Neighborhood Med. Health Care, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2026 NY Slip Op 51600(U))

Reported in New York Official Reports at Neighborhood Med. Health Care, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2026 NY Slip Op 51600(U))

Civil Court of the City of New York, Kings County

Decided on September 16, 2026

Index No. CV-733224-20/KI

Sandra Elena Roper, J.

Recitation as required by CPLR § 2219(a) of the papers considered in review of this Motion:

Papers:

Notice of Motion and Affidavits Annexed 1

Notice of Cross Motion and Affidavits Annexed 2

Defendant’s Affirmation in Opposition and Reply 3

Plaintiff’s Memorandum of Law 4

Defendant’s Memorandum of Law 5

Upon the foregoing cited papers, Defendant’s Motion for Summary Judgment and Plaintiff’s Cross-Motion for Summary Judgment, after oral arguments heard September 15, 2026, and July 29, 2026, are decided as follows:

Defendant’s Motion for Summary Judgment is GRANTED in its entirety, and Plaintiff’s Cross Motion for Summary Judgment is DENIED as moot in its entirety.

The instant claim is in the amount of $196.22 for date of service January 14, 2020, to January 27, 2020, for services rendered to Plaintiff’s assignor, Ramona Del Carmen Peralta, under claim number 52-9025-J24. Plaintiff’s bill included two columns for charges: the “charge [*2]for each procedure,” which totaled $204.34 and was relied upon by State Farm, and the “total charge per day,” which totaled $196.22, and was relied upon by Plaintiff as the “billed amount.”

Defendant argues that Plaintiff’s claim is barred by the Kings County action Declaratory Action, State Farm Mut. Auto. Ins. Co. v. Neighborhood Med. Health Care, P.C., Index No. 522495/2020 (the “DJ Action”). In that case, the Supreme Court decided:

“Neighborhood Medical Health Care, P.C. has no right to receive payment for the bills submitted to SFMAIC and SFFCC and listed in “Exhibit 1″ of the Summons and Verified Complaint because Neighborhood Medical Health Care, P.C. failed and/or refused to appear for an EUO requested by SFMAIC and SFFCC, and thus breached a condition of coverage and violated its obligations under the No-Fault Laws.”

The Declaratory Action’s Summons and Verified Complaint included a chart of claims, annexed as Exhibit “1,” which included bill amounts, EUO scheduling letters with dates, and claim numbers for each assignor (“EIP”) that it identified by a set of initials.

Under claim number 529025J24, Exhibit “1” contains the following rows (selected columns):

Plaintiff argues the following:

(1) Claim number 529025J24 appears on Exhibit “1” in association with five (5) different sets of initials: “EC,” “FB,” “JMR,” “IMR” and “RDP.” The NF-10 identifies the policyholder under that claim as Edwin Carrasco (NY St Cts Elec Filing [NYSCEF], Doc No. 6).

(2) The dates of service in suit, January 14, 2020, to January 27, 2020, appear on two rows of Exhibit “1,” one coded “IMR” and one coded “RDP,” which are identical in [*4]every column shown, including an Amount Billed of $204.34. The rows coded “RDP” and “JMR” for December 10, 2019 are likewise identical, each at $64.31.

(3) No row of Exhibit “1” lists an amount of $196.22.

(4) The line charges on the NF-3 sum to $204.34. The difference between that sum and the $196.22 total stated on the NF-3 is $8.12, attributable to the January 14, 2020, date of service, for which the line charges sum to $75.72, and the stated charge is $67.60. Defendant’s Explanation of Review cites Ground Rule 11 of the Physical Medicine section of the Workers’ Compensation Medical Fee Schedule (reason code 133) as to that date of service (NY St Cts Elec Filing [NYSCEF], Doc No. 6).

(5) For the rows with an approximate date of mailing of February 24, 2020, including the two rows bearing the dates of service in suit, the “1st EUO Letter” and “1st EUO Date” columns are blank.

(6) The EUO letter appendices identify an eligible injured person “IDELMI M RODRIGUEZ,” who appears on Exhibit “1” under “JMR” for the December 10, 2019 date of service and under “IMR” for the January 14-27, 2020. dates of service (NY St Cts Elec Filing [NYSCEF] Doc Nos. 4, 6).

The assignor in this instant matter is identified in the record by the following forms of names and by the disputed initials of “RDP” contained in Exhibit 1 of the Declaratory Judgment.

It is upon this disputed “RDP” initials that Plaintiff argues creates a triable issue of fact to defeat Defendant’s motion for summary judgment premised upon Res Judicata and Collateral Estoppel relief. Plaintiff argues that “RDP” is not the initials of the assignor because “D” is not part of her actual name. Whereas Defendant argues that “RDP” sufficiently identifies the assignor in this case, Ramona Del Carmen Peralta, particularly in light of among other identifying connecting markers: the amount included in the Declaratory Judgment is reflective of the total charges identified in Plaintiff’s created bill for this assignor under the “charge for each procedure” column; the identical claim number; the EUO scheduling letter dates; and the denial date (see, Allay Med. Servs., P.C. v Nationwide Ins., 70 Misc 3d 139[A], 2021 NY Slip Op 50087[U] [App Term 2021]).

Indeed, a novel issue which turns upon the stylistic rules in which Spanish names may properly be abbreviated as initials. Plaintiff may be correct that “D” in R”D”P which represents Spanish “Del” in assignor’s name, Ramona “Del” Carmen Peralta is not part of her actual name per se.^FN1 However, since there are no strict rules on abbreviated initials of Spanish names containing the preposition “Del” Defendant’s inclusion of “D” in “RDP” is not a fatally defective identifier in Exhibit 1, nor does it establish a triable issue of fact as argued by Plaintiff. “RDP” is but one of the permissible permutations of assignor’s abbreviated name initials in Spanish, with or without the “D”. It is herein opined that insurer’s inartful drafting of the Declaratory Judgment summons and complaint resulted in this avoidable protracted disputed Spanish language naming issue. Nevertheless, Defendant Insurer’s argument: as to the totality of the identifiable information, including consistent claim number, EUO scheduling letter dates, denial dates, bill amount in the record, and a proper permissible permutation of assignor’s Spanish abbreviated initials, provides sufficient corroborating identifying information in order to find that the instant claim and assignor are identical to the claimant in the Declaratory Judgment action; prevails here (see, id.). Plaintiff’s argument as to an alleged discrepancy between the amount listed on Plaintiff’s created bill and the amount listed in the Declaratory Judgment is rejected as mathematically unsound. The total charges listed in the “charge for each procedure” column as listed on Plaintiff’s created bill does in fact mathematically total $204.34, which Defendant properly included in the Declaratory Judgment.

Therefore, Plaintiff’s recovery is barred by the doctrines of Res Judicata and Collateral Estoppel. Defendant’s Motion for Summary Judgment is Granted. Plaintiff’s Cross Motion is Denied as moot. This case is dismissed with prejudice.

This constitutes Decision and Order of This Court.

Date: September 16, 2026

Brooklyn, New York

Hon. Sandra Elena Roper, JCC