June 23, 2017

Island Life Chiropractic, P.C. v Commerce Ins. Co. (2017 NY Slip Op 50856(U))

https://www.beynensonlaw.com/case-law/island-life-chiropractic-p-c-v-commerce-ins-co-2017-ny-slip-op50856u/

Court: Appellate Term, Second Department
Decided: June 23, 2017
Citation: 2017 NY Slip Op 50856(U) · 56 Misc 3d 129(A)
Posture: Summary judgment
Outcome: Provider prevailed
Issues: Policy issues
Legal questions: Exhaustion of policy limits (see the maps)

Cite as

Island Life Chiropractic, P.C. v Commerce Ins. Co., 56 Misc 3d 129(A), 2017 NY Slip Op 50856(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017)

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 failed to establish that policy limits were exhausted when the provider's claim became complete. Seeking summary judgment, the insurer asserted exhaustion under a Massachusetts-issued policy that it acknowledged provided personal injury protection benefits pursuant to New York law. It contended that claims exceeded the available coverage and that it had paid the policy limit in accordance with 11 NYCRR 65-3.15. Under that regulation and Nyack Hosp. v General Motors Acceptance Corp., however, it did not establish exhaustion at the relevant time. The Appellate Term, Second Department, reversed the order granting the insurer summary judgment and denied its motion.

Reported in New York Official Reports at Island Life Chiropractic, P.C. v Commerce Ins. Co. (2017 NY Slip Op 50856(U))

[*1]

Island Life Chiropractic, P.C. v Commerce Ins. Co.

2017 NY Slip Op 50856(U) [56 Misc 3d 129(A)]

Decided on June 23, 2017

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 23, 2017

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

PRESENT: : DAVID ELLIOT, J.P., MICHAEL L. PESCE, MARTIN M. SOLOMON, JJ
2014-1875 Q C

Island Life Chiropractic, P.C., as Assignee of Joseph, Jude, Appellant,
against
Commerce Ins. Co., Respondent.

The Rybak Firm, PLLC (Damin J. Toell, Esq.), for appellant. Bruno, Gerbino & Soriano, LLP (Mitchell L. Kaufman, Esq.), for respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Jodi Orlow, J.), entered June 25, 2014. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint.

Defendant’s motion sought summary judgment on the ground that the amount of available coverage had been exhausted. Although the insurance policy had been issued in Massachusetts, defendant acknowledged that, pursuant to New York law, the insurance policy provided $50,000 in personal injury protection benefits. Defendant further contended that claims exceeding $50,000 had been received and that defendant had paid $50,000 in accordance with 11 NYCRR 65-3.15. However, defendant failed to establish, as a matter of law, an exhaustion of the [*2]coverage limits of the insurance policy at issue, as defendant did not demonstrate that the policy had been exhausted at the time the claim at issue was complete (see 11 NYCRR 65-3.15; Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294 [2007]). Consequently, defendant did not establish its entitlement to summary judgment dismissing the complaint.

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.

ELLIOT, J.P., PESCE and SOLOMON, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 23, 2017

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.

Exhaustion of policy limits

Open the full map

Did the insurer prove the policy’s no-fault limits were properly exhausted before it became obligated to pay the claim?

This decision: Insurer's proof did not establish exhaustion (or compliance with 65-3.15); defense fails on this record

Held the insurer failed to establish exhaustion of the $50,000 coverage as a matter of law because it did not demonstrate the policy had been exhausted when the claim at issue was complete.

Limits exhaustedCoverage left when dueExhaustion not provedTriable issue / hearingDefense not heardThis decisionCites it or cited by itCited or followed

Of the 68 decisions on this question in the Second Department courts and the Court of Appeals, 34 (this one included) are in the same category.

Cited by

American Tr. Ins. Co. v Trinity Pain Mgt. of Staten Is., PLLC (2023 NY Slip Op 51337(U))The insurer's petition to vacate a no-fault award was denied because its policy-exhaustion evidence was insufficient.

Similar decisions

Island Life Chiropractic, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51465(U))The insurer was granted summary judgment because its proof established that it had issued no policy covering the loss.
Island Life Chiropractic, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51824(U))The provider failed to establish that its claims were denied late or that timely denials were conclusory, vague or legally meritless.
Island Life Chiropractic, P.C. v National Liab. & Fire Ins. Co. (2017 NY Slip Op 51843(U))The insurer failed to prove mailing of IME notices, and the provider failed to establish its prima facie entitlement to summary judgment.
Island Life Chiropractic, P.C. v Omni Indem. Co. (2017 NY Slip Op 51258(U))The insurer's summary judgment dismissing the complaint was affirmed on its defense that it had issued no policy covering the loss.
Island Life Chiropractic, P.C. v Travelers Ins. Co. (2016 NY Slip Op 51413(U))The provider's mailing affidavit raised a factual issue whether the insurer received requested verification, precluding dismissal as premature.