthwise Medical Associates, P.C., as Assignee of Rosa, Reynaldo, Appellant,

against

Nationwide Ins. and Harleysville Worcester Insurance Company, Respondents.

The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Hollander Legal Group, P.C. (Allan S. Hollander of counsel), for respondents.

Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), dated October 7, 2021. The order granted defendant’s motion for, in effect, summary judgment dismissing the complaint, denied plaintiff’s cross motion for summary judgment, and denied, as moot, plaintiff’s separate motion to dismiss the affirmative defenses.

ORDERED that, on the court’s own motion, the caption is amended to reflect the addition of Harleysville Worcester Insurance Company as a party defendant, and the caption has been amended accordingly; and it is further,

ORDERED that the order is affirmed, with $25 costs.

Healthwise Medical Associates, P.C. (Healthwise) commenced this action against defendant Nationwide Ins. (Nationwide) to recover assigned first-party no-fault benefits for medical services provided to its assignor, Reynaldo Rosa, as a result of injuries Rosa allegedly sustained in an automobile accident on July 6, 2016, under claim number 655439-GD. Harleysville Worcester Insurance Company (Harleysville) appeared in the action by serving and filing an answer in which it characterized itself as having been incorrectly sued as Nationwide, thereby agreeing that the allegations in the complaint were properly asserted against it.

Before Healthwise commenced this action, Harleysville had commenced a declaratory judgment action in Supreme Court, Nassau County, against Healthwise, among other providers, and its assignor, Rosa, alleging that Harleysville had no duty to pay no-fault benefits to the named defendants therein, as Rosa was not an eligible injured person pursuant to the no-fault regulations, and, thus, not covered under the insurance policy. In an order dated June 20, 2018 and entered August 29, 2018, the Supreme Court, upon defaults in appearing in the action by, insofar as is relevant here, both Rosa and Healthwise, granted an unopposed motion by Harleysville for summary judgment, declared “that Harleysville is not required to provide insurance coverage to [Rosa and Healthwise] for any claims arising out of the date of loss of July 6, 2016, Nationwide claim number 655439-GD.”

Harleysville thereafter moved in the Civil Court for, in effect, summary judgment dismissing the complaint on the ground that the instant action is barred by virtue of the order in the declaratory judgment action. Healthwise cross-moved for summary judgment and to dismiss Harleysville’s affirmative defenses. Healthwise also separately moved to dismiss Harleysville’s affirmative defenses. By order dated October 7, 2021, the Civil Court granted Harleysville’s motion, denied Healthwise’s cross motion for summary judgment, and also denied, as moot, Healthwise’s separate motion to dismiss the affirmative defenses. The court stated,

“Defendant has presented the Declaratory Judgment Order of the Supreme Court, County of Nassau, dated June 20, 2018, under Index Number 611998/2017, which declared that HARLEYSVILLE, a subsidiary company of NATIONWIDE and the underwriter of the subject policy of insurance, has no obligation to provide No-Fault reimbursement to Plaintiff with regard to the claims under NATIONWIDE claim number 655439-GD and the date of accident of July 6, 2016, at issue.”

Since Harleysville voluntarily appeared in this action and the Civil Court treated Harleysville Worcester Insurance Company as a proper defendant but the caption was not amended accordingly, on the court’s own motion, we amend the caption to reflect the addition of Harleysville Worcester Insurance Company as a party defendant.

On appeal, the only issue raised by Healthwise with respect to so much of the Civil Court’s order as granted Harleyville’s motion is whether the Supreme Court order entered August 29, 2018 should have res judicata effect on this action, thereby warranting the dismissal of the complaint herein. “Under the doctrine of res judicata, a final adjudication of a claim on the merits precludes relitigation of that claim and all claims arising out of the same transaction or series of transactions by a party or those in privity with a party” (Ciraldo v JP Morgan Chase Bank, N.A., 140 AD3d 912, 913 [2016]; see Matter of Hunter, 4 NY3d 260, 269 [2005]; Schuylkill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 [1929]). Upon a review of the record, we find that the Civil Court did not improvidently exercise its discretion in determining that Harleysville’s declaratory judgment order has res judicata effect on this action, as Harleysville proffered sufficient evidence to support its contention that it is “the proper insurer” (cf. Quality Health Supply Corp. v Hertz Co., 68 Misc 3d 131[A],[U] [App Term, 2d [*2]Dept, 2d, 11th & 13th Jud Dists 2020]). Under the circumstances presented, the Civil Court correctly granted Harleysville’s motion and, in effect, dismissed the complaint in its entirety, as any judgment in favor of Healthwise in this action would destroy or impair rights or interests established by the order in the declaratory judgment action (see Schuylkill Fuel Corp., 250 NY at 306-307; Flushing Traditional Acupuncture, P.C. v Kemper Ins. Co., 42 Misc 3d 133[A], 2014 NY Slip Op 50052[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]; EBM Med. Health Care, P.C. v Republic W. Ins., 38 Misc 3d 1, 2 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]).

Accordingly, the order is affirmed.

ALIOTTA, P.J., TOUSSAINT and BUGGS, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 2, 2022

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.

Effect of insurer's declaratory judgment

Open the full map

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

Held the default declaratory judgment obtained against the provider and its assignor res judicata on the action because the insurer submitted sufficient evidence that it was the proper insurer under the same claim number.

