Reported in New York Official Reports at Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51551(U))
| Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. |
| 2018 NY Slip Op 51551(U) [61 Misc 3d 136(A)] |
| Decided on November 2, 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 November 2, 2018
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2016-305 K C
against
State Farm Mutual Automobile Ins. Co., Appellant.
Rivkin Radler, LLP (Stuart M. Bodoff of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered December 11, 2015. The order denied 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 granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court which denied defendant’s motion, which had sought summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs).
In its motion, defendant established that initial and follow-up letters scheduling an EUO had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]); that plaintiff’s assignor had failed to appear on either date (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]); and that the claims had been timely denied on that ground (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123). As plaintiff failed to raise a triable issue of fact in opposition to defendant’s motion, defendant is entitled to summary judgment dismissing the complaint.
Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 02, 2018
Reported in New York Official Reports at Dynasty Med. Care, P.C. v 21st Century Sec. Ins. Co. (2018 NY Slip Op 51550(U))
| Dynasty Med. Care, P.C. v 21st Century Sec. Ins. Co. |
| 2018 NY Slip Op 51550(U) [61 Misc 3d 136(A)] |
| Decided on November 2, 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 November 2, 2018
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2015-2902 RI C
against
21st Century Security Insurance Company, Appellant.
Law Office of Bryan M. Rothenberg (Jennifer A. Joseph of counsel), for appellant. Baker Sanders, LLC (Malgorzata Rafalko of counsel), for respondent (no brief filed).
Appeal from an order of the Civil Court of the City of New York, Richmond County (Orlando Marrazzo, Jr., J.), entered October 15, 2015. The order denied 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 granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court which denied defendant’s motion for summary judgment dismissing the complaint.
Contrary to plaintiff’s contentions, defendant established that it had first learned of the accident on the date it had received an NF-2 form, which form had been submitted more than 30 days after the accident had occurred, and that it had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) its denial of claim forms, which denied plaintiff’s claims on the ground that written notice of the accident had not been submitted to defendant within 30 days of its occurrence (see 11 NYCRR 65-1.1 [d]). The denial of claim forms further advised plaintiff that late notice would be excused if reasonable justification for the failure to give timely notice was provided (see 11 NYCRR 65-3.3 [e]). As defendant established its prima facie entitlement to judgment as a matter of law (see TAM Med. Supply Corp. v [*2]Fiduciary Ins. Co. of Am., 53 Misc 3d 129[A], 2016 NY Slip Op 51352[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]; Ukon Med. Care, P.C. v Clarendon Natl. Ins. Co., 37 Misc 3d 136[A], 2012 NY Slip Op 52176[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]), the burden shifted to plaintiff to demonstrate a triable issue of fact. The affirmation of plaintiff’s counsel submitted in opposition to defendant’s motion failed to demonstrate the existence of a triable issue of fact. Plaintiff’s remaining contentions lack merit.
Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 02, 2018
Reported in New York Official Reports at Continental Med., P.C. v MVAIC (2018 NY Slip Op 51549(U))
[*1]| Continental Med., P.C. v MVAIC |
| 2018 NY Slip Op 51549(U) [61 Misc 3d 136(A)] |
| Decided on November 2, 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 November 2, 2018
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2015-2611 Q C
against
MVAIC, Appellant.
Marshall & Marshall, PLLC (Tracy Bader Pollack of counsel), for appellant. Israel, Israel & Purdy, LLP (Jennifer Greenhalgh Howard of counsel), for respondent.
Appeal from a decision of the Civil Court of the City of New York, Queens County (Larry Love, J.), dated October 29, 2014, deemed from a judgment of that court entered March 13, 2015 (see CPLR 5512 [a]). The judgment, entered pursuant to the decision, after a nonjury trial, awarded plaintiff the principal sum of $15,646.35.
ORDERED that the judgment is reversed, with $30 costs, and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the complaint.
After a nonjury trial in this action by a provider to recover assigned first-party no-fault benefits, the Civil Court awarded judgment to plaintiff in the principal sum of $15,646.35.
The evidence adduced at trial was insufficient to establish that plaintiff had exhausted its remedies against the vehicle’s owner (see Matter of Acosta-Collado v Motor Veh. Acc. Indem. Corp., 103 AD3d 714 [2013]; Hauswirth v American Home Assur. Co., 244 AD2d 528 [1997]). As a result, plaintiff’s claim is premature (see Matter of Acosta-Collado, 103 AD3d 714; Hauswirth, 244 AD2d 528; Dr. Abakin, D.C., P.C. v MVAIC, 21 Misc 3d 134[A], 2008 NY Slip Op 5218[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2008]; see also Matter of Sweet v Motor Veh. Acc. Indem. Corp., 287 AD2d 510 [2001]; Matter of Troches v Motor Veh. Acc. Indem. Corp., 171 AD2d 873 [1991]).
Accordingly, the judgment is reversed and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the complaint.
PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 02, 2018Sunrise Acupuncture, P.C. v Kemper Independence Ins. Co. (2018 NY Slip Op 28344)
Reported in New York Official Reports at Sunrise Acupuncture, P.C. v Kemper Independence Ins. Co. (2018 NY Slip Op 28344)
| Sunrise Acupuncture, P.C. v Kemper Independence Ins. Co. |
| 2018 NY Slip Op 28344 [62 Misc 3d 307] |
| October 31, 2018 |
| Gomez, J. |
| Civil Court of the City of New York, Bronx County |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected through Wednesday, January 16, 2019 |
[*1]
| Sunrise Acupuncture, P.C., as Assignee of Sharise Davis, Plaintiff, v Kemper Independence Ins. Co., Defendant. |
Civil Court of the City of New York, Bronx County, October 31, 2018
APPEARANCES OF COUNSEL
Gullo & Associates, LLC. for defendant.
Gary Tsirelman, PC for plaintiff.
{**62 Misc 3d at 308} OPINION OF THE COURT
Upon the testimony and evidence proffered at trial, the court hereby finds in favor of defendant and dismisses the complaint.
The instant action is for the payment of no-fault insurance benefits for medical treatment. The complaint alleges, in relevant part, the following: On May 16, 2008, assignor Sharise Davis (Davis) was involved in an automobile accident. At the time of the instant accident, Davis was covered under an automobile insurance policy issued by defendant, which provided benefits under the New York State No-Fault Law.[FN*] Davis sought treatment from plaintiff Sunrise Acupuncture, P.C., the assignee of Davis’ no-fault benefits under defendant’s policy. Plaintiff submitted claims for medical treatment provided to Davis and defendant denied them. Based on the foregoing, pursuant to the New York State No-Fault Law and the policy, plaintiff seeks judgment in the amount of $425 plus interest.
On July 28, 2013, this court (Taylor, J.) denied defendant’s motion for summary judgment and dismissal of the complaint. The court held that defendant failed to submit admissible evidence in support of its claim that Davis was not an insured under the policy issued to the Albanos. Defendant appealed and the Appellate Term affirmed (Sunrise Acupuncture P.C. v Kemper Independence Ins. Co., 50 Misc 3d 133[A], 2016 NY Slip Op 50025[U], *1 [App Term, 1st Dept 2016] [“We sustain the denial of defendant-insurer’s motion for summary judgment. Although defendant asserted that the underlying no-fault claim is precluded by a provision of the subject insurance policy limiting coverage, upon the death of the insured, to the ‘legal representative of the deceased,’ defendant failed to tender evidentiary proof in admissible form establishing that the policy contained such a provision”]).
At trial, the parties stipulated to the admission of several documents in evidence, some of which will be discussed hereinafter. More importantly, the parties limited the court’s inquiry to one issue, namely, whether under the instant facts defendant’s insurance policy afforded coverage to Davis.
The parties submitted the insurance policy at issue (exhibit B). Said policy was issued to Ronald and America Albano. According{**62 Misc 3d at 309} to the policy, the term began on July 24, [*2]2007, and ended a year later. Per the declarations, the policy covered a 1998 Mercury and a 1980 Plymouth automobile. Section III of the policy governed coverage with respect to the foregoing vehicles. Specifically, the policy defined a “your covered auto” as “[a]ny vehicle shown in the Declaration,” and “[a]ny of the following types of vehicles on the date you become the owner . . . [including] [a] private passenger auto.” The policy further defined a “family member” as “a person related to you by blood, marriage or adoption who is a resident of your household.” Per the policy, “ '[b]odily injury,’ means bodily harm, sickness or disease, including death that result.” “ ’Occupying’ means in, upon, getting in, on out or off.” Part B or the Medical Payments Coverage portion of the policy defined “insured” as “[y]ou or any ‘family member’ . . . [w]hile ‘occupying’ . . . a motor vehicle designed for use mainly on public roads.” Part B of the policy further stated that defendant “will pay reasonable expenses incurred for necessary medical . . . services because of ‘bodily injury’ . . . [c]aused by accident and . . . [s]ustained by an ‘insured.’ ” Section IV of the policy, titled General Policy Conditions, stated that
“[y]our rights and duties under this policy may not be assigned without our written consent. However, if a named insured shown in the Declarations dies, coverage will be provided for . . . [t]he surviving spouse if a resident in the same household at the time of death . . . [and] [t]he legal representative of the deceased person as if a named insured shown in the Declarations . . . only with respect to . . . [t]he representative’s responsibility to maintain or use ‘your covered auto.’ ”
The parties submitted two death certificates (exhibit D), which indicate that the Albanos died in June 2007, and letters testamentary (exhibit C), which establish that on January 7, 2008, Raquel Davis (Raquel) was appointed as the executor of Ronald Albano’s will. The parties submitted a notice of intention to make claim (exhibit F), which indicates that Davis made a claim to defendant for no-fault benefits arising from an accident on May 16, 2008, in which she was involved while operating the 1998 Mercury. Lastly, the parties submitted a letter dated July 14, 2008 (exhibit E) sent by defendant to Davis, wherein defendant denies coverage to Davis under the policy because the accident occurred after the Albanos died and the policy “issued to the Albanos contains a provision that {**62 Misc 3d at 310}limits coverage upon the death of the named insured to the surviving spouse or legal representative of the deceased person, but only with respect to the representative’s legal responsibility to maintain or use the vehicle scheduled on the policy.” The letter further stated that “[s]ince you are neither the legal representative nor surviving spouse of Ronald Albano, the policy will not provide you with coverage as an insured.”
