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November 19, 2010

Golden Age Med. Supply, Inc. v Clarendon Natl. Ins. Co. (2010 NY Slip Op 52010(U))

https://www.beynensonlaw.com/case-law/golden-age-med-supply-inc-v-clarendon-natl-ins-co-2010-ny-slip-op52010u/

Court
Appellate Term, Second Department
Decided
November 19, 2010
Citation
2010 NY Slip Op 52010(U) · 29 Misc 3d 136(A)
Posture
Summary judgment
Outcome
Insurer prevailed
Issues
Policy issues Assignments and standing
Legal questions
Challenging the assignment of benefits (see the maps)
Cite as
Golden Age Med. Supply, Inc. v Clarendon Natl. Ins. Co., 29 Misc 3d 136(A), 2010 NY Slip Op 52010(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2010)

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 raised a triable issue as to whether the New Jersey policy was fraudulently obtained, subject to curing its affidavit. The Appellate Term, Second Department, conditionally modified the order to deny the provider's partial summary judgment motion, while leaving the insurer's cross motion denied. The insurer had not shown cancellation, and its documents did not establish entitlement to dismissal. Under 11 NYCRR 65-3.11 (d), the assignor could not unilaterally revoke the assignment after services were rendered. The insurer's affidavit lacked the conformity certificate required by CPLR 2309 (c) and Real Property Law § 299-a (1). Modification required filing and serving an identical affidavit with a proper certificate within 60 days after service of the decision and order with notice of entry; otherwise, the order would be affirmed.

Reported in New York Official Reports at Golden Age Med. Supply, Inc. v Clarendon Natl. Ins. Co. (2010 NY Slip Op 52010(U))

[*1]
Golden Age Med. Supply, Inc. v Clarendon Natl. Ins. Co.
2010 NY Slip Op 52010(U) [29 Misc 3d 136(A)]
Decided on November 19, 2010
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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 19, 2010

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : PESCE, P.J., GOLIA and RIOS, JJ
2009-254 K C.
Golden Age Medical Supply, Inc. as Assignee of ORLANDO ESPINAL, JESICA SABOUR and FRITZ SABOUR, Respondent,

against

Clarendon National Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Alice Fisher Rubin, J.), entered August 6, 2008. The order granted plaintiff’s motion for partial summary judgment and denied defendant’s cross motion for partial summary judgment.

ORDERED that the order is modified by providing that plaintiff’s motion for partial summary judgment is denied and, as so modified, affirmed without costs on condition that defendant, within 60 days of service upon it of a copy of this decision and the order entered hereon with notice of entry, serve upon plaintiff and file with the Clerk of the Civil Court an affidavit of Carol Keyes, identical to the affidavit submitted previously by defendant, accompanied by a certificate demonstrating that the notary administered the oath as prescribed by the laws of the State of New Jersey. In the event that defendant fails to duly serve and file such an affidavit, the order is affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for partial summary judgment seeking to recover on the claims it submitted for healthcare services rendered to assignor Orlando Espinal. Defendant cross-moved for summary judgment seeking dismissal of the complaint insofar as it sought to recover for services rendered to assignor Espinal. The Civil Court granted plaintiff’s motion and denied defendant’s cross motion. Defendant appeals, arguing that its cross motion should have been granted or, in the alternative, that plaintiff’s motion should have been denied because defendant raised a triable issue of fact.

Defendant argues first that the complaint should be dismissed as to the subject claims, which were submitted on January 14, 2002, because defendant’s assignor agreed to revoke the assignment in a December 2002 stipulation. Regardless of whether this defense was properly presented, it fails as a matter of law because “the assignor or legal representative of the assignor shall not unilaterally revoke the assignment after the services for which the assignment was originally executed were rendered” (Insurance Department Regulations [11 NYCRR] § 65-3.11 [d]). [*2]

Defendant’s second argument is that plaintiff should not recover for services rendered to assignor Espinal because he made material misrepresentations in order to obtain the subject New Jersey insurance policy. While New York law does not allow for the retroactive cancellation of an automobile insurance policy (see Vehicle and Traffic Law § 313), New Jersey law does allow for such retroactive rescission for a material misrepresentation at the inception of the policy (see Rutgers Cas. Ins. Co. v LaCroix, 194 NJ 515, 946 A2d 1027 [2008]), and, had there been a cancellation of the subject insurance policy, New Jersey law would properly be applied (see Matter of Eagle Ins. Co. v Singletary, 279 AD2d 56 [2000]). However, defendant has not demonstrated that it cancelled the subject insurance policy.

On the other hand, defendant’s employee’s assertion that the subject insurance policy was obtained by fraud and/or material misrepresentations is a permissible affirmative defense that, if proved, precludes any recovery by the insured or a health care provider who accepts an assignment of the insured’s no-fault benefits (see A.B. Med. Servs. PLLC v Commercial Mut. Ins. Co., 12 Misc 3d 8, 11 [App Term, 2d & 11th Jud Dists 2006]). We find that while the documents attached to defendant’s cross motion are not a sufficient basis for an award of summary judgment dismissing the complaint as to the claims submitted for services rendered to assignor Espinal, they are sufficient to raise a triable issue of fact as to whether the subject insurance policy was fraudulently obtained.

