Reported in New York Official Reports at American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C. (2025 NY Slip Op 01337)
American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C. |
2025 NY Slip Op 01337 |
Decided on March 12, 2025 |
Appellate Division, Second Department |
Duffy, J.P. |
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
This opinion is uncorrected and subject to revision before publication in the Official Reports. |
COLLEEN D. DUFFY, J.P.
ROBERT J. MILLER
LINDA CHRISTOPHER
LOURDES M. VENTURA, JJ.
2023-06053
(Index No. 503023/22)
v
Comfort Choice Chiropractic, P.C., etc., appellant.
APPEAL by the defendant, in an action pursuant to Insurance Law § 5106(c) for a de novo determination of claims for no-fault insurance benefits, from an order of the Supreme Court, Kings County (Debra Silber, J.), dated May 4, 2023. The order denied the defendant’s motion pursuant to CPLR 3211(a) to dismiss the complaint for lack of subject matter jurisdiction and pursuant to 11 NYCRR 65.4.10(j)(4) for an award of attorney’s fees.
Gary Tsirelman, P.C., Brooklyn, NY, for appellant.
Larkin Farrell, LLC, New York, NY (Anthony R. Troise of counsel), for respondent.
OPINION & ORDER
The issue on appeal, an issue of first impression for this Court, is whether, under certain circumstances, separate and distinct arbitral awards can be treated by a court as, in effect, a single arbitral award under Insurance Law § 5106(c) and pursuant to 11 NYCRR 65-4.10(h)(1)(ii) for the purposes of determining whether the requisite $5,000 threshold establishing subject matter jurisdiction has been met to allow for a de novo review of claims for no-fault insurance benefits. As set forth below, we hold that the plain language of Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1) does not contemplate allowing separate and distinct arbitral awards to be treated as, in effect, a single arbitral award or to be combined by a court for the purposes of meeting the required monetary jurisdictional threshold under Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii). Our reading of these subdivisions of Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii) comports with the plain meaning of the words contained therein as well as the legislative intent of the statute and related authority.
Background of the Action
As is relevant to this appeal, in January 2022, the plaintiff American Transit Insurance Company commenced this action pursuant to Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii) to seek de novo review of four separate arbitral awards issued by a master arbitrator (hereinafter the arbitral awards). The four arbitral awards were issued by the same master arbitrator, following separate arbitration proceedings upon the plaintiff’s denial of payment for medical services performed by the defendant for Nancy Bayona, an individual who alleged that she was injured as a result of a motor vehicle accident in February 2019 when she was riding as a passenger in a taxi insured by the plaintiff. The arbitration proceedings arose upon the plaintiff’s denial of each of four claims submitted to it by the defendant for a repeated course of chiropractic treatment of Bayona performed by the defendant between March 8 and September 4, 2019. After each of the four arbitration proceedings, the master arbitrator issued an arbitral award in favor of the defendant, [*2]respectively, as follows: $4,767.63 for chiropractic services performed in March 2019; $4,767.63 for chiropractic services performed in March 2019 and April 2019; $4,767.63 for chiropractic services performed in April 2019 and May 2019; and $3,178.42 for chiropractic services performed in August 2019. Thereafter, pursuant to Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii), the plaintiff commenced this action seeking de novo review of the four arbitral awards.
Procedural History
The defendant moved pursuant to CPLR 3211(a)(2) to dismiss the complaint for lack of subject matter jurisdiction and pursuant to 11 NYCRR 65-4.10(j)(4) for an award of attorney’s fees for its work in preparing its motion. The defendant contended that the complaint should be dismissed as the Supreme Court lacked subject matter jurisdiction over the four arbitral awards, since each arbitral award was less than the requisite $5,000 threshold under Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii)—the relevant statute and regulation conferring subject matter jurisdiction for de novo review of the claims by the court. The defendant also contended, inter alia, that, pursuant to 11 NYCRR 65-4.10(j)(4), it was entitled to attorney’s fees for its work in preparing its motion to dismiss. The plaintiff opposed the motion, contending, among other things, that the four arbitral awards were, in effect, a single arbitral award which, collectively, exceeded the requisite $5,000 threshold. The plaintiff contended that, since the arbitral awards involved the same parties, were decided by the same arbitrator on the same day, and essentially involved the same services, they, therefore, in effect, constituted a single arbitral award. In an order dated May 4, 2023, the court denied the defendant’s motion (hereinafter the May 2023 order). The court determined, inter alia, that the four arbitral awards, in effect, constituted a single arbitral award and also denied the defendant’s request pursuant to 11 NYCRR 65.4.10(j)(4) for an award of attorney’s fees. The defendant appeals.
For the reasons set forth below, we reverse the May 2023 order and grant the defendant’s motion to dismiss the complaint on the ground that the Supreme Court lacked subject matter jurisdiction and for an award of attorney’s fees. We also remit the matter to the Supreme Court, Kings County, for a determination of the amount of reasonable attorney’s fees to be awarded to the defendant pursuant to 11 NYCRR 65.4.10(j)(4).
The Relevant Statutes
The relevant statute and regulation governing the monetary jurisdictional threshold for a de novo action, such as this one, are Insurance Law § 5106(c) and 11 NYCRR 65-4.10.
Insurance Law § 5106(c)
Insurance Law § 5106(c) provides, in relevant part:
“An award by an arbitrator shall be binding except where vacated or modified by a master arbitrator in accordance with simplified procedures to be promulgated or approved by the superintendent. The grounds for vacating or modifying an arbitrator’s award by a master arbitrator shall not be limited to those grounds for review set forth in article seventy-five of the civil practice law and rules. The award of a master arbitrator shall be binding except for the grounds for review set forth in article seventy-five of the civil practice law and rules, and provided further that where the amount of such master arbitrator’s award is five thousand dollars or greater, exclusive of interest and attorney’s fees, the insurer or the claimant may institute a court action to adjudicate the dispute de novo” (emphasis added).
Pursuant to subdivision (h)(1) of 11 NYCRR 65-4.10,
“[a] decision of a master arbitrator is final and binding, except for:
“(i) court review pursuant to an article 75 proceeding; or
“(ii) if the award of the master arbitrator is $5,000 or greater, exclusive of interest and attorney’s fees, either party may, in lieu of an article 75 proceeding, institute a court action to adjudicate the dispute de novo” (emphasis added).Thus, where a master arbitrator’s award is $5,000 or greater, exclusive of interest and attorney’s fees, a court may [*3]conduct a de novo adjudication of a no-fault insurance claim.
Contrary to the determination of the Supreme Court and, as set forth herein, we find that the plain language contained in both Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii) does not allow a court to treat separate arbitral awards as, in effect, a single, combined arbitral award for the purposes of meeting the subject matter jurisdictional threshold for de novo review—even under circumstances such as those here, where the service provider was the same in each circumstance, the insurance company was the same, the service recipient was the same, and the services that were provided were the same.
