December 7, 2018
A & F Med., P.C. v Global Liberty Ins. Co. of N.Y. (2018 NY Slip Op 51812(U))
https://www.beynensonlaw.com/case-law/a-f-med-p-c-v-global-liberty-ins-co-of-n-y-2018-ny-slip-op-51812u/
- Decided
- December 7, 2018
- Citation
- 2018 NY Slip Op 51812(U)
- Posture
- Summary judgment
- Outcome
- Provider prevailed
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 A & F Med., P.C. v Global Liberty Ins. Co. of N.Y. (2018 NY Slip Op 51812(U))
| A & F Med., P.C. v Global Liberty Ins. Co. of N.Y. |
| 2018 NY Slip Op 51812(U) |
| Decided on December 7, 2018 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
Decided on December 7, 2018
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHELLE WESTON, J.P., MICHAEL L. PESCE, BERNICE D. SIEGAL, JJ
2015-1045 K C
against
Global Liberty Ins. Co. of NY, Appellant.
Rossillo & Licata, P.C. (Nancy S. Linden of counsel), for appellant. Korsunskiy Legal Group, P.C. (Henry R. Guindi and Melissa Berkman 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 January 16, 2015, deemed from a judgment of that court entered March 9, 2015 (see CPLR 5501 [c]). The judgment, entered pursuant to the January 16, 2015 order denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment, awarded plaintiff the principal sum of $1,916.46.
ORDERED that the judgment is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint and plaintiff cross-moved for summary judgment. By order entered January 16, 2015, the Civil Court denied defendant’s motion and granted plaintiff’s cross motion. This appeal by defendant ensued. A judgment was subsequently entered on March 9, 2015, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).
Pursuant to 11 NYCRR 65—3.6 (b), upon sending a second examination under oath (EUO) scheduling letter to plaintiff’s assignor, defendant was required to send plaintiff a delay letter (see Doshi Diagnostic Imaging Servs. v State Farm Ins. Co., 16 Misc 3d 42 [App Term, 2d Dept, 9th & 10th Jud Dist 2007]; see also Advantage Radiology, P.C. v Nationwide Mut. Ins. Co., 55 Misc 3d 91 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]). However, it failed to do so. Consequently, defendant failed to demonstrate that it had properly tolled the time to pay or deny plaintiff’s claims and, as a result, it is precluded from raising its proferred defense that plaintiff’s assignor had failed to appear for duly scheduled EUOs (see Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 [2009]).
Accordingly, the judgment is affirmed.
WESTON, J.P., PESCE and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 07, 2018
Legal questions (2)
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.
Is an IME/EUO no-show defense precluded if the insurer did not timely deny the claim on that ground?
This decision: No-show defense is subject to preclusion and fails for want of a timely, proper denial
Held the insurer precluded from its EUO no-show defense because it sent the provider no delay letter with the second EUO letter, so it did not show the time to pay or deny was tolled.
Of the 508 decisions on this question in the Second Department courts and the Court of Appeals, 166 (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 did not show its requests met the regulatory timing, follow-up or justification requirements (rules on the question, but another ground decided the case)
Held the insurer's EUO no-show defense failed because it did not send the provider the delay letter required by 11 NYCRR 65-3.6 (b) when it sent the second EUO scheduling letter.
Of the 858 decisions on this question in the Second Department courts and the Court of Appeals, 102 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Doshi Diagnostic Imaging Servs. v State Farm Ins. Co. (2007 NY Slip Op 27193) FollowedAn insurer may request medical-necessity verification from a prescribing physician if it properly notifies the applicant of outstanding requests.
- Advantage Radiology, P.C. v Nationwide Mut. Ins. Co. (2017 NY Slip Op 27061)An insurer need not send counsel a delay letter when verification is sought directly from the provider.
- Westchester Med. Ctr. v Lincoln Gen. Ins. Co. (2009 NY Slip Op 02589) FollowedThe insurer's investigation letters did not toll the 30-day period to pay or deny the provider's claim.
Similar decisions
- A.C. Med., P.C. v Ameriprise Ins. Co. (2016 NY Slip Op 51787(U))The insurer failed to establish timely denials and was precluded from asserting the provider's EUO nonappearance defense.
- PR Med., P.C. v Travelers Home & Mar. Ins. Co. (2018 NY Slip Op 51649(U))The insurer established timely EUO notices and denials and the assignor's two nonappearances; the provider raised no triable issue.
- Oriental Health Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51761(U))The provider's challenge to ineffective delay letters did not defeat the insurer's summary judgment motion based on EUO nonappearance.
- Allay Med. Servs., P.C. v Metropolitan Gen. Ins. Co. (2019 NY Slip Op 51617(U))The insurer established timely EUO notices, the assignor's failure to appear twice, and timely denials based on those nonappearances.
- St. Locher Med., P.C. v IDS Prop. Cas. Ins. Co. (2017 NY Slip Op 50919(U))The insurer failed to establish timely EUO scheduling and denials, defeating its motion for summary judgment based on nonappearance.