July 14, 2015

Great Health Care Chiropractic, P.C. v Progressive Ins. Co. (2015 NY Slip Op 51077(U))

https://www.beynensonlaw.com/case-law/great-health-care-chiropractic-p-c-v-progressive-ins-co-2015-ny-slip-op-51077u/

Court: Appellate Term, Second Department
Decided: July 14, 2015
Citation: 2015 NY Slip Op 51077(U)
Posture: Summary judgment
Outcome: Insurer prevailed
Later treatment: Followed in 1 later decision (see Cited by)
Issues: Declaratory judgment, res judicata
Legal questions: Effect of insurer's declaratory judgment (see the maps)

Cite as

Great Health Care Chiropractic, P.C. v Progressive Ins. Co., 2015 NY Slip Op 51077(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015)

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 provider's no-fault action was barred by res judicata under an unvacated default declaratory judgment denying benefits from the accident. The insurer's declaratory action in Supreme Court, Nassau County, alleged a fraudulent insurance scheme involving three accidents. The resulting judgment declared that the provider and other providers were not entitled to benefits from those accidents. Following EBM Med. Health Care, P.C. v Republic W. Ins., the declaration remained conclusive despite entry on default, and recovery would impair rights established by it. After consolidation of three benefits actions for disposition of the insurer's motion, the Appellate Term, Second Department, affirmed the order, insofar as appealed from, granting summary judgment dismissing this provider's complaint.

Reported in New York Official Reports at Great Health Care Chiropractic, P.C. v Progressive Ins. Co. (2015 NY Slip Op 51077(U))

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

Great Health Care Chiropractic, P.C. as Assignee of ANTHONY MATHEWS, Appellant,
against
Progressive Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered January 29, 2013. The order, insofar as appealed from, upon granting the branch of defendant’s motion seeking to consolidate three actions for purposes of disposition of the branch of defendant’s motion seeking summary judgment dismissing the complaints therein, granted the branch of defendant’s motion seeking summary judgment dismissing the complaint in the above-captioned action.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits for services rendered to its assignor, who had allegedly sustained injuries in a motor vehicle accident on February 19, 2011, defendant moved to consolidate the instant action with two other actions and for summary judgment dismissing the complaint in each of the three actions, contending that each action is barred by virtue of a default judgment in a Supreme Court declaratory judgment action. Plaintiff appeals from so much of an order of the Civil Court as, upon consolidating the three actions for purposes of disposition of the motion, granted the branch of defendant’s motion seeking summary judgment dismissing the complaint in the above-captioned action.

The record indicates that defendant commenced a declaratory judgment action in Supreme Court, Nassau County, against plaintiff and a number of other providers, as well as a number of allegedly injured assignors, asserting a fraudulent insurance scheme involving three separate car accidents, including the accident on February 19, 2011. In a judgment entered on default on April 16, 2012, the Supreme Court declared that plaintiff and a number of other providers were not entitled to recover no-fault benefits arising out of the three accidents. In light of the default declaratory judgment, the present action is barred under the doctrine of res judicata (see EBM Med. Health Care, P.C. v Republic W. Ins., 38 Misc 3d 1 [App Term, 2d, 11th & 13th Jud Dists 2012]; 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, 11th & 13th Jud Dists 2012]), as any judgment in favor of plaintiff in the instant action would destroy or impair rights or interests established by the Supreme Court judgment (see SZ Med., P.C. v Erie Ins. Co., 24 Misc 3d 126[A], 2009 NY Slip Op 51221[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). “[A] declaratory judgment is a conclusive final determination, notwithstanding that it was entered on default, since res judicata [*2]applies to a judgment taken by default which [as in the present case] has not been vacated” (EBM Med. Health Care, P.C. v Republic W. Ins., 38 Misc 3d at 3).

Accordingly, the order, insofar as appealed from, is affirmed.

Weston, J.P., Aliotta and Elliot, JJ., concur.

Decision Date: July 14, 2015

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 the action barred by res judicata because the unvacated default declaratory judgment declared the provider not entitled to benefits arising from the accidents in the alleged fraud scheme.

Barred by DJBarred in partNot bound: partiesDJ does not reachStayed pending DJStay deniedThis decisionCites it or cited by itCited or followed

Of the 152 decisions on this question in the Second Department courts and the Court of Appeals, 98 (this one included) are in the same category.

Cited in this decision

A label shows how this decision treated the case it cites.

EBM Med. Health Care, P.C. v Republic W. Ins. (2012 NY Slip Op 22300) FollowedAn unvacated default declaratory judgment has res judicata effect in a provider's pending no-fault action.
Ava Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50233(U)) FollowedAn unvacated default declaratory order barring no-fault benefits is a final determination that can preclude a provider's action under res judicata.
SZ Med., P.C. v Erie Ins. Co. (2009 NY Slip Op 51221(U)) FollowedThe providers' no-fault action was barred by res judicata because a prior declaratory judgment resolved coverage for the same accident.

Cited by

A label shows how the later decision treated this one.

Kerisli Chiropractic, P.C. v American Tr. Ins. Co. (2018 NY Slip Op 28325) FollowedA default declaratory order specifying the parties' rights has res judicata effect when it remains unvacated.
Total Chiropratic P.C. v Mercury Cas. Ins. Co. (2021 NY Slip Op 50142(U))The provider's claims were barred by an unvacated default declaratory judgment determining coverage against both provider and assignor.

Similar decisions

Vital Meridian Acupuncture, P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51078(U))An unvacated default declaratory judgment barring a provider's recovery of no-fault benefits precludes its action for those benefits under res judicata.
Vital Meridian Acupuncture, P.C. v Republic W. Ins. Co. (2015 NY Slip Op 50222(U))A default declaratory judgment conclusively determining no obligation to pay no-fault benefits bars a contrary recovery under res judicata.
Atlantic Chiropractic, P.C. v Liberty Mut. Fire Ins. Co. (2016 NY Slip Op 51072(U))An entered default declaratory judgment barring no-fault coverage has preclusive effect even without service of notice of entry.
Active Chiropractic, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 50200(U))An order granting entry of a default judgment without declaring the parties' rights has no preclusive effect in a no-fault action.
Ultimate Health Prods., Inc. v American Tr. Ins. Co. (2015 NY Slip Op 50906(U))The provider's benefits action was barred by res judicata under an unvacated default declaratory order denying no-fault coverage.