Thus, as noted herein, the Supreme Court should not have treated these four separate arbitral awards as, in effect, one arbitral award that, collectively, met the $5,000 threshold for de novo review.
Accordingly, the Supreme Court should have granted that branch of the defendant’s motion which was to dismiss the complaint for lack of subject matter jurisdiction, as well as that branch of its motion which was for an award of attorney’s fees.
Statutory Interpretation
Plain Language
In matters of statutory interpretation, the primary consideration is to discern and give effect to the Legislature’s intent (see Yatauro v Mangano, 17 NY3d 420, 426). “The starting point for discerning legislative intent is the language of the statute itself” (id. at 426). “Inasmuch as the text of a statute is the clearest indicator of such legislative intent, where the disputed language is unambiguous, [courts] are bound to give effect to its plain meaning” (Makinen v City of New York, 30 NY3d 81, 85 [alternation and internal quotation marks omitted]). “[T]he text of a provision ‘is the clearest indicator of legislative intent and courts should construe unambiguous language to give effect to its plain meaning'” (Matter of Albany Law School v New York State Off. of Mental Retardation & Dev. Disabilities, 19 NY3d 106, 120, quoting Matter of DaimlerChrysler Corp. v Spitzer, 7 NY3d 653, 660; see Majewski v Broadalbin-Perth Cent. School Dist., 91 NY2d 577, 583). “When the plain language of the statute is precise and unambiguous, it is determinative” (Matter of Washington Post Co. v New York State Ins. Dept., 61 NY2d 557, 565; see Loehr v New York State Unified Court System, 150 AD3d 716, 720).
Here, the plain language of Insurance Law § 5106(c) expressly provides that an arbitrator’s award must meet the $5,000 threshold in order to permit a party to seek a de novo determination by commencing an action in a court as to the award. Likewise, 11 NYCRR 65-4.10(h)(1)(ii) sets forth that “if the award of the master arbitrator is $5,000 or greater, exclusive of interest and attorney’s fees, either party may, in lieu of an article 75 proceeding, institute a court action to adjudicate the dispute de novo” (emphasis added).
The use of the singular in the statute and the regulation—”arbitrator’s award” in Insurance Law § 5106(c) and “the award” in 11 NYCRR 65-4.10(h)(1)(ii)—means one, single award, not a combination or collective group (see Verneau v Consol. Edison Co. of N.Y., Inc., 37 NY3d 387, 395 [“The legislature’s choice of the singular indefinite article—’a’ claim—means the liability to be transferred is for a single claim at the time of application“]). The Legislature did not opt to use the plural, and there is no other language in either the statute or the regulation that would allow for the singular to be interpreted as encompassing the plural (cf. Powers v 31 E 31 LLC, 24 NY3d 84, 91 [“Although the 1968 Building Code refers to a ‘parapet . . . railing[,] or fence’ in the singular, it specifically provides that ‘words used in the singular include the plural, and the plural the singular’ (1968 Building Code of City of NY [Administrative Code of City of NY] §§ 27-231, 27-334)” (emphasis added)]). To the extent that the statute or the regulation do not expressly address the issue of treating multiple arbitral awards as, in effect, a singular arbitral award, “[c]ourts ‘cannot amend a statute by inserting words that are not there, nor will a court read into a statute a provision which the legislature did not see fit to enact'” (People v Corr, ____ NY3d ____, ____, 2024 NY Slip Op 03379, *2, quoting People v Hardy, 35 NY3d 466 [alteration and internal quotation marks omitted]). Indeed, “[i]n the absence of a statutory definition, we construe words of ordinary import with their usual and commonly understood meaning” (Nadkos, Inc. v Preferred Contrs. Ins. Co. Risk Retention Group LLC, 34 NY3d 1, 7 [internal quotation marks omitted]).
Given the plain language of Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii), it was not proper for the Supreme Court to expand the scope of the legislation by [*4]construing it to allow for multiple arbitral awards to be treated as, in effect, one, or as a single, combined arbitral award in order to meet the requisite threshold (see e.g. Wells Fargo Bank, N.A. v Yapkowitz, 199 AD3d 126, 133 [“it would be improper for the court to essentially rewrite the statute to substitute ‘borrowers’ in the plural for ‘borrower’ in the singular under RPAPL 1304(2)”]).
Since the language of the statute and the regulation is plain and unambiguous, it is unnecessary to consider the legislative history (see Nadkos, Inc. v Preferred Contrs. Ins. Co. Risk Retention Group LLC, 34 NY3d at 5). Nonetheless, as set forth herein, the history underpinning the legislation at issue lends further support to our conclusion that the singular language in the legislation referring to “award” was deliberate and that the Legislature did not contemplate that courts would invoke their authority to exercise discretion to treat multiple arbitral awards as, in effect, a singular arbitral award to meet the $5,000 statutory threshold.
Legislative History
Although the legislative history of the statute is sparse, in February 1973, then-Governor Nelson A. Rockefeller signed the Comprehensive Automobile Insurance Reparations Act into law and issued a memorandum to the then-existing members of the New York Legislature entitled, “Governor’s Memoranda, Approval of the Comprehensive Automobile Insurance Reparations Act” (hereinafter the Governor’s Memo), which provides, in relevant part, as follows:
“With the enactment of this measure, the present automobile insurance system—a system which costs too much, takes too long to pay off and delivers too little protection—will be cast aside. In its stead will be a new insurance reparations system which
“- assures that every auto accident victim will be compensated for substantially all of his economic loss, promptly and without regard to fault;
“- will eliminate the vast majority of auto accident negligence suits, thereby freeing our courts for more important tasks; and
“- provides substantial premium savings to all New York motorists.
“The passage of no-fault auto insurance is a triumph of good sense and a victory for the people. On the solid foundation of this bill, I hope that we can continue to achieve further premium savings and get even more negligence cases out of the courts in the future.
“I am, therefore, pleased to give my approval of this long overdue measure” (Governor’s Mem approving L 1973, ch 13, 1973 McKinney’s Sess Laws of NY at 2335 [emphasis added]).
The Governor’s Memo approving the no-fault system of handling claims such as the ones that were the subject of the four arbitration proceedings expressly provides that one of the primary purposes for enactment of the statute was to relieve the burden of these type of cases on the courts (see id.).
Construing the legislation at issue to allow a court to exercise its discretion in determining whether to treat separate arbitral awards as, in effect, one collective arbitral award for the purposes of establishing subject matter jurisdiction is contrary to the stated purpose of the legislation. Such construction could greatly expand the number of such cases heard by a court, rather than reduce the number of these types of cases within the court system, as anticipated by the enactment of the statutes.