With respect to plaintiff’s timely objection to the form of defendant’s employee’s affidavit, we note that while defendant permissibly sought to cure this defect in its reply papers (see Moccia v Carrier Car Rental, Inc., 40 AD3d 504 [2007]), defendant submitted a certificate of authenticity rather than the required certificate of conformity (see CPLR 2309 [c]; Real Property Law § 299-a [1]; see also Ford Motor Credit Co. v Prestige Gown Cleaning Serv., 193 Misc 2d 262 [Civ Ct, Queens County 2002]). Because the certificate of conformity can be given nunc pro tunc effect once the proper certificate is obtained, the order is modified by providing that plaintiff’s motion for partial summary judgment is denied on the conditions stated above (see Eastern Star Acupuncture, P.C. v Clarendon Natl. Ins. Co., 26 Misc 3d 131[A], 2010 NY Slip Op 50043[U] [App Term, 1st Dept 2010]; see generally Sandoro v Andzel, 307 AD2d 706 [2003]). Pesce, P.J., Golia and Rios, JJ., concur.
Decision Date: November 19, 2010

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.

Challenging the assignment of benefits

Open the full map

Could the insurer contest the validity of the provider’s assignment of benefits, or had it waived that defense?

This decision: On the merits, the assignment or the claimant's showing is adequate, or the alleged defect is not a defect (rules on the question, but another ground decided the case)

Rejected the defense that the assignor revoked the assignment in a later stipulation, because 11 NYCRR 65-3.11 (d) bars unilateral revocation after the services were rendered.

  • Court of AppealsCt App 1
  • Appellate DivisionApp Div 12
  • Appellate TermApp Term 60
  • Trial courtsTrial 23
2007, Court of Appeals: 1 decision (1 Defense waived)2018, Appellate Division: 1 decision (1 Assignment sufficient)2013, Appellate Division: 1 decision (1 Defense waived)2011, Appellate Division: 1 decision (1 Defense waived)2007, Appellate Division: 2 decisions (2 Defense waived)2006, Appellate Division: 2 decisions (1 Defense waived, 1 Assignment defense upheld)2005, Appellate Division: 3 decisions (3 Defense waived)2004, Appellate Division: 1 decision (1 Defense waived)2025, Appellate Division: 1 decision (1 Assignment defense upheld)2016, Appellate Term: 1 decision (1 Defense waived)2014, Appellate Term: 1 decision (1 Defense waived)2013, Appellate Term: 1 decision (1 Defense waived)2010, Appellate Term: 5 decisions (3 Defense waived, 2 Assignment sufficient)2009, Appellate Term: 2 decisions (1 Defense waived, 1 Assignment sufficient)2008, Appellate Term: 4 decisions (2 Defense waived, 2 Assignment defense upheld)2007, Appellate Term: 3 decisions (1 Assignment sufficient, 1 Assignment defense upheld, 1 Issue of fact)2006, Appellate Term: 18 decisions (11 Defense waived, 6 Assignment sufficient, 1 Assignment defense upheld)2005, Appellate Term: 19 decisions (9 Defense waived, 10 Assignment sufficient)2004, Appellate Term: 6 decisions (1 Defense waived, 3 Assignment sufficient, 2 Issue of fact)2022, Trial courts: 1 decision (1 Defense waived)2020, Trial courts: 1 decision (1 Assignment defense upheld)2011, Trial courts: 2 decisions (1 Defense waived, 1 Assignment sufficient)2009, Trial courts: 1 decision (1 Defense waived)2007, Trial courts: 1 decision (1 Assignment sufficient)2006, Trial courts: 2 decisions (2 Assignment defense upheld)2005, Trial courts: 8 decisions (5 Defense waived, 2 Assignment sufficient, 1 Assignment defense upheld)2004, Trial courts: 7 decisions (3 Assignment sufficient, 4 Assignment defense upheld)This decision
20052010201520202025
Defense waivedAssignment sufficientAssignment defense upheldIssue of factThis decision

Of the 96 decisions on this question in the Second Department courts and the Court of Appeals, 31 (this one included) are in the same category.

Cited in this decision

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

  • A.B. Med. Servs. PLLC v Commercial Mut. Ins. Co. (2006 NY Slip Op 26118) FollowedAn insurer may assert the insured's fraudulent policy procurement against a provider assignee despite the 30-day preclusion rule.
  • Eastern Star Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2010 NY Slip Op 50043(U)) FollowedAn out-of-state affidavit lacking the required certificate of conformity may receive nunc pro tunc effect once the certificate is obtained.

Similar decisions

  • Rigid Med. of Flatbush, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50582(U))The insurer failed to establish an EUO-authorizing policy endorsement or proper EUO notices, leaving its denial untimely.
  • Brooklyn Hgts. Physical Therapy, P.C. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 52406(U))The insurer established the assignor's IME nonappearance and defeated the provider's challenge to the duplicate denial requirement.
  • Lifex Med. Care, P.C. v Safeco Natl. Ins. Co. (2011 NY Slip Op 51221(U))The provider failed to establish summary judgment entitlement, and the insurer's fraudulent-procurement defense lacked admissible proof.
  • A.M. Med. Servs., P.C. v Nationwide Mut. Ins. Co. (2006 NY Slip Op 51425(U))The insurer's EUO transcripts supported a founded belief of fraud, raising a coverage issue that defeated both summary judgment motions.
  • Fiutek v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51840(U))The insurer proved the assignor's IME nonappearance, but conflicting mailing evidence prevented dismissal of one claim.
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