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March 12, 2013

Ideal Med. Supply v Mercury Cas. Ins. Co. (2013 NY Slip Op 23068)

https://www.beynensonlaw.com/case-law/ideal-med-supply-v-mercury-cas-ins-co-2013-ny-slip-op-23068/

Court
Appellate Term, First Department
Decided
March 12, 2013
Citation
2013 NY Slip Op 23068 · 39 Misc 3d 15
Posture
Summary judgment
Outcome
Provider prevailed
Later treatment
Followed in 2 later decisions (see Cited by)
Issues
Declaratory judgment, res judicata
Legal questions
Effect of insurer's declaratory judgment (see the maps)
Cite as
Ideal Med. Supply v Mercury Cas. Ins. Co., 39 Misc 3d 15 (App Term, 1st Dept 2013)

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.

A nonparty provider is not bound by a declaratory judgment against its assignor in an action commenced after the assignment. The insurer obtained a declaration permitting denial of all no-fault claims arising from the assignor's accident, but the provider was not a party to that action. The Appellate Term, First Department, affirmed denial of the insurer's motion for summary judgment. The provider lacked a full and fair opportunity to contest the issues and, under Gramatan Home Invs. Corp. v Lopez, was not in privity with the assignor because the action followed the assignment. A separate concurrence questioned the outcome's consistency with no-fault objectives but agreed that controlling precedent required affirmance.

Reported in New York Official Reports at Ideal Med. Supply v Mercury Cas. Ins. Co. (2013 NY Slip Op 23068)

Ideal Med. Supply v Mercury Cas. Ins. Co.
2013 NY Slip Op 23068 [39 Misc 3d 15]
Accepted for Miscellaneous Reports Publication
AT1
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, May 8, 2013

[*1]

Ideal Medical Supply, as Assignee of Lee Cuffie, Respondent,
v
Mercury Casualty Insurance Company, Appellant.

Supreme Court, Appellate Term, First Department, March 12, 2013

APPEARANCES OF COUNSEL

Picciano & Scahill, P.C., Westbury (Albert J. Galatan of counsel), for appellant. Baker, Sanders, Barshay, Grossman, Fass, Muhlstock & Neuwirth, LLC, Garden City (Steven J. Neuwirth of counsel), for respondent.

{**39 Misc 3d at 16} OPINION OF THE COURT

Per Curiam.

Order, entered April 17, 2012, affirmed, without costs.

A related Supreme Court action brought by the defendant insurer against various medical providers resulted in a declaration that defendant was entitled to deny all no-fault claims arising from injuries allegedly sustained by plaintiff’s assignor (Cuffie) in the underlying July 2, 2008 motor vehicle accident. Since the plaintiff medical supplies provider was not a party to the declaratory judgment action it is not bound by Supreme Court’s determination, as it did not have a full and fair opportunity to contest the issues in that proceeding (see Gilberg v Barbieri, 53 NY2d 285, 291 [1981]). Although plaintiff’s assignor was a named party in the prior action, plaintiff cannot be deemed to be in privity with its assignor, since the declaratory judgment action was commenced after the assignment (see Gramatan Home Invs. Corp. v Lopez, 46 NY2d 481, 486-487 [1979]).

Schoenfeld, J. (concurring). In light of the Court of Appeals’ holding in Gramatan Home Invs. Corp. v Lopez (46 NY2d 481 [1979]), I join my colleagues in voting to affirm the order denying summary judgment to the defendant insurer. Considerations of due process prohibit binding a party to the result of an action in which that party has not been given an opportunity to be heard. I write separately to [*2]acknowledge that the outcome reached today does not serve to promote the purposes of this State’s No-Fault Law to provide a less costly, more efficient automobile accident reparation system and to ease court congestion (see Montgomery v Daniels, 38 NY2d 41, 50-51 [1975]).