Thus, even if the language in the legislation did not unambiguously state that a single arbitral award, rather than a collective set of arbitral awards, must equal or exceed $5,000 in order to meet the jurisdictional threshold establishing subject matter jurisdiction such that a court could undertake a de novo review of the arbitral award, construing the legislation as so doing supports the legislative intent to promptly resolve no-fault reimbursements, “reduce the burden on the courts and to provide substantial premium savings to New York motorists” (Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498, 505 [internal quotation marks omitted] [plaintiff medical provider demonstrated entitlement to summary judgment in a no-fault insurance action, as the provider submitted evidence that payment of no-fault benefits was overdue and proof that its claim was mailed to and received by the defendant insurer]; see Contact Chiropractic, P.C. v New York [*5]City Tr. Auth., 31 NY3d 187, 194-196 [stating that the no-fault law is aimed at ensuring prompt compensation for losses incurred by accident victims without regard to fault or negligence, to reduce the burden on the courts, and to provide substantial premium savings to New York motorists, and holding that a three-year statute of limitations, not six-year statute of limitations, applies]; Matter of Medical Socy. of State of N.Y. v Serio, 100 NY2d 854, 860 [challenged regulations reducing notice and claim filing time frames were fully consistent with the Insurance Law since “[t]he primary aims of this new system were to ensure prompt compensation for losses incurred by accident victims without regard to fault or negligence, to reduce the burden on the courts and to provide substantial premium savings to New York motorists”]).[FN1]
Given that one of the intended purposes of the statute was to relieve the burden of these type of cases on the courts—as evidenced by the Governor’s Memo approving the no-fault system of handling claims such as the ones that were the subject of the four arbitration proceedings, it is evident that the singular language in the statute and regulation referring to “award” was deliberate. Thus, the Supreme Court’s treatment of the four arbitral awards as, in effect, one arbitral award, was improper and inconsistent with the legislation’s intended purpose.
Relevant Caselaw
Additionally, although not dispositive to the issue before this Court, relevant authority supports this Court’s interpretation of the statute and the regulation as well. In 2003, in Matter of Medical Socy. of State of N.Y. v Serio (100 NY2d 854), the Court of Appeals, among other things, upheld a regulation that reduced the time frame in which a motor-vehicle accident victim is required to submit a notice of claim to an insurer from 90 days to 30 days after the accident under the no-fault insurance system pursuant to Insurance Law § 5106(a) and reduced the time in which to submit proof of loss due to medical treatment from 180 days to 45 days. There, in promulgating the regulation, the Superintendent of Insurance had concluded that the proposed amendments “would better
effectuate the legislative purpose of providing prompt compensation” (Matter of Medical Socy. of State of N.Y. v Serio, 100 NY2d at 860) and the Court noted that a primary aim of this system was to reduce the burden on the courts (see id. at 860, citing the Governor’s Mem approving L 1973, ch 13, 1973 McKinney’s Sess Laws of NY at 2335).
Likewise, in 1997, in Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co. (90 NY2d 274), the Court of Appeals also discussed the legislative intent underlying New York State’s no-fault system recognizing that “[t]o string out belated and extra bites at the apple is, on the present state of the law, inherently contradictory and unfounded under the statutes, regulations and policies that pertain to and govern this dispute, and we should not countenance such practices on the state of this record and these regulations and statutes” (id. at 286 [insurer precluded from raising an intoxication exclusion defense because it failed to deny the claim within 30 days as required by Insurance Law § 5106(a)]).
This legislative intent—to ensure prompt resolution of claims under the no-fault statutory system and to alleviate the burden of these types of cases in court (see Pommells v Perez, 4 NY3d 566, 570)—is furthered by our conclusion that the legislation does not provide the parties or a court with discretion to treat separate arbitral awards as, in effect, one arbitral award to meet the $5,000 threshold for de novo review.
Manipulating Claims
To the extent that the plaintiff posited that a narrow construction of the language of the legislation will allow for service providers to manipulate the way their claims are issued in order to avoid a court’s de novo review of an arbitral award, such a contention is specious. As an initial matter, parties are free to chart the course of their disputes regarding claims with respect to the issuance of a claim by a service provider and the submission of any disputed claims, either singularly [*6]or collectively, to arbitration. More importantly, given the stated goal of the legislation to reduce the number of these type of cases before a court, limiting the amount of cases subject to de novo review promotes the purpose of the statutes.
The statutory language and legislative history evidence that the Legislature intended that review of such cases by a court be the exception, not the norm. Further, litigants with arbitral awards totaling less than $5,000 may still seek to vacate an arbitral award of a master arbitrator through a CPLR article 75 proceeding (see Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d 703, 705 [“The term ‘court appeal’ applies to a proceeding such as this, taken pursuant to CPLR article 75 to vacate or confirm a master arbitration award”]; Matter of Custen v General Acc. Fire & Life Ins. Co., 126 AD2d 256, 258 [“it is clear that the Legislature intended the provision of CPLR article 75 to apply only to the review of the awards of master arbitrators (see, Insurance Law § 5106[c])”]).
Related Authority
Our conclusion as to the meaning of the legislation also is consistent with a comparable determination by our sister court, the Appellate Division, First Department. Although not binding on this Court, the First Department’s determination in 2021, in an action with similar facts to those here, American Tr. Ins. Co. v Health Plus Surgery Ctr., LLC (192 AD3d 497), is instructive. There, the First Department affirmed the grant of a defendant’s motion to dismiss a complaint for de novo adjudication on the ground that “[t]he medical services provided to [the] plaintiff’s insured were separate and distinct from each other, were billed separately and should not be combined to meet the $5,000 threshold for de novo review” (id. at 497-498).
In a similar vein, in 2014, in Imperium Ins. Co. v Innovative Chiropractic Servs., P.C. (43 Misc 3d 137[A], 2014 NY Slip Op 50697[U] [App Term, 1st Dept]), a case decided by the Appellate Term, First Department, which involved an action seeking, among other things, de novo review of five, separately issued, arbitral awards of a master arbitrator in favor of the defendant medical providers, that court held that none of the five arbitral awards at issue in that case met or exceeded the $5,000 threshold requirement set forth in Insurance Law § 5106 and, thus, de novo review was unavailable (see Imperium Ins. Co., 2014 NY Slip Op 50697[U]).
The Vagaries of Nisi Prius Decisions
We note that, notwithstanding the Appellate Division, First Department’s determination in American Tr. Ins. Co. v Health Plus Surgery Ctr., LLC, (192 AD3d at 497-498), the Supreme Court, New York County, has, in certain circumstances—American Tr. Ins. Co. v Surgicore of Jersey City LLC (69 Misc 3d 1216[A], 2020 NY Slip Op 51398[U] [Sup Ct, NY County]) and American Tr. Ins. Co. v Horizon Anesthesia Group, PC (2021 NY Slip Op 32654[U] [Sup Ct, NY County])—treated distinct arbitral awards to be a single, unified arbitral award for the purposes of the jurisdictional threshold of Insurance Law § 5106(c).