  • Appellate DivisionApp Div 4
  • Appellate TermApp Term 132
  • Trial courtsTrial 27
2021, Appellate Division: 1 decision (1 Stayed pending DJ)2016, Appellate Division: 1 decision (1 Stayed pending DJ)2015, Appellate Division: 1 decision (1 Stay denied)2025, Appellate Division: 1 decision (1 Barred by DJ)2023, Appellate Term: 7 decisions (5 Barred by DJ, 1 Not bound: parties, 1 DJ does not reach)2022, Appellate Term: 11 decisions (9 Barred by DJ, 1 DJ does not reach, 1 Stay denied)2021, Appellate Term: 11 decisions (8 Barred by DJ, 2 Not bound: parties, 1 DJ does not reach)2020, Appellate Term: 12 decisions (9 Barred by DJ, 1 Not bound: parties, 2 DJ does not reach)2019, Appellate Term: 15 decisions (7 Barred by DJ, 3 Not bound: parties, 1 DJ does not reach, 4 Stay denied)2018, Appellate Term: 11 decisions (7 Barred by DJ, 2 Not bound: parties, 2 DJ does not reach)2017, Appellate Term: 5 decisions (3 Barred by DJ, 2 DJ does not reach)2016, Appellate Term: 15 decisions (13 Barred by DJ, 1 Not bound: parties, 1 DJ does not reach)2015, Appellate Term: 14 decisions (11 Barred by DJ, 1 Not bound: parties, 2 DJ does not reach)2014, Appellate Term: 4 decisions (4 Barred by DJ)2013, Appellate Term: 3 decisions (1 Barred by DJ, 1 DJ does not reach, 1 Stayed pending DJ)2012, Appellate Term: 3 decisions (2 Barred by DJ, 1 Not bound: parties)2011, Appellate Term: 2 decisions (1 Barred by DJ, 1 DJ does not reach)2010, Appellate Term: 2 decisions (1 Not bound: parties, 1 Stayed pending DJ)2009, Appellate Term: 1 decision (1 Barred by DJ)2008, Appellate Term: 1 decision (1 Not bound: parties)2024, Appellate Term: 3 decisions (1 Not bound: parties, 2 DJ does not reach)2025, Appellate Term: 11 decisions (1 Barred by DJ, 1 Barred in part, 1 Not bound: parties, 8 DJ does not reach)2026, Appellate Term: 1 decision (1 Not bound: parties)2023, Trial courts: 1 decision (1 DJ does not reach)2022, Trial courts: 3 decisions (2 Barred by DJ, 1 Not bound: parties)2021, Trial courts: 4 decisions (4 Barred by DJ)2020, Trial courts: 1 decision (1 Barred by DJ)2019, Trial courts: 1 decision (1 Barred by DJ)2018, Trial courts: 1 decision (1 Barred by DJ)2013, Trial courts: 2 decisions (2 Barred by DJ)2011, Trial courts: 2 decisions (1 Barred by DJ, 1 Stayed pending DJ)2009, Trial courts: 1 decision (1 Stayed pending DJ)2008, Trial courts: 1 decision (1 Not bound: parties)2007, Trial courts: 2 decisions (1 Barred by DJ, 1 Stayed pending DJ)2006, Trial courts: 1 decision (1 Not bound: parties)2024, Trial courts: 2 decisions (1 Barred by DJ, 1 DJ does not reach)2026, Trial courts: 4 decisions (3 Barred by DJ, 1 Stay denied)2012, Trial courts: 1 decision (1 Stay denied)This decision
2010201520202025
Barred by DJBarred in partNot bound: partiesDJ does not reachStayed pending DJStay deniedThis decisionCites it or cited by itCited or followedDistinguished or limited

Of the 163 decisions on this question in the Second Department courts and the Court of Appeals, 100 (this one included) are in the same category.

Cited in this decision

A label shows how this decision treated the case it cites.

  • Quality Health Supply Corp. v Hertz Co. (2020 NY Slip Op 50996(U)) Contrasted (cf., but see)The defendant failed to support substitution of a different entity or show that a declaratory judgment barred the provider's claims.
  • Flushing Traditional Acupuncture, P.C. v Kemper Ins. Co. (2014 NY Slip Op 50052(U))The provider's no-fault action was barred by res judicata because a default declaratory judgment denied its right to benefits.
  • EBM Med. Health Care, P.C. v Republic W. Ins. (2012 NY Slip Op 22300)An unvacated default declaratory judgment has res judicata effect in a provider's pending no-fault action.

Cited by

A label shows how the later decision treated this one.

  • Horizon P.T. Care, P.C. v Kemper Ins. Co. (2025 NY Slip Op 50823(U)) Contrasted (cf., but see)The insurer failed to establish that a default declaratory judgment obtained by another insurer barred the provider's claims.

Similar decisions

  • Allay Med. Servs., P.C. v Nationwide Ins. (2021 NY Slip Op 50086(U))The provider's action was barred by res judicata because the prior declaratory judgment covered the same claim and accident.
  • Metro Health Prods., Inc. v Nationwide Ins. (2016 NY Slip Op 51122(U))An unpleaded res judicata defense may support summary judgment when it causes no surprise or prejudice to the opposing party.
  • Horizon P.T. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2023 NY Slip Op 50295(U))The provider's claims were barred by res judicata because a prior default declaratory judgment adjudicated the same bills.
  • Ahava Med. Diagnostic, P.C. v Hertz Co. (2022 NY Slip Op 50298(U))A prior no-coverage declaratory judgment retains its binding effect even if notice of entry is served after a provider's default judgment.
  • St. Mark’s Med. Health Care, PLLC v 21st Century Ins. Co. (2020 NY Slip Op 50851(U))An unvacated default declaratory judgment can bar a provider's later no-fault action under res judicata.
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