Principles of contract interpretation apply equally to insurance policies (Gilbane Bldg. Co./TDX Constr. Corp. v St. Paul Fire & Mar. Ins. Co., 143 AD3d 146, 151 [1st Dept 2016], affd 31 NY3d 131 [2018]; State of New York v American Mfrs. Mut. Ins. Co., 188 AD2d 152, 154 [3d Dept 1993]). Thus, in interpreting an insurance policy, the court must determine the rights and obligations of the parties, using the specific language of the policy itself (Gilbane Bldg. Co./TDX Constr. Corp. at 150-151 [“In this action for a judgment declaring the parties’ rights under an insurance policy, this Court must be guided by the rules of contract interpretation because (a)n insurance policy is a contract between the insurer and the insured. As a result, the extent of coverage is controlled by the relevant policy terms, not by the terms of the underlying trade contract that required the named insured to purchase coverage” (internal quotation marks and citation omitted)]; Sanabria v American Home Assur. Co., 68 NY2d 866, 868 [1986]; State of New York v Home Indem. Co., 66 NY2d 669, 671 [1985]; Stasack v Capital Dist. Physicians’ Health Plan, 290 AD2d 866, 866 [3d Dept 2002]; Stainless, Inc. v Employers Fire Ins. Co., 69 AD2d 27, 32-33 [1st Dept 1979]).
When the language in an insurance policy is clear and unambiguous, the interpretation of said document and the determination of the rights and obligations of the parties is a question of law to be adjudicated by the court (Kenyon v Knights Templar & Masonic Mut. Aid Assn., 122 NY 247, 254 [1890]; Stainless, Inc. v Employers Fire Ins. Co., 69 [*3]AD2d 27, 32 [1st Dept 1979], affd 49 NY2d 924 [1980]; Stasack v Capital Dist. Physicians’ Health Plan, 290 AD2d 866, 866 [3d Dept 2002]). However, if the language in the policy is ambiguous, the court can use extrinsic evidence to determine the intent of the parties to the policy and resolution of the rights and obligations of the parties is a question of fact, to be determined by the trier of fact (State of New York v Home Indem. Co., 66 NY2d 669, 671 [1985]; Hartford Acc. & Indem. Co. v Wesolowski, 33 NY2d 169, 173 [1973]; Stainless, Inc. at 32). If the extrinsic evidence{**62 Misc 3d at 311} is conclusory, failing to equivocally resolve the ambiguity in a policy, interpretation of the policy remains a question of law for the court to decide, deciding any ambiguities against the insurer (State of New York at 669; Stainless, Inc. at 32).
In interpreting an insurance policy, the language of the policy, when clear and unambiguous, must be given its plain and ordinary meaning (United States Fid. & Guar. Co. v Annunziata, 67 NY2d 229, 232 [1986]; Sanabria at 868). In such a case, the policy should be construed in a way “that affords a fair meaning to all of the language employed by the parties in the contract and leaves no provision without force and effect” (Raymond Corp. v National Union Fire Ins. Co. of Pittsburgh, Pa., 5 NY3d 157, 162 [2005]; American Express Bank v Uniroyal, Inc., 164 AD2d 275, 277 [1st Dept 1990]; Fifth Ave. Exec. Staffing v Virtual Communities, Inc., 2002 NY Slip Op 50082[U], *1 [App Term, 1st Dept 2002]).
Based on the foregoing, the court finds that at the time of the accident, Davis was not an insured as defined by the policy issued by defendant to the Albanos. As such, Davis was never entitled to no-fault benefits under the instant policy.
As noted above, when interpreting coverage pursuant to an insurance policy, we do so using contract law (Gilbane Bldg. Co./TDX Constr. Corp. at 151; State at 154). Thus, when the language in an insurance policy is clear and unambiguous, the interpretation of said document and the determination of the rights and obligations of the parties thereunder is a question of law for the court (Kenyon at 254; Stainless, Inc. at 32; Stasack at 866). In interpreting an insurance policy, the language of the policy, when clear and unambiguous, must be given its plain and ordinary meaning (United States Fid. & Guar. Co. at 232; Sanabria at 868), and the policy must be construed in a way “that affords a fair meaning to all of the language employed by the parties in the contract and leaves no provision without force and effect” (Raymond Corp. at 162; American Express Bank at 277; Fifth Ave. Exec. Staffing, 2002 NY Slip Op 50082[U], *1).
Here, because it is undisputed that Davis’ accident occurred nine months after the death of the Albanos, it is clear that the demise of the Albanos triggered section IV of the policy, rendering section III of the policy inapplicable and limiting coverage to those persons listed under section IV of the policy. Specifically, upon the Albanos’ death, per the policy the only insureds were a surviving spouse and generally, the Albanos’ legal representative.{**62 Misc 3d at 312} Given that Raquel was appointed as executor of Ronald Albano’s will, Raquel was the only insured under the instant policy and the only person entitled to coverage. Thus, Davis, which as per Kemper’s letter was Raquel’s daughter, was neither a surviving spouse as defined by the policy or a legal representative of the Albanos. Thus, Davis was not an insured under the instant policy. Accordingly, defendant had no obligation to provide no-fault benefits to Davis and properly denied those claims.