In Surgicore, although the Supreme Court took note of the plain language of the statute (see Surgicore, 2020 NY Slip Op 51398[U], *2 [“[Insurance Law] § 5106(c)’s reference to a master arbitrator’s award, singular, must be given effect. A plaintiff may not, therefore, aggregate various arbitral awards in order to meet the statutory minimum of $5,000”] [alteration and internal quotation marks omitted]), the court nonetheless distinguished the facts in that case from the Supreme Court determination that was later affirmed in American Tr. Ins. Co. v Health Plus Surgery Ctr., LLC, (192 AD3d at 497-498). The Surgicore court determined that distinct arbitral awards, one for a pre-operative nerve block in the amount of $517.89, and the other for the same person for an operation in the amount of $25,962.93, were more properly understood as a single unified arbitral award for the purposes of the de novo review threshold of Insurance Law § 5106(c), without citation to legislative authority to do so. The court noted that treating the awards as separate and distinct “would exalt form over substance to no purpose” (Surgicore, 2020 NY Slip Op 51398[U], *2).
And, in Horizon Anesthesia (2021 NY Slip Op 32654[U]), the plaintiff commenced an action seeking a de novo adjudication of three separate master arbitrator’s awards: an award in favor of Horizon in the amount of $1,469.99 and two awards in favor of NHSC in the amounts of $258.94 and $16,237.97. Citing American Tr. Ins. Co. v Health Plus Surgery Ctr., LLC, (192 AD3d at 497), the Horizon Anesthesia court concluded that clearly the award in favor of Horizon did not meet the $5,000 threshold, and the plaintiff could combine awards to meet the same. However, the court denied that branch of the defendants’ cross-motion which was to dismiss the complaint insofar as asserted against NHSC, since once of the two arbitral awards, in the amount $16,234.97 issued against that defendant, met the threshold. The court essentially disregarded the statutory language [*7]and found that there was no reason to separate the other arbitral award of $258.94 against that defendant (see Horizon Anesthesia, 2021 NY Slip Op 032654[U]).
In contrast, in American Tr. Ins. Co. v Unicorn Acupuncture, P.C. (2023 NY Slip Op 33008[U] [Sup Ct, Kings County]), the Supreme Court, Kings County, declined to treat as a single unified arbitral award, three distinct arbitral awards for acupuncture treatment performed on the same client by the same service provider over a period of 2½ years. There, the individual arbitral awards were each less than the $5,000 jurisdictional threshold: one, in the sum of $2,838.63, pertained to medical services billed between May 1 and December 27, 2017; the second, in the sum of $4,349.67, pertained to medical services billed between March 1, 2018 and February 28, 2019; and the third, in the sum of $1,811.80, pertained to medical services billed between March 15 and November 19, 2019. There, despite the plain language of the legislation and its express purpose, the court reasoned that there was no bright-line rule as to when separate arbitral awards should be treated as, in effect, a single, unified arbitral award, and determined that “the billing period, and the length of time the services provided are [factors to assess] in whether the arbitration awards should be considered distinct from each other” (id. at *4). The court, noting that the arbitral awards were for separate treatments performed over a period of 2½ years, found that those facts distinguished the case from Surgicore (2020 NY Slip Op 51398[U]), wherein the Supreme Court, New York County, determined that separate arbitral awards for services that were performed in one day were, in effect, one arbitral award and not separate and distinct arbitral awards (see Unicorn Acupuncture, 2023 NY Slip Op 33008[U], *4).
Although each of the nisi prius determinations of these Supreme Court cases yielded different results, a common theme in each is the discretion each Supreme Court exercised in order to deviate from the express and intended purpose of the legislation, essentially carving out exceptions to the legislation and creating a set of factors to consider in deciding whether to carve out an exception to the legislation. In each instance, the courts did so without citing any legislative authority or approval.
The Arbitral Awards are Separate and Distinct and Do Not Meet the Requisite Jurisdictional Threshold
Here, although the four arbitral awards pertained to a repeated course of treatment performed by the same service provider over a period of six months, each treatment was billed separately and each arbitral award was an amount less than $5,000. Also, of note, unlike Surgicore (2020 NY Slip Op 51398[U]), wherein the Supreme Court, New York County, treated the separate arbitral awards regarding payments for a single procedure that was performed on the same day as, in effect, a unified arbitral award to meet the statutory threshold for de novo review, this case does not deal with a singular procedure being performed on the same day.
Rather, here, like the three separate arbitral awards for acupuncture services performed over a period of 2½ years in Unicorn Acupuncture (2023 NY Slip Op 33008[U] [Supreme Court declined to consider three arbitral awards for acupuncture services performed over the period of 2½ years as a single, unified arbitral award]), at issue is a repeated course of multiple treatments over an extended period of time.
In sum, although the legislation at issue plainly requires that a single arbitral award meet the monetary threshold for de novo review by a court, and one of the intended purposes of the legislation is to reduce the number of such cases in New York State’s court system, the Supreme Court here, like other nisi prius courts in New York, in effect, delegated to itself the authority to carve out an exception to the legislation.
Given the plain language of the legislation, as well as its express intended purpose, we find no such authority has been provided by the Legislature to do so.
Accordingly, the Supreme Court should have granted that branch of the defendant’s motion which was pursuant to CPLR 3211(a)(2) to dismiss the complaint for lack of subject matter jurisdiction.
Attorney’s Fees
Insurance Law § 5106(a) provides, in part, that “if a valid claim [for no-fault benefits] or portion was overdue, the claimant shall also be entitled to recover his attorney’s reasonable fee, for services necessarily performed in connection with securing payment of the overdue claim, subject to limitations promulgated by the superintendent in regulations.” 11 NYCRR 65-4.10(j)(4), provides in pertinent part: “The attorney’s fee for services rendered in connection with a court adjudication of dispute de novo, as provided in section 5106(c) of the Insurance Law, or in a court appeal from [*8]a master arbitration award and any further appeals, shall be fixed by the court adjudicating the matter.”
In light of our determination herein, pursuant to 11 NYCRR 65.4.10(j)(4), the Supreme Court also should have granted that branch of the defendant’s motion which was for an award of attorney’s fees (see Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co., 170 AD3d 1168).
The plaintiff’s remaining contention is without merit.
