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February 8, 2019

Atlantic Chiropractic, P.C. v Utica Mut. Ins. Co. (2019 NY Slip Op 50173(U))

https://www.beynensonlaw.com/case-law/atlantic-chiropractic-p-c-v-utica-mut-ins-co-2019-ny-slip-op50173u/

Court
Appellate Term, Second Department
Decided
February 8, 2019
Citation
2019 NY Slip Op 50173(U)
Posture
Summary judgment
Outcome
Insurer prevailed
Later treatment
Followed in 1 later decision (see Cited by)
Issues
Declaratory judgment, res judicata Discovery and procedure
Legal questions
Effect of insurer's declaratory judgment (see the maps)
Cite as
Atlantic Chiropractic, P.C. v Utica Mut. Ins. Co., 2019 NY Slip Op 50173(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019)

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 insurer did not waive res judicata by answering before entry of the declaratory judgment on which that defense depended. A default declaratory judgment relieved the insurer of paying benefits to the provider and assignor because the alleged accident was staged and outside coverage. The provider showed no prejudice or surprise from amendment, and the insurer established that the defense had merit. Under CPLR 3025 (b), leave to amend should therefore have been granted. The unvacated default judgment barred recovery that would impair the rights it established. The Appellate Term, Second Department, reversed, granted leave to add res judicata, deemed the amended answer timely served nunc pro tunc, and granted the insurer summary judgment dismissing the complaint.

Reported in New York Official Reports at Atlantic Chiropractic, P.C. v Utica Mut. Ins. Co. (2019 NY Slip Op 50173(U))

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

Atlantic Chiropractic, P.C., as Assignee of Kenya Peavy, Respondent,

against

Utica Mutual Ins. Co., Appellant.

Bruno, Gerbino & Soriano, LLP (Nathan Shapiro of counsel), for appellant. Zara Javakov, P.C. (Zara Javakov of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered December 17, 2014. The order denied defendant’s motion for leave to amend its answer, pursuant to CPLR 3025 (b), to add, among other things, the affirmative defense of res judicata, to deem the amended answer served nunc pro tunc and, in effect, for summary judgment dismissing the complaint on the ground that plaintiff’s action is barred based on that doctrine.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for leave to amend its answer, pursuant to CPLR 3025 (b), to add, among other things, the affirmative defense of res judicata, to deem the amended answer served nunc pro tunc and in effect, for summary judgment dismissing the complaint on the ground that plaintiff’s action is barred based on that doctrine is granted.

Plaintiff commenced this action in the Civil Court in August 2011 to recover assigned first-party no-fault benefits. On November 21, 2011, the insurer commenced a declaratory judgment action in the Supreme Court, Nassau County, and, approximately two weeks later, on December 8, 2011, served an answer in the Civil Court action. In a declaratory judgment entered May 7, 2013 upon the failure of plaintiff and its assignor to appear and answer the complaint, the Supreme Court declared, among other things, that the insurer is not required to pay no-fault benefits to the provider and its assignor on the ground that the alleged accident was a staged incident and, therefore, was not covered under the policy in question. Thereafter, the insurer moved in the Civil Court for leave to amend its answer to include, insofar as is relevant, the affirmative defense of res judicata, to deem the amended answer timely served nunc pro tunc, and, in effect, for summary judgment dismissing the complaint on the ground that plaintiff’s action in the Civil Court is barred under the doctrine of res judicata. Plaintiff opposed the [*2]motion. By order dated December 17, 2014, the Civil Court denied defendant’s motion, finding that defendant had waived its res judicata defense by submitting its answer in the Civil Court after it had commenced the declaratory judgment action.

Generally, leave to amend a pleading pursuant to CPLR 3025 (b) should be granted where there is no significant prejudice or surprise to the opposing party and where the proof submitted in support of the motion indicates that the amendment may have merit (see Edenwald Contr. Co. v City of New York, 60 NY2d 957, 959 [1983]; Ingrami v Rovner, 45 AD3d 806, 808 [2007]). In opposition to defendant’s motion, plaintiff failed to demonstrate any prejudice (see Barrett v Kasco Constr. Co., 84 AD2d 555, 556 [1981], affd 56 NY2d 830 [1982]) or surprise (see CPLR 3018 [b]; Rogoff v San Juan Racing Assn., 77 AD2d 831, 832 [1980], affd 54 NY2d 883 [1981]; Renelique v State-Wide Ins. Co., 50 Misc 3d 137[A], 2016 NY Slip Op 50096[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]) as a result of the proposed amendment to the answer, while defendant established that the proposed affirmative defense had merit. Contrary to the determination of the Civil Court that defendant had waived its defense of res judicata, defendant had no basis to assert that defense before May 7, 2013, when the declaratory judgment was entered in the Supreme Court (see Metro Health Prods., Inc. v Nationwide Ins., 52 Misc 3d 138[A], 2016 NY Slip Op 51122[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]; Renelique, 50 Misc 3d 137[A], 2016 NY Slip Op 50096[U]). Consequently, the Civil Court should have granted the branches of defendant’s motion seeking leave to amend the answer to include the res judicata defense and to deem the answer timely served nunc pro tunc.