Plaintiff’s reliance on section III of the instant policy to extend coverage to Davis is unavailing. While it is true that section III of the policy defines “family member” as “a person related to you by blood, marriage or adoption who is a resident of your household,” and part B of the policy states that defendant “will pay reasonable expenses incurred for necessary medical . . . services because of ‘bodily injury’ . . . [c]aused by accident and . . . [s]ustained by an ‘insured,’ ” section III is simply inapplicable here since it clearly only applies while the Albanos were alive. Any other interpretation would render the limiting language in section IV of the policy meaningless, which would violate a central tenet of contract law—that a policy must be construed in a way “that affords a fair meaning to all of the language employed by the parties in the contract and leaves no provision without force and effect” (Raymond Corp. at 162; American Express Bank [*4]at 277; Fifth Ave. Exec. Staffing, 2002 NY Slip Op 50082[U], *1).
Moreover, even if section III were dispositive, here, the record is bereft of any evidence that Davis was an insured thereunder. To be sure, part B of the policy provided coverage for “ ’bodily injury’ . . . [c]aused by accident and . . . [s]ustained by an ‘insured.’ ” However, as noted above, an insured is, inter alia, a “family member,” meaning “a person related to you by blood, marriage or adoption who is a resident of your household.” Here, the record is bereft of any evidence establishing that Davis was related to the Albanos and that if so, she resided in their household. It is hereby ordered that the complaint be dismissed, with prejudice.
Footnotes
Footnote *:Comprehensive Motor Vehicle Insurance Reparations Act (Insurance Law § 5101 et seq.) and its implementing regulations (11 NYCRR 65-3.1 et seq.).
Reported in New York Official Reports at Abruscato v Allstate Prop.& Cas. Ins. Co. (2018 NY Slip Op 07279)
| Abruscato v Allstate Prop.& Cas. Ins. Co. |
| 2018 NY Slip Op 07279 [165 AD3d 1209] |
| October 31, 2018 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1] (October 31, 2018)
| Giovanni Abruscato, Appellant, v Allstate Property and Casualty Insurance Company, Respondent. |
Pamela Gabiger, Poughkeepsie, NY, for appellant.
Peter C. Merani, P.C., New York, NY (Eric M. Wahrburg of counsel), for respondent.
In an action, inter alia, to recover no-fault insurance benefits for medical expenses and lost wages, the plaintiff appeals from an order of the Supreme Court, Dutchess County (James W. Hubert, J.), dated July 28, 2016. The order, insofar as appealed from, granted that branch of the defendant’s motion which was pursuant to CPLR 3211 (a) (7) to dismiss the complaint and denied the plaintiff’s cross motion pursuant to CPLR 3025 (b) for leave to amend the complaint.
Ordered that the order is modified, on the law, by deleting the provision thereof granting that branch of the defendant’s motion which was to dismiss so much of the first cause of action as sought to recover no-fault insurance benefits for medical expenses, and substituting therefor a provision denying that branch of the defendant’s motion; as so modified, the order is affirmed insofar as appealed from, without costs or disbursements.
The plaintiff allegedly sustained injuries as a result of a motor vehicle accident in which his vehicle collided with a deer. The defendant was the plaintiff’s motor vehicle insurance carrier at the time of the accident. The plaintiff submitted to the defendant an application for motor vehicle no-fault insurance benefits. The defendant denied certain claims for no-fault insurance benefits on the ground that the plaintiff’s injuries were not causally related to the accident.
The plaintiff commenced this action, inter alia, to recover no-fault benefits for medical expenses and lost wages. The defendant moved, among other things, pursuant to CPLR 3211 (a) (7) to dismiss the complaint, and the plaintiff cross-moved pursuant to CPLR 3025 (b) for leave to amend the complaint. By order dated July 28, 2016, the Supreme Court, inter alia, granted that branch of the defendant’s motion and denied the plaintiff’s cross motion.
In considering a motion to dismiss the complaint for failure to state a cause of action, the court must afford the complaint a liberal construction, take the allegations of the complaint as true, and provide the plaintiff the benefit of every possible favorable inference (see EBC I, Inc. v Goldman, Sachs & Co., 5 NY3d 11, 19 [2005]; Leon v Martinez, 84 NY2d 83, 88 [1994]). “Where evidentiary material is submitted and considered on a motion to dismiss [the] complaint pursuant to CPLR 3211 (a) (7), and the motion is not converted into one for summary judgment, the question becomes whether the plaintiff has a cause of action, not whether the plaintiff has stated one, and unless it has [*2]been shown that a material fact as claimed by the plaintiff to be one is not a fact at all and unless it can be said that no significant dispute exists regarding it, dismissal should not eventuate” (Rabos v R&R Bagels & Bakery, Inc., 100 AD3d 849, 851-852 [2012]; see Guggenheimer v Ginzburg, 43 NY2d 268, 275 [1977]).
We agree with the Supreme Court’s determination granting that branch of the defendant’s motion which was pursuant to CPLR 3211 (a) (7) to dismiss so much of the first cause of action as sought to recover no-fault insurance benefits for lost wages. It is undisputed that the plaintiff did not submit a claim for reimbursement for lost wages, and therefore the defendant’s obligation to pay or deny such a claim never arose (see 11 NYCRR 65-3.8; see also Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]; Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 106 AD3d 157 [2013]).