Conclusion
Based on the plain language of Insurance Law § 5106(c) and 11 NYCRR 65-4.10(h)(1)(ii), the legislative intent of the statute, and related persuasive authority, we hold that the four arbitral awards at issue here should not have been treated as, in effect, a single arbitral award in order to meet the $5,000 jurisdictional threshold. Therefore, the defendant’s motion to dismiss the complaint for lack of subject matter jurisdiction and for an award of attorney’s fees should have been granted, and we remit the matter to the Supreme Court, Kings County, for a determination of the amount of reasonable attorney’s fees to be awarded to the defendant pursuant to 11 NYCRR 65.4.10(j)(4) (see Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co., 170 AD3d 1168, 1168 [affirming vacatur of a master arbitrator’s determination and remitting the matter to determine the petitioner’s reasonable attorney’s fees for the appeal]; Matter of GEICO Ins. v AAAMG Leasing Corp., 148 AD3d 703, 705 [reversing an order and judgment and granting that branch of the cross-petition which was for attorney’s fees]).
Accordingly, the order is reversed, on the law, the defendant’s motion pursuant to CPLR 3211(a) to dismiss the complaint for lack of subject matter jurisdiction and pursuant to 11 NYCRR 65.4.10(j)(4) for an award of attorney’s fees is granted, and the matter is remitted to the Supreme Court, Kings County, for a determination of the amount of reasonable attorney’s fees to be awarded to the defendant.
MILLER, CHRISTOPHER and VENTURA, JJ., concur.
ORDERED that the order is reversed, on the law, with costs, the defendant’s motion pursuant to CPLR 3211(a) to dismiss the complaint for lack of subject matter jurisdiction and pursuant to 11 NYCRR 65.4.10(j)(4) for an award of attorney’s fees is granted, and the matter is remitted to the Supreme Court, Kings County, for a determination of the amount of reasonable attorney’s fees to be awarded to the defendant.
Darrell M. Joseph
Clerk of the Court
Footnote 1: Notably, the legislation was also enacted to ensure that motor-vehicle accident victims receive prompt payment for their economic loss (see Insurance Law § 5106[c]; Governor’s Mem approving L 1973, ch 13, 1973 McKinney’s Sess Laws of NY at 2335). Circumscribing the scope of cases that are subject to de novo review by a court ensures that most of the arbitral awards subject to this legislation are final such that there will be prompt resolution and payment of the arbitral awards. Expanding de novo review of arbitral awards by treating certain, separate arbitral awards as, in effect, a single arbitral award for the purpose of the legislation’s jurisdictional threshold could foil this intended purpose.
Reported in New York Official Reports at Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C. (2025 NY Slip Op 01363)
Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C. |
2025 NY Slip Op 01363 |
Decided on March 12, 2025 |
Appellate Division, Second Department |
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
This opinion is uncorrected and subject to revision before publication in the Official Reports. |
COLLEEN D. DUFFY, J.P.
ROBERT J. MILLER
LINDA CHRISTOPHER
LOURDES M. VENTURA, JJ.
2023-08357
(Index No. 513224/22)
v
Comfort Choice Chiropractic, P.C., etc., appellant.
Gary Tsirelman, P.C., Brooklyn, NY, for appellant.
Larkin Farrell, LLC, New York, NY (Anthony R. Troise of counsel), for respondent.
DECISION & ORDER
In a proceeding pursuant to CPLR article 75 to vacate an arbitration award dated February 11, 2022, Comfort Choice Chiropractic, P.C., appeals from an order and judgment (one paper) of the Supreme Court, Kings County (Aaron D. Maslow, J.), dated August 10, 2023. The order and judgment, insofar as appealed from, denied that branch of the cross-motion of Comfort Choice Chiropractic, P.C., which was pursuant to 11 NYCRR 65-4.10(j)(4) for an award of attorney’s fees.
ORDERED that the order and judgment is reversed insofar as appealed from, on the law, with costs, that branch of the cross-motion of Comfort Choice Chiropractic, P.C., which was pursuant to 11 NYCRR 65-4.10(j)(4) for an award of attorney’s fees is granted, and the matter is remitted to the Supreme Court, Kings County, for a determination of the amount of reasonable attorney’s fees to be awarded to Comfort Choice Chiropractic, P.C.
In May 2022, American Transit Insurance Company (hereinafter American Transit) commenced this proceeding against Comfort Choice Chiropractic, P.C. (hereinafter Comfort Choice), pursuant to CPLR article 75 to vacate an arbitration award, dated February 11, 2022, entered in favor of Comfort Choice. As relevant to this appeal, Comfort Choice opposed and cross-moved, inter alia, pursuant to 11 NYCRR 65-4.10(j)(4) for an award of attorney’s fees. By order and judgment dated August 10, 2023, the Supreme Court denied the petition and confirmed the arbitration award but also denied that branch of the cross-motion of Comfort Choice. Comfort Choice appeals from so much of the order and judgment as denied that branch of its cross-motion.
Pursuant to Insurance Law § 5106(a), if a valid claim or portion of a claim for no-fault benefits is overdue, “the claimant shall also be entitled to recover his [or her] attorney’s reasonable fee, for services necessarily performed in connection with securing payment of the overdue claim, subject to the limitations promulgated by the superintendent in regulations.” “[T]he superintendent’s regulations provide that an attorney’s fee for services rendered in connection with ‘a court appeal from a master arbitration award . . . shall be fixed by the court adjudicating the matter'” (Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d 703, 705, quoting 11 NYCRR 65-4.10[j][4]).
Here, the Supreme Court should have granted that branch of Comfort Choice’s cross-motion which was pursuant to 11 NYCRR 65-4.10(j)(4) for an award of attorney’s fees (see Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d 703).
Accordingly, the matter is remitted to the Supreme Court, Kings County, for a determination of the amount of reasonable attorney’s fees to which Comfort Choice is entitled (see Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co., 170 AD3d 1168; Matter of GEICO Ins. v AAAMG Leasing Corp., 148 AD3d at 705).
DUFFY, J.P., MILLER, CHRISTOPHER and VENTURA, JJ., concur.
Darrell M. Joseph
Clerk of the Court
Reported in New York Official Reports at Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50306(U))
[*1]Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. |
2025 NY Slip Op 50306(U) |
Decided on March 7, 2025 |
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 March 7, 2025
PRESENT: : WAVNY TOUSSAINT, P.J., CHEREÉ A. BUGGS, LISA S. OTTLEY, JJ
2023-838 K C
against
State Farm Mutual Automobile Ins. Co., Respondent.
The Rybak Firm, PLLC (Oleg Rybak and Richard Rozhik of counsel), for appellant. Rivkin Radler, LLP (Stuart M. Bodoff of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (D. Bernadette Neckles, J.), dated June 26, 2023. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross-motion for summary judgment and plaintiff’s separate motion to dismiss defendant’s affirmative defenses.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court (D. Bernadette Neckles, J.) dated June 26, 2023, which granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross-motion for summary judgment and plaintiff’s separate motion to dismiss defendant’s affirmative defenses. Plaintiff argues on appeal that the order should be reversed, defendant’s motion should be denied, and either the matter should be remitted to the Civil Court to decide what plaintiff denominated as an amended cross-motion for summary judgment, or in the alternative, plaintiff’s separate motion to dismiss defendant’s affirmative defenses should be granted.
