November 24, 2020
Unitrin Direct Ins. Co. v Beckles (2020 NY Slip Op 06974)
https://www.beynensonlaw.com/case-law/unitrin-direct-ins-co-v-beckles-2020-ny-slip-op-06974/
- Decided
- November 24, 2020
- Citation
- 2020 NY Slip Op 06974 · 188 AD3d 620
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Followed in 2 later decisions (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 Unitrin Direct Ins. Co. v Beckles (2020 NY Slip Op 06974)
| Unitrin Direct Ins. Co. v Beckles |
| 2020 NY Slip Op 06974 [188 AD3d 620] |
| November 24, 2020 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| Unitrin Direct Insurance Company, Appellant, v Alan Dennis Beckles, M.D., et al., Defendants, and Jules Francois Parisien, M.D., et al., Respondents. |
Goldberg, Miller & Rubin P.C., New York (Eli Shmulik and Harlan R. Schreiber of counsel), for appellant.
The Rybak Firm PLLC, Brooklyn (Maksim Leyvi of counsel), for respondents.
Order, Supreme Court, New York County (Melissa A. Crane, J.), entered on or about November 1, 2019, which denied summary judgment on plaintiff’s first cause of action for a declaration disclaiming coverage for no-fault benefits sought by defendants-respondents Jules Francois Parisien, M.D. and SP Orthotic Surgical & Medical Supply, Inc., unanimously reversed, on the law, with costs, the motion granted, and it is declared that plaintiff has no coverage obligation for no-fault benefits sought by the defendants-respondents. The Clerk is directed to enter judgment accordingly.
Where, as here, the insurer submits evidence of a medical provider claim (NF-3), the timely request for an independent medical examination (IME) of the injured claimant within 15 days of the receipt of that claim, and the injured claimant is a no-show at two duly noticed IMEs, the basis for disclaimer of coverage is established, as a matter of law, and summary judgment is properly awarded to the insurer with respect to further coverage obligations and reimbursement of outstanding medical bills with respect to all treating providers (see Kemper Independence Ins. Co. v Adelaida Physical Therapy, P.C., 147 AD3d 437 [1st Dept 2017]; National Liab. & Fire Ins. Co. v Tam Med. Supply Corp., 131 AD3d 851 [1st Dept 2015]). Concur—Renwick, J.P., Kapnick, Gesmer, Kern, JJ.
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 proved mailed, compliant requests and the nonappearance; claimant's answers rejected
Held the insurer established its disclaimer as a matter of law by showing a provider claim, a timely IME request within 15 days of its receipt, and the claimant's nonappearance at two duly noticed IMEs.
Of the 164 decisions on this question in the First Department courts and the Court of Appeals, 93 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Kemper Independence Ins. Co. v Adelaida Physical Therapy, P.C. (2017 NY Slip Op 00916) FollowedThe insurer failed to establish whether its EUO notices were subject to regulatory deadlines or complied with applicable deadlines.
- National Liab. & Fire Ins. Co. v Tam Med. Supply Corp. (2015 NY Slip Op 06763) FollowedThe insurer failed to establish that it requested the assignor's EUO within the regulatory time frame.
Cited by
A label shows how the later decision treated this one.
- Country-Wide Ins. Co. v Duff (2022 NY Slip Op 51289(U)) FollowedAn assignor's two unjustified IME nonappearances defeat all providers' claims when the IME was duly scheduled within 15 days of an NF-3 claim's receipt.
- Country-Wide Ins. Co. v Ware (2021 NY Slip Op 50506(U)) FollowedAn assignor's failure to appear twice for timely and properly scheduled IMEs voids the policy from inception for all claims.
- State Farm Fire & Cas. Co. v Blackburn (2023 NY Slip Op 50745(U))The insurer established EUO nonappearance defenses against seven providers, but one provider's binding claim withdrawal eliminated any controversy.
Similar decisions
- Unitrin Advantage Ins. Co. v Cohen & Kramer M.D., P.C. (2020 NY Slip Op 06474)The insurer proved mailing of IME notices and the claimant's three nonappearances despite an incorrect floor designation.
- Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC (2011 NY Slip Op 01948)An assignor's failure to attend required IMEs permits retroactive denial of no-fault claims regardless of denial timeliness.
- Nationwide Gen. Ins. Co. v Gaines (2025 NY Slip Op 01896)IME notices sent before receipt of claims are not subject to the verification notification requirements of 11 NYCRR 65-3.5 and 65-3.6.
- Unitrin Advantage Ins. Co. v All of NY, Inc. (2018 NY Slip Op 00810)The insurer's EUO defense failed for four claims because of untimely scheduling notices or insufficient denial grounds.
- Hereford Ins. Co. v Lida’s Med. Supply, Inc. (2018 NY Slip Op 03226)The insurer's scheduling letters, service affidavits, and medical professionals' affidavits established the claimants' IME nonappearances.