We also agree with the Supreme Court’s determination granting those branches of the defendant’s motion which were to dismiss the second and third causes of action to recover damages for intentional and negligent infliction of emotional distress, respectively. The conduct alleged, even if proven, was not sufficiently extreme and outrageous to support the cause of action to recover damages for intentional infliction of emotional distress (see Brunache v MV Transp., Inc., 151 AD3d 1011, 1014 [2017]; Long Is. Care Ctr., Inc. v Goodman, 137 AD3d 874, 875 [2016]). Additionally, the relationship between the plaintiff and the defendant does not give rise to a duty which could furnish a basis for tort liability in negligence (see Pirrelli v OCWEN Loan Servicing, LLC, 129 AD3d 689, 692 [2015]; Baumann v Hanover Community Bank, 100 AD3d 814, 816 [2012]).
We also agree with the Supreme Court’s determination granting that branch of the defendant’s motion which was to dismiss the fourth cause of action, which sought declaratory relief, since the plaintiff has an adequate alternative remedy in the form of a cause of action to recover no-fault insurance benefits (see Stuckey v Lutheran Care Found. Network, Inc., 140 AD3d 734, 736 [2016]; Alizio v Feldman, 82 AD3d 804, 805 [2011]; BGW Dev. Corp. v Mount Kisco Lodge No. 1552 of Benevolent & Protective Order of Elks of U.S. of Am., 247 AD2d 565, 568 [1998]).
Further, the Supreme Court providently exercised its discretion in denying the plaintiff’s cross motion for leave to amend the complaint, because the proposed amendments were palpably insufficient and patently devoid of merit (see White Knight of Flatbush, LLC v Deacons of the Dutch Congregation of Flatbush, 159 AD3d 939 [2018]; Ferrandino & Son, Inc. v Wheaton Bldrs., Inc., LLC, 82 AD3d 1035, 1037 [2011]; Lucido v Mancuso, 49 AD3d 220, 229 [2008]).
However, the Supreme Court should have denied that branch of the defendant’s motion which was to dismiss so much of the first cause of action as sought to recover no-fault insurance benefits for medical expenses. The defendant contends, inter alia, that the plaintiff lacked standing because he had assigned his right to no-fault insurance benefits for medical expenses to his medical providers. Although the defendant submitted evidence that the plaintiff assigned his right to no-fault benefits to two medical providers (hereinafter the assignees), the plaintiff’s evidentiary submissions showed that other medical providers had also billed him for their services. Moreover, upon the defendant’s determination that the injury was not causally related to the motor vehicle accident, the assignees were no longer precluded from seeking payment from the plaintiff (see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 318 [2007]; Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, 199 [1997]; Rotwein v Stancil, 15 Misc 3d 19, 21 [2007]). Since there was a failure of insurance coverage rendering the plaintiff personally responsible for the medical bills (see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d at 318; Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d at 199; Rotwein v Stancil, 15 Misc 3d at 21), the plaintiff has a cause of action to recover no-fault insurance benefits for medical expenses from the defendant (see Guggenheimer v Ginzburg, 43 NY2d at 275). Balkin, J.P., Sgroi, Maltese and Christopher, JJ., concur.
Urmas Med., P.C. v 21st Century Centennial Ins. Co. (2018 NY Slip Op 51526(U))Reported in New York Official Reports at Urmas Med., P.C. v 21st Century Centennial Ins. Co. (2018 NY Slip Op 51526(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
21st Century Centennial Ins. Co., Respondent.
Gary Tsirelman, P.C. (Joseph Padrucco and Devon Christian of counsel), for appellant. Law Offices of Buratti, Rothenberg & Burns (Marisa Villafana-Jones of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (John J. Kelley, J.), entered March 10, 2017. 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.
After plaintiff filed a notice of trial in this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint. Plaintiff opposed the motion arguing, among other things, that the motion was untimely. In reply papers, defendant conceded that its motion was untimely and, for the first time, sought to provide good cause for its untimely filing of the motion. By order entered March 10, 2017, the Civil Court found “defendant’s motion to be timely,” and granted the motion.
CPLR 3212 (a) provides that a motion for summary judgment “shall be made no later than one hundred twenty days after the filing of the note of issue, except with leave of court on good cause shown” (see also Brill v City of New York, 2 NY3d 648, 651 [2004]). On appeal, as in the court below, defendant concedes that it moved for summary judgment more than 120 days after the notice of trial had been filed. Defendant argues that it had been unaware that the motion was late until it read plaintiff’s opposition papers, after which it submitted reply papers in which it sought to provide good cause for the late motion. Since defendant failed to demonstrate, in its moving papers, good cause for not filing its motion within the time frame of CPLR 3212 (a), the Civil Court improvidently exercised its discretion in entertaining defendant’s motion after considering the good cause arguments defendant raised for the first time in its reply papers (see [*2]Nationstar Mtge., LLC v Weisblum, 143 AD3d 866, 869 [2016]; Goldin v New York & Presbyt. Hosp., 112 AD3d 578, 579 [2013]). We note that “[a]rguments raised for the first time in reply may be considered if the original movant is given the opportunity to respond and submits papers in surreply” (Gluck v New York City Tr. Auth., 118 AD3d 667, 668 [2014]). In the case at bar, however, “there is no indication that plaintiff was afforded an opportunity to submit a surreply” (Gottlieb v Wynne, 159 AD3d 799, 801 [2018]).
Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.
ELLIOT, J.P., WESTON and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: October 26, 2018
Reported in New York Official Reports at Kerisli Chiropractic, P.C. v American Tr. Ins. Co. (2018 NY Slip Op 28325)
| Kerisli Chiropractic, P.C. v American Tr. Ins. Co. |
| 2018 NY Slip Op 28325 [61 Misc 3d 1004] |
| October 18, 2018 |
| Kennedy, J. |
| Civil Court of the City of New York, Kings County |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected through Wednesday, December 26, 2018 |
[*1]
| Kerisli Chiropractic, P.C., as Assignee of Miguel Cueto, Plaintiff, v American Transit Insurance Co., Defendant. |
Civil Court of the City of New York, Kings County, October 18, 2018
APPEARANCES OF COUNSEL
Law Offices of Daniel J. Tucker, Brooklyn (John Reinus of counsel), for defendant.
Zara Javakov PC, Brooklyn (Adam Waknine of counsel), for plaintiff.
{**61 Misc 3d at 1005} OPINION OF THE COURT
Defendant moves to dismiss the complaint pursuant to CPLR 3211 (a) (5), contending that the action is barred by the doctrine of res judicata, or in the alternative, for an order granting defendant summary judgment pursuant to CPLR 3212.
Plaintiff Kerisli Chiropractic, P.C. commenced the instant action to recover assigned first-party no-fault benefits for medical services provided to its assignor as a result of injuries sustained in an August 23, 2010 automobile incident.
Defendant insurer commenced a declaratory judgment action in Supreme Court against Kerisli Chiropractic, P.C. and moved for summary judgment for an order “adjudging and [*2]decreeing that” Kerisli Chiropractic, P.C. “is not entitled to no fault benefits” for the August 23, 2010 collision.
Kerisli Chiropractic, P.C. did not answer or oppose the motion. The Supreme Court issued an order, reciting the specific declaratory relief requested by the insurer and granting the motion on default.
In the instant no-fault action, defendant insurer moves to dismiss the complaint claiming that the Supreme Court’s order in the declaratory judgment action is a conclusive final determination, which pursuant to res judicata, bars the instant action.
In opposition, plaintiff contends defendant insurer failed to establish its entitlement to res judicata or collateral estoppel, arguing that orders granted on default are not preclusive, and that res judicata only applies to those issues that have been litigated and determined in a prior action, not to actions where an issue due to a party’s default is not litigated. Citing federal cases, plaintiff asserts that Supreme Court’s order granted on default has thus no preclusive effect. (See In re Adler, Coleman Clearing Corp., 205 Fed Appx 856, 857 [2d Cir 2006], citing Abrams v Interco Inc., 719 F2d 23, 34 n 9 [2d Cir 1983].){**61 Misc 3d at 1006}
Pursuant to res judicata, a disposition on the merits bars litigation between the same parties of a cause of action arising out of the same transaction or series of transactions as a cause of action that either was raised or could have been raised in the prior action (see Abraham v Hermitage Ins. Co., 47 AD3d 855 [2d Dept 2008], affg 2005 WL 6205455 [Sup Ct, Queens County 2005]).
This court notes plaintiff relies on federal cases in its assertion that default judgments lack preclusive effect. However, under New York state law, default judgments which have not been vacated are final orders, thus preclusive. (See Lazides v P & G Enters., 58 AD3d 607 [2d Dept 2009], revg 2007 WL 6861118 [Sup Ct, Kings County 2007].) The courts have reasoned that to hold otherwise would destroy or impair the rights or interests established by default judgment. (See Schuylkill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 [1929]; Great Health Care Chiropractic, P.C. v Progressive Ins. Co., 48 Misc 3d 134[A], 2015 NY Slip Op 51077[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015].)
As the Supreme Court’s declaratory default judgment order against Kerisli Chiropractic, P.C. has not been vacated, the order hence constitutes a final determination, which precludes the instant no-fault action.
Plaintiff also cites cases holding that a mere entry of default judgment in a declaratory judgment action “cannot be considered a conclusive final determination and, thus, can have no preclusive effect in the action at bar.” (See Active Chiropractic, P.C. v 21st Century Ins. Co., 58 Misc 3d 156[A], 2018 NY Slip Op 50200[U], *2 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018]; Promed Orthocare Supply, Inc. v AIG Advantage Ins. Co., 50 Misc 3d 128[A], 2015 NY Slip Op 51886[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; Metro Health Prods., Inc. v Nationwide Ins., 48 Misc 3d 85 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015].)
The above cases are distinguished from the case at bar, as there is no declaration made by the default judgment orders in the declaratory judgment action at issue in each case. This court takes judicial notice respectively of the default judgment orders in the declaratory judgment actions in Active Chiropractic, P.C., from Supreme Court, New York County dated December 8, 2014, and in Promed Orthocare Supply, Inc., from Supreme Court, Nassau County dated March 15, 2010. (See Caffrey v North Arrow Abstract & Settlement Servs., Inc., 160 [*3]AD3d 121 [2d Dept 2018].){**61 Misc 3d at 1007}
In Active Chiropractic, P.C. (2018 NY Slip Op 50200[U], *1), the Supreme Court’s order in the declaratory judgment action merely states that an unrelated relief requested by insurer is granted, and that “the remainder of the motion [is] granted without opposition.” The order does not indicate that a judicial declaration was made by the court, or that a declaration was a relief sought by movant. As the Supreme Court’s order merely grants the entry of default judgment, and is devoid of a judicial declaration, the Appellate Term, Second Department found that the order could not be considered a final order. Absent a judicial declaration, in a declaratory judgment action, it would be impossible to deem or enforce the order as preclusive.