Contrary to plaintiff’s contention on appeal, defendant’s verification requests, which [*2]sought information such as plaintiff’s management agreements, W-2 forms, business-related bank records, and lease agreements, to determine whether plaintiff was ineligible to collect no-fault benefits pursuant to 11 NYCRR 65-3.16 (a) (12) due to a failure to meet licensing requirements (see State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]) were not improper (see Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., — Misc 3d —, 2025 NY Slip Op 50195[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2025]).
As plaintiff’s appellate brief notes, the order appealed from “made no mention of [plaintiff’s] Amended Cross-Motion.” Consequently, we do not reach any issue with respect to plaintiff’s amended cross-motion for summary judgment, as it was not addressed in the order appealed from (see Katz v Katz, 68 AD2d 536, 542-543 [1979]). However, we note that, contrary to the contention in plaintiff’s appellate brief, the denial of defendant’s motion for summary judgment in a declaratory judgment action brought in the Supreme Court, Nassau County, has no preclusive effect on this case, as it was not a final determination on the merits (see Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 83 Misc 3d 41, 45 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2024]).
Plaintiff’s remaining contentions lack merit.
Accordingly, the order is affirmed.
TOUSSAINT, P.J., BUGGS and OTTLEY, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: March 7, 2025
Reported in New York Official Reports at Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50306(U))
[*1]Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. |
2025 NY Slip Op 50306(U) [85 Misc 3d 132(A)] |
Decided on March 7, 2025 |
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 March 7, 2025
PRESENT: : WAVNY TOUSSAINT, P.J., CHEREÉ A. BUGGS, LISA S. OTTLEY, JJ
2023-838 K C
against
State Farm Mutual Automobile Ins. Co., Respondent.
The Rybak Firm, PLLC (Oleg Rybak and Richard Rozhik of counsel), for appellant. Rivkin Radler, LLP (Stuart M. Bodoff of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (D. Bernadette Neckles, J.), dated June 26, 2023. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross-motion for summary judgment and plaintiff’s separate motion to dismiss defendant’s affirmative defenses.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court (D. Bernadette Neckles, J.) dated June 26, 2023, which granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross-motion for summary judgment and plaintiff’s separate motion to dismiss defendant’s affirmative defenses. Plaintiff argues on appeal that the order should be reversed, defendant’s motion should be denied, and either the matter should be remitted to the Civil Court to decide what plaintiff denominated as an amended cross-motion for summary judgment, or in the alternative, plaintiff’s separate motion to dismiss defendant’s affirmative defenses should be granted.
Contrary to plaintiff’s contention on appeal, defendant’s verification requests, which [*2]sought information such as plaintiff’s management agreements, W-2 forms, business-related bank records, and lease agreements, to determine whether plaintiff was ineligible to collect no-fault benefits pursuant to 11 NYCRR 65-3.16 (a) (12) due to a failure to meet licensing requirements (see State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]) were not improper (see Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., — Misc 3d —, 2025 NY Slip Op 50195[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2025]).
As plaintiff’s appellate brief notes, the order appealed from “made no mention of [plaintiff’s] Amended Cross-Motion.” Consequently, we do not reach any issue with respect to plaintiff’s amended cross-motion for summary judgment, as it was not addressed in the order appealed from (see Katz v Katz, 68 AD2d 536, 542-543 [1979]). However, we note that, contrary to the contention in plaintiff’s appellate brief, the denial of defendant’s motion for summary judgment in a declaratory judgment action brought in the Supreme Court, Nassau County, has no preclusive effect on this case, as it was not a final determination on the merits (see Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 83 Misc 3d 41, 45 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2024]).
Plaintiff’s remaining contentions lack merit.
Accordingly, the order is affirmed.
TOUSSAINT, P.J., BUGGS and OTTLEY, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: March 7, 2025
Reported in New York Official Reports at KBJ Med. Practice, P.C. v Lancer Ins. Co. (2025 NY Slip Op 50277(U))
[*1]KBJ Med. Practice, P.C. v Lancer Ins. Co. |
2025 NY Slip Op 50277(U) |
Decided on March 3, 2025 |
Civil Court Of The City Of New York, Bronx County |
Rivera, J. |
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 March 3, 2025
KBJ Medical Practice, P.C. AAO ISMAEL SEJOUR, Plaintiff
against Lancer Insurance Co., Defendant |
Index No. CV-716872-22/BX
Attorneys for Plaintiff: Sanders Grossman Aronova, PLLC
Attorneys for Defendant: Hollander Legal Group, PC Brenda Rivera, J.
Recitation, as required by CPLR 2219(a), of the papers considered in the review of this motion:
Papers NumberedMotion 1
Opposition 2
Reply 3
Defendant moves pursuant to CPLR 3212 for an Order granting summary judgment based on the Assignor, Ismael Sejour’s failure to attend an examination under oath. On a motion for summary judgment, the moving party must make prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence in admissible form to demonstrate the absence of any material issues of fact. CPLR § 3212(b); Friends of Thayer Lake LLC v. Brown, 27 NY3d 1039 (2016); Kershaw v. Hosp. for Special Surgery, 114 AD3d 75 (1st Dept. 2013). Thus, on this summary judgment motion, Defendant has the burden of demonstrating that there are no issues of fact regarding whether proper notices of the examination under oath were mailed to the Assignor, and that the Assignor failed to appear for the examination under oath. Bath Ortho Supply Inc. v New York Central Mut. Fire Ins. Co., 2012 NY Slip Op 50271(U), (App Term, 1st Dept 2002).
In order to meet this burden, the movant may submit an affidavit by someone with personal knowledge of the facts establishing that the Assignor was properly noticed and failed to appear. CPLR 3212(b). In 2024, the Legislature eased the affidavit requirement by permitting the submission of an affirmation instead. CPLR 2106. In support of the motion, Defendant submits the affirmation and affidavits of its attorney Mr. Allan S. Hollander, President of Hollander Legal Group, PC (Attorney) to establish that the notices directing the Assignor to appear were properly mailed and that the Assignor failed to appear. The Attorney’s affirmation and affidavits use many of the boilerplate language tailored to meet the statutory requirements such as: that the mailings were created and maintained in the ordinary course of business, that Defendant has the duty to create and mail the documents in the ordinary course of business, that [*2]the affidavit is made from personal knowledge, that the record is made at or near the time of the alleged transaction, and/or that the affiant has personal knowledge of the facts because they oversee the department or the office procedures. However, it is not sufficient to merely recite buzz words or boilerplate language tailored to meet evidentiary requirements. The affiant must demonstrate that the information alleged is obtained by personal knowledge of the facts from the affiant’s personal observation, personal experience, or personal involvement in the process. See: 5 N.Y.Prac., Evidence in New York State and Federal Courts § 6:18; and John H. Wigmore, Evidence in Trials at Common Law § 657 (Chadbourn rev. 1979)(personal knowledge is the impression derived through the exercise of one’s senses, not from the report of others).