“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, 913-914 [2016]; see Matter of Hunter, 4 NY3d 260, 269 [2005]; Schuylkill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 [1929]). It is well settled that default judgments which have not been vacated can have res judicata effect (see Lazides v P & G Enters., 58 AD3d 607 [2009]; Matter of Allstate Ins. Co. v Williams, 29 AD3d 688, 690 [2006]; Matter of Eagle Ins. Co. v Facey, 272 AD2d 399 [2000]; Ava Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co., 34 Misc 3d 149[A], 2012 NY Slip Op 50233[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]). In light of the Supreme Court declaratory judgment, we reverse the order and grant the branch of defendant’s motion seeking, in effect, summary judgment dismissing the complaint as barred (see Active Chiropractic, P.C. v Allstate Ins., 58 Misc 3d 156[A], 2018 NY Slip Op 50201[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018]; Metro Health Prods., Inc. v Nationwide Ins., 52 Misc 3d 138[A], 2016 NY Slip Op 51122[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]; J.K.M. Med. Care, P.C. v Liberty Mut. Fire Ins. Co., 52 Misc 3d 137[A], 2016 NY Slip Op 51071[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]; Renelique, 50 Misc 3d 137[A], 2016 NY Slip Op 50096[U]; EBM Med. Health Care, P.C. v Republic W. Ins., 38 Misc 3d 1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]), as any judgment in favor of plaintiff in the present action would destroy or impair rights or interests established by the judgment in the declaratory judgment action (see Schuylkill Fuel Corp., 250 NY 304; 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., 38 Misc 3d 1).

Accordingly, the order is reversed and defendant’s motion for leave to amend its answer pursuant to CPLR 3025 (b) to add, among other things, the affirmative defense of res judicata, to deem the proposed amended answer timely served nunc pro tunc and, in effect, for summary judgment dismissing the complaint on the ground that plaintiff’s action is barred is granted.

PESCE, P.J., WESTON and ALIOTTA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: February 08, 2019

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 that a default declaratory judgment against the provider and its assignor, declaring the accident staged and uncovered, barred the earlier-commenced action by res judicata; the defense was not waived, since it arose only when the judgment was entered.

  • Appellate DivisionApp Div 4
  • Appellate TermApp Term 132
  • Trial courtsTrial 28
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: 5 decisions (4 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 followed

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

  • Renelique v State-Wide Ins. Co. (2016 NY Slip Op 50096(U))An unpleaded res judicata defense may support summary judgment absent surprise or prejudice to the opposing party.
  • 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.
  • Ava Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50233(U))An unvacated default declaratory order barring no-fault benefits is a final determination that can preclude a provider's action under res judicata.
  • Active Chiropractic, P.C. v Allstate Ins. (2018 NY Slip Op 50201(U))An unpleaded res judicata defense may support summary judgment absent surprise or prejudice to the opposing party.
  • J.K.M. Med. Care, P.C. v Liberty Mut. Fire Ins. Co. (2016 NY Slip Op 51071(U))The insurer's answer was deemed amended to assert res judicata because the provider alleged no surprise or prejudice from that defense.
  • 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.
  • 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.

Cited by

A label shows how the later decision treated this one.

  • Psychology After Acc., P.C. v State Farm Fire & Cas. Ins. Co. (2019 NY Slip Op 51932(U)) FollowedA declaratory judgment entered on default may bar a provider's no-fault action under res judicata.
  • Sutter Pharmacy v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op 50610(U))The insurer's late, successive summary judgment motion was granted based on a subsequent declaratory judgment barring coverage.

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.
  • J.C. Healing Touch Rehab, P.C. v 21st Century Ins. Co. (2020 NY Slip Op 51296(U))The insurer's later summary judgment motion was permissible, and a declaratory judgment barred the provider's claims under res judicata.
  • 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.
  • ZG Chiropractic Care, P.C. v 21st Century Ins. Co. (2021 NY Slip Op 50079(U))The insurer justified vacating its default through an existing stay and obtained dismissal based on a preclusive declaratory judgment.
  • 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.
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