Similarly, in Promed Orthocare Supply, Inc., the Supreme Court’s order in the declaratory judgment action merely states that “plaintiff’s unopposed motion for a judgment on default as against” various defendants “is granted.” The order makes no reference to a judicial declaration or indicates that a declaration was sought in the motion. As with the Supreme Court order at Active Chiropractic, P.C., the Appellate Term, Second Department in Promed Orthocare Supply, Inc. held that the order could not be considered a conclusive final determination, absent declaration of the issues litigated on default. (See Promed Orthocare Supply, Inc., 2015 NY Slip Op 51886[U], *1; Active Chiropractic, P.C., 2018 NY Slip Op 50200[U]; see also Vital Meridian Acupuncture, P.C. v Republic W. Ins. Co., 46 Misc 3d 147[A], 2015 NY Slip Op 50222[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015].) To have res judicata effect in a declaratory judgment action, the order must specify the issues that were determined so that those issues could be identified as barred in future litigations.
In the instant no-fault action, contrary to Active Chiropractic, P.C. and Promed Orthocare Supply, Inc., the Supreme Court’s declaratory judgment order determines the rights of the parties and is thus preclusive as a final order. The Supreme Court’s order recites the specific declaratory relief requested by the insurer, and grants the motion on default, leaving no ambiguity as to the substance of the court’s declaration.
An order specifying the court’s declaratory judgment is a conclusive final determination, notwithstanding that it was entered on default. (See Lazides v P & G Enters. at 607; Metro Health Prods., Inc. v Nationwide Ins., 48 Misc 3d 85 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015].)
As the Supreme Court order pertaining to the instant no-fault action is a conclusive final determination of the rights of{**61 Misc 3d at 1008} the parties herein, plaintiff is barred from relitigating the claim pursuant to the doctrine of res judicata.
Lastly, plaintiff cites Metro Health Prods., Inc., which is distinguished from the facts of the instant action. Contrary to the case at bar, the order in the declaratory judgment action at issue in Metro Health Prods., Inc. directed the insurer to settle judgment on notice. The insurer failed to settle judgment on notice, and the Appellate Term, Second Department held that an order to settle judgment on notice is not a conclusive final determination and is thus not preclusive. (See Metro Health Prods., Inc., 48 Misc 3d 85.)
As the Supreme Court’s declaratory judgment pertaining to the instant action is a final conclusive determination, hence with preclusive effect, defendant’s motion is granted. It is hereby ordered that the action is dismissed.
Reported in New York Official Reports at Maiga Prods. Corp. v Hertz Co. (2018 NY Slip Op 51448(U))
[*1]| Maiga Prods. Corp. v Hertz Co. |
| 2018 NY Slip Op 51448(U) [61 Misc 3d 132(A)] |
| Decided on October 12, 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 October 12, 2018
PRESENT: : MICHELLE WESTON, J.P., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2016-3065 K C
against
Hertz Co., Appellant.
Rubin, Fiorella & Friedman, LLP (Kyeko M. Stewart and Lindsay Padover of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell and Karina Barska of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Steven Z. Mostofsky, J.), entered July 25, 2016, deemed from a judgment of that court entered August 4, 2016 (see CPLR 5512 [a]). The judgment, entered pursuant to the July 25, 2016 order granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment dismissing the complaint, awarded plaintiff the principal sum of $3,698.07.
ORDERED that the judgment is reversed, with $30 costs, so much of the order entered July 25, 2016 as granted plaintiff’s motion for summary judgment is vacated, and summary judgment dismissing the complaint is awarded to defendant pursuant to CPLR 3212 (b), in accordance with the decision herein.
Plaintiff commenced this action on April 17, 2014 to recover assigned first-party no-fault benefits for supplies provided to its assignor, who had purportedly been injured in a motor vehicle accident on November 16, 2013. Thereafter, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs). By order entered July 25, 2016, the Civil Court granted plaintiff’s motion and denied defendant’s cross motion. A judgment was entered on August 4, 2016 pursuant to the order, awarding plaintiff the principal sum of $3,698.07. On appeal, defendant argues that the complaint should [*2]be dismissed, as the action is barred by an order of the Supreme Court, New York County, entered April 20, 2017, which declared that the insurer herein is not obligated to pay “any current or future” claim for no-fault benefits arising out of the November 16, 2013 motor vehicle accident, due to the failure by the assignor herein to appear for scheduled EUOs. Defendant further argues that, in any event, plaintiff failed to establish its prima facie entitlement to summary judgment.
Contrary to the determination of the Civil Court, plaintiff’s motion papers failed to prove, prima facie, that it was entitled to summary judgment, as the proof it submitted failed to demonstrate that the claims at issue had not been timely denied (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).