Although the Attorney states that he oversees all the office procedures, he does not establish personal knowledge from observation or involvement with the procedures. The Attorney also states that his knowledge is “based upon a review of the file maintained by this office,” and that “counsel for” Defendant or “an individual with personal knowledge of the information therein” created and mailed the notices. Thus, contradicting the allegation of personal knowledge. Moreover, the Attorney states that the notices were mailed via the United States Post Office by certified mail, return receipt requested and first-class mail. However, the notices attached to the motion indicate that the notices were only sent via first-class mail. The Attorney also fails to attach proof of certified mail, which would have met the burden. The contradictory affidavit and notices raise issues of fact as to whether the notices were properly mailed and whether the Attorney has personal knowledge.
Alternatively, the movant may also meet its burden by providing proof of the actual mailings, such as affidavits/affirmations of mailing or post office receipts with attendant signatures, or by establishing the presumption of mailing and receipt by providing proof of a standard office mailing procedure designed to ensure that items are properly addressed and mailed, sworn to by someone with personal knowledge of the procedure. U.S. Bank N.A. v Pickering-Robinson, 197 AD3d 757 (2021) quoting Citibank, N.A. v Conti-Scheurer, 172 AD3d 17 (2019); see Caliber Home Loans, Inc. v Weinstein, 197 AD3d 1232 (2021). In order for the presumption of mailing and receipt to arise, the standard mailing procedures followed by insurers in the regular course of business must be geared so as to ensure the likelihood that a notice is always properly addressed and mailed. Nassau Insurance Company v Diane M. Murray et al., 46 NY2d 828 (1978). This is the standard of proof that is often misapplied as Defendant insurers often recite boiler plate language describing their office procedures but do not establish that the office procedures ensure that the notices are always properly addressed and mailed.
As proof of its standard office procedure, Defendant submits the affidavit of Lenny H. LaFace, (LaFace) a Senior No-Fault Examiner located in Long Beach, New York. LaFace states that he is the custodian of the records, that the records were created by a person with knowledge of the facts or were made from information transmitted by a person with knowledge of the facts, that the records were made near the time of the transaction, that the records were created and kept in the regular course of business, and that he has personal knowledge of Defendant’s regular business practices relating to the handling of No-Fault claims. LaFace also describes the procedures for mailing notices which involves a chain of custody of at least two employees and coordination with separate offices when examinations under oath, verification requests, or independent examinations are requested. However, LaFace’s affidavit merely recites hearsay information and boilerplate language tailored to meet mailing requirements, and while the procedures described may increase the likelihood that notices are properly addressed and mailed, [*3]the procedures described fall short of the required standard to “ensure the likelihood that a notice is always properly addressed and mailed.” Thus, the mere recitation of boiler plate language describing standard office procedures is not sufficient where the office procedures do not ensure the likelihood that a notice is always properly addressed and mailed, particularly where the affiant is not personally involved in the process and the notices are handled by more than one person. One way to meet the burden and to establish that the office procedures “ensure the likelihood that the notice is always properly addressed and mailed” is to have each employee electronically log or document the chain of custody of the notice with their name, date and time each notice is handled along with a copy of the log. The affirmation/affidavit submitted on the motion should include said information, instead of generically reciting that an employee followed the office procedures. While this appears to add extra steps to the process, it is a necessary step as the grant of summary judgment deprives a litigant of their day in court and the burden to eliminate all triable issues is a very high burden which may not be based upon hearsay information, generic or boilerplate language.
Therefore, the court finds that Defendant failed to meet the burden of demonstrating the absence of any material issues of fact with respect to whether the Defendant mailed to the Assignor the notices to appear for the examination under oath. However, Defendant met its burden in establishing that the Assignor failed to appear at the examination under oath by submitting a certified transcript by a non-interested reporter and the Attorney’s affidavit of personal knowledge establishing the Assignor’s nonappearance.
Accordingly, Defendant’s motion is granted only to the extent of granting that portion of the motion finding that the Assignor failed to appear at an examination under oath and leaving the issue of the proper mailing of the notice to appear to be determined at trial.
Date: March 3, 2025Hon. Brenda Rivera, JCC
Reported in New York Official Reports at KBJ Med. Practice, P.C. v Lancer Ins. Co. (2025 NY Slip Op 50277(U))
[*1]KBJ Med. Practice, P.C. v Lancer Ins. Co. |
2025 NY Slip Op 50277(U) [85 Misc 3d 1225(A)] |
Decided on March 3, 2025 |
Civil Court Of The City Of New York, Bronx County |
Rivera, J. |
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 March 3, 2025
KBJ Medical
Practice, P.C. AAO ISMAEL SEJOUR, Plaintiff
against Lancer Insurance Co., Defendant |
Index No. CV-716872-22/BX
Attorneys for Plaintiff: Sanders Grossman Aronova, PLLC
Attorneys for Defendant: Hollander Legal Group, PC Brenda Rivera, J.
Recitation, as required by CPLR 2219(a), of the papers considered in the review of this motion:
Papers & nbsp; NumberedMotion 1
Opposition 2
Reply 3
Defendant moves pursuant to CPLR 3212 for an Order granting summary judgment based on the Assignor, Ismael Sejour’s failure to attend an examination under oath. On a motion for summary judgment, the moving party must make prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence in admissible form to demonstrate the absence of any material issues of fact. CPLR § 3212(b); Friends of Thayer Lake LLC v. Brown, 27 NY3d 1039 (2016); Kershaw v. Hosp. for Special Surgery, 114 AD3d 75 (1st Dept. 2013). Thus, on this summary judgment motion, Defendant has the burden of demonstrating that there are no issues of fact regarding whether proper notices of the examination under oath were mailed to the Assignor, and that the Assignor failed to appear for the examination under oath. Bath Ortho Supply Inc. v New York Central Mut. Fire Ins. Co., 2012 NY Slip Op 50271(U), (App Term, 1st Dept 2002).