As (now retired) Justice Golia properly recognized in closely analogous circumstances, no-fault actions do not fit squarely within the Gramatan rule, given “the unique nature and reality of the assignment of claims for first-party benefits under the Insurance{**39 Misc 3d at 17} Law and the no-fault regulations of this State” (Magic Recovery Med. & Surgical Supply Inc. v State Farm Mut. Auto. Ins. Co., 27 Misc 3d 67, 69 [2010 dissenting op]). That being so, and in view of the prior Supreme Court judgment declaring that plaintiff’s assignor and the assignee providers named as defendants in that action “are not entitled to first-party benefits” stemming from the subject motor vehicle accident due to the assignor’s “material misrepresentations in the procurement of the insurance policy,” it is not unreasonable to say that the denial of summary judgment dismissing this assignee provider’s claim tends to exalt form over substance, delaying the seemingly inevitable dismissal of the claim until after trial. Nonetheless, on balance, I feel compelled to adhere to the rule set forth in Gramatan without a signal to the contrary from a higher appellate authority. Lastly, and parenthetically, it is noted that in the event the plaintiff assignee does not ultimately succeed against defendant on the no-fault claim, plaintiff could seek redress against the assignor under the clear terms of the assignment of benefits form.

Lowe, III, P.J., and Torres, J., concur; Schoenfeld, J., concurs in a separate opinion.

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: No preclusion because the claimant (or insurer) was not a party or privy to the DJ

Held the provider was not bound by the Supreme Court declaration because it was not a party to the declaratory action, and was not in privity with its named assignor since the assignment predated that action.

  • Appellate TermApp Term 5
  • Trial courtsTrial 5
2022, Appellate Term: 1 decision (1 Barred by DJ)2019, Appellate Term: 1 decision (1 DJ does not reach)2013, Appellate Term: 1 decision (1 Not bound: parties)2010, Appellate Term: 1 decision (1 Barred by DJ)2015, Appellate Term: 1 decision (1 Not bound: parties)2023, Trial courts: 1 decision (1 Barred by DJ)2020, Trial courts: 3 decisions (3 Not bound: parties)2018, Trial courts: 1 decision (1 Stayed pending DJ)This decision
2010201220142016201820202022
Barred by DJNot bound: partiesDJ does not reachStayed pending DJThis decisionCites it or cited by itCited or followed

Of the 10 decisions on this question in the First Department courts and the Court of Appeals, 5 (this one included) are in the same category. One decision in other departments that cites or is cited by this one is on the full map.

Cited in this decision

  • Magic Recovery Med. & Surgical Supply Inc. v State Farm Mut. Auto. Ins. Co. (2010 NY Slip Op 20130)The provider was not collaterally estopped by default declaratory judgments in actions where it was neither a party nor in privity.

Cited by

A label shows how the later decision treated this one.

  • Quality Psychological Servs. v Infinity Prop. & Cas. Co. (2015 NY Slip Op 50645(U)) FollowedThe insurer failed to establish that the assignor lacked innocent-third-party protection under the rescinded Pennsylvania policy.
  • Professional Health Imaging, P.C. v Old Republic Ins. Co. (2014 NY Slip Op 50200(U)) FollowedThe provider's no-fault claim was not barred by collateral estoppel based on dismissal of its assignor's federal personal injury action.

Similar decisions

  • A.B. Med. Servs. PLLC v Commercial Mut. Ins. Co. (2006 NY Slip Op 26118)An insurer may assert the insured's fraudulent policy procurement against a provider assignee despite the 30-day preclusion rule.
  • A.B. Med. Servs. PLLC v USAA Gen. Indem. Co. (2005 NY Slip Op 25297)A provider's election to arbitrate no-fault claims does not bar another provider from litigating claims arising from the same accident.
  • Jamaica Med. Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 21359)A provider's arbitration election does not bar another provider from suing for benefits arising from the same accident.
  • Amaze Med. Supply Inc. v General Assur. Co. (2006 NY Slip Op 50910(U))The insurer's proof of mailing IME notices and the assignor's nonappearance raised a triable issue defeating the provider's cross motion.
  • Daily Med. Equip. Distrib. Ctr., Inc. v American Tr. Ins. Co. (2015 NY Slip Op 51897(U))A declaratory judgment denying a provider's accident-related no-fault entitlement has preclusive effect even if entered on default.
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