Upon the record presented to the Civil Court, defendant failed to demonstrate that it had timely (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and properly denied the claims. Thus, defendant did not show that it is not precluded from interposing its defense (see Nyack Hosp. v Encompass Ins. Co., 23 AD3d 535 [2005]; Points of Health Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133[A], 2010 NY Slip Op 51338[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2010]) that plaintiff’s assignor had failed to appear for duly scheduled EUOs. Consequently, defendant’s cross motion for summary judgment dismissing the complaint was properly denied.
However, for the reasons stated in K.O. Med., P.C., as Assignee of Brutus Christopher v Mercury Cas. Co. (57 Misc 3d 155[A], 2017 NY Slip Op 51614[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]), in the interest of judicial economy, upon taking judicial notice of the order of the Supreme Court, New York County, entered April 20, 2017, we award defendant summary judgment dismissing the complaint pursuant to CPLR 3212 (b).
Accordingly, the judgment is reversed, so much of the order entered July 25, 2016 as granted plaintiff’s motion for summary judgment is vacated, and summary judgment dismissing the complaint is awarded to defendant pursuant to CPLR 3212 (b).
WESTON, J.P., ALIOTTA and ELLIOT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: October 12, 2018Mingmen Acupuncture Servs., PC v Global Liberty Ins. Co. of N.Y. (2018 NY Slip Op 51358(U))
Reported in New York Official Reports at Mingmen Acupuncture Servs., PC v Global Liberty Ins. Co. of N.Y. (2018 NY Slip Op 51358(U))
against
Global Liberty Insurance Company of New York, Defendant-Appellant.
Defendant, as limited by its brief, appeals from so much of an order of the Civil Court of the City of New York, New York County (Debra Rose Samuels, J.), entered September 28, 2017, as denied its motion for summary judgment dismissing the complaint.
Per Curiam.
Order (Debra Rose Samuels, J.), entered September 28, 2017, insofar as appealed from, reversed, with $10 costs, motion granted, and the complaint dismissed. The Clerk is directed to enter judgment accordingly.
The defendant-insurer made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely denied plaintiff’s first-party no-fault claims based on a sworn independent examination report [IME] of its examining acupuncturist/chiropractor, which set forth a factual basis and medical rationale for her stated conclusion that the assignor’s injuries were resolved and that there was no need for further acupuncture treatment (see Rummel G. Mendoza, D.C., P.C. v Chubb Indem. Ins. Co., 47 Misc 3d 156[A], 2015 NY Slip Op 50900[U][App Term, 1st Dept 2015]); Utica Acupuncture, P.C. v Interboro Ins. Co., 39 Misc 3d 139[A], 2013 NY Slip Op 50643[U] [App Term, 1st Dept 2013]).
In opposition, the affidavit of plaintiff’s principal failed to raise a triable issue since it was not based on an examination of the assignor, nor did it meaningfully rebut the findings of defendant’s examining acupuncturist/chiropractor, including the normal results of the range of motion testing (see Arnica Acupuncture PC v Interboard Ins. Co., 137 AD3d 421 [2016]; Rummel G. Mendoza, D.C., P.C. v Chubb Indem. Ins. Co., 47 Misc 3d 156[A]). Nor did the assignor’s subjective complaints of pain overcome the objective medical tests detailed in the IME report (see Arnica Acupuncture PC v Interboard Ins. Co., 137 AD3d 421; TC Acupuncture, P.C. v Tri-State Consumer Ins. Co., 52 Misc 3d 131[A], 2016 NY Slip Op 50978[U] [App Term, 1st Dept 2016]).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concur I concur I concur
Decision Date: September 26, 2018
Reported in New York Official Reports at Village Med. Supply, Inc. v Travelers Prop. Cas. Ins. Co. (2018 NY Slip Op 51311(U))
| Village Med. Supply, Inc. v Travelers Prop. Cas. Ins. Co. |
| 2018 NY Slip Op 51311(U) [61 Misc 3d 126(A)] |
| Decided on September 17, 2018 |
| Appellate Term, First 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 September 17, 2018
PRESENT: Shulman, P.J., Cooper, Edmead, JJ.
570014/18
against
Travelers Property Casualty Insurance Company, Defendant-Appellant.
Defendant, as limited by its brief, appeals from an order of the Civil Court of the City of New York, New York County (Erika M. Edwards, J.), entered June 1, 2016, which denied its motion for summary judgment dismissing the complaint.
Per Curiam.
Order (Erika M. Edwards, J.), entered June 1, 2016, reversed, with $10 costs, motion granted and complaint dismissed. The Clerk is directed to enter judgment accordingly.
Defendant-insurer established its prima facie entitlement to summary judgment dismissing the underlying first-party no-fault claims as premature, since the record conclusively establishes that plaintiff failed to respond to timely requests for verification (see St. Vincent Med. Care, P.C. v. Country Wide Ins. Co., 80 AD3d 599, 600 [2011]). No triable issue was raised by plaintiff’s claim that defendant had no “good reason” (11 NYCRR 65-3.2[c]) for its verification request for a manufacturer’s invoice documenting the cost of the supplies provided to the assignor (see New Way Med. Supply Corp. v State Farm Mut. Auto Ins. Co., 56 Misc 3d 132[A], 2017 NY Slip Op 50925[U] [App Term 2d, 11th and 13th Jud Dists 2017]; see also 12 NYCRR 442.2[a]).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concur I concur I concur
Decision Date: September 17, 2018