In order to meet this burden, the movant may submit an affidavit by someone with personal knowledge of the facts establishing that the Assignor was properly noticed and failed to appear. CPLR 3212(b). In 2024, the Legislature eased the affidavit requirement by permitting the submission of an affirmation instead. CPLR 2106. In support of the motion, Defendant submits the affirmation and affidavits of its attorney Mr. Allan S. Hollander, President of Hollander Legal Group, PC (Attorney) to establish that the notices directing the Assignor to appear were properly mailed and that the Assignor failed to appear. The Attorney’s affirmation and affidavits use many of the boilerplate language tailored to meet the statutory requirements such as: that the mailings were created and maintained in the ordinary course of business, that Defendant has the duty to create and mail the documents in the ordinary course of business, that [*2]the affidavit is made from personal knowledge, that the record is made at or near the time of the alleged transaction, and/or that the affiant has personal knowledge of the facts because they oversee the department or the office procedures. However, it is not sufficient to merely recite buzz words or boilerplate language tailored to meet evidentiary requirements. The affiant must demonstrate that the information alleged is obtained by personal knowledge of the facts from the affiant’s personal observation, personal experience, or personal involvement in the process. See: 5 N.Y.Prac., Evidence in New York State and Federal Courts § 6:18; and John H. Wigmore, Evidence in Trials at Common Law § 657 (Chadbourn rev. 1979)(personal knowledge is the impression derived through the exercise of one’s senses, not from the report of others).
Although the Attorney states that he oversees all the office procedures, he does not establish personal knowledge from observation or involvement with the procedures. The Attorney also states that his knowledge is “based upon a review of the file maintained by this office,” and that “counsel for” Defendant or “an individual with personal knowledge of the information therein” created and mailed the notices. Thus, contradicting the allegation of personal knowledge. Moreover, the Attorney states that the notices were mailed via the United States Post Office by certified mail, return receipt requested and first-class mail. However, the notices attached to the motion indicate that the notices were only sent via first-class mail. The Attorney also fails to attach proof of certified mail, which would have met the burden. The contradictory affidavit and notices raise issues of fact as to whether the notices were properly mailed and whether the Attorney has personal knowledge.
Alternatively, the movant may also meet its burden by providing proof of the actual mailings, such as affidavits/affirmations of mailing or post office receipts with attendant signatures, or by establishing the presumption of mailing and receipt by providing proof of a standard office mailing procedure designed to ensure that items are properly addressed and mailed, sworn to by someone with personal knowledge of the procedure. U.S. Bank N.A. v Pickering-Robinson, 197 AD3d 757 (2021) quoting Citibank, N.A. v Conti-Scheurer, 172 AD3d 17 (2019); see Caliber Home Loans, Inc. v Weinstein, 197 AD3d 1232 (2021). In order for the presumption of mailing and receipt to arise, the standard mailing procedures followed by insurers in the regular course of business must be geared so as to ensure the likelihood that a notice is always properly addressed and mailed. Nassau Insurance Company v Diane M. Murray et al., 46 NY2d 828 (1978). This is the standard of proof that is often misapplied as Defendant insurers often recite boiler plate language describing their office procedures but do not establish that the office procedures ensure that the notices are always properly addressed and mailed.
As proof of its standard office procedure, Defendant submits the affidavit of Lenny H. LaFace, (LaFace) a Senior No-Fault Examiner located in Long Beach, New York. LaFace states that he is the custodian of the records, that the records were created by a person with knowledge of the facts or were made from information transmitted by a person with knowledge of the facts, that the records were made near the time of the transaction, that the records were created and kept in the regular course of business, and that he has personal knowledge of Defendant’s regular business practices relating to the handling of No-Fault claims. LaFace also describes the procedures for mailing notices which involves a chain of custody of at least two employees and coordination with separate offices when examinations under oath, verification requests, or independent examinations are requested. However, LaFace’s affidavit merely recites hearsay information and boilerplate language tailored to meet mailing requirements, and while the procedures described may increase the likelihood that notices are properly addressed and mailed, [*3]the procedures described fall short of the required standard to “ensure the likelihood that a notice is always properly addressed and mailed.” Thus, the mere recitation of boiler plate language describing standard office procedures is not sufficient where the office procedures do not ensure the likelihood that a notice is always properly addressed and mailed, particularly where the affiant is not personally involved in the process and the notices are handled by more than one person. One way to meet the burden and to establish that the office procedures “ensure the likelihood that the notice is always properly addressed and mailed” is to have each employee electronically log or document the chain of custody of the notice with their name, date and time each notice is handled along with a copy of the log. The affirmation/affidavit submitted on the motion should include said information, instead of generically reciting that an employee followed the office procedures. While this appears to add extra steps to the process, it is a necessary step as the grant of summary judgment deprives a litigant of their day in court and the burden to eliminate all triable issues is a very high burden which may not be based upon hearsay information, generic or boilerplate language.
Therefore, the court finds that Defendant failed to meet the burden of demonstrating the absence of any material issues of fact with respect to whether the Defendant mailed to the Assignor the notices to appear for the examination under oath. However, Defendant met its burden in establishing that the Assignor failed to appear at the examination under oath by submitting a certified transcript by a non-interested reporter and the Attorney’s affidavit of personal knowledge establishing the Assignor’s nonappearance.
Accordingly, Defendant’s motion is granted only to the extent of granting that portion of the motion finding that the Assignor failed to appear at an examination under oath and leaving the issue of the proper mailing of the notice to appear to be determined at trial.
Date: March 3, 2025Hon. Brenda Rivera, JCC
Reported in New York Official Reports at Medical Supply of NY Servs. Inc. v State Farm Mut. Auto Ins. Co. (2025 NY Slip Op 50301(U))
[*1]Medical Supply of NY Servs. Inc. v State Farm Mut. Auto Ins. Co. |
2025 NY Slip Op 50301(U) |
Decided on February 21, 2025 |
Civil Court Of The City Of New York, Richmond County |
Helbock, Jr., J. |
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 February 21, 2025
Medical Supply of NY Services Inc. AAO Felix Juma Diaz, Plaintiff,
against State Farm Mutual Auto Ins. Co., Defendant. |
Index No. CV-719638-23/RI
Robert J. Helbock, Jr., J.
The Decision//Order on the Defendant’s Motion to reargue the motion for summary Judgment is as follows:
The plaintiff, MEDICAL SUPPLY OF NY SERVICES, INC. (the “Plaintiff”), as assignee of FELIX JUMA DIAZ (the “Assignor”) commenced this action against STATE FARM MUTUAL AUTO INS. CO. (the “Defendant”) to recover assigned first-party No-Fault benefits for medical treatment provided to the Assignor on May 17, 2023. The Defendant moved for summary judgment based upon Assignor’s failure to attend two duly scheduled Examinations Under Oath (“EUOs”) on September 8, 2023. On March 27, 2024, this Court denied the Defendant’s motion, finding there was an issue of fact regarding the Assignor’s failure to attend the EUOs. The Notice of Entry for the decision and order was filed April 2, 2024.
The Defendant filed the instant motion on May 2, 2024, for leave to reargue the motion for summary judgment on the basis that the Court overlooked or misapprehended matters of fact or law in its prior decision. Plaintiff filed opposition on October 21, 2024. Arguments were heard on December 19, 2024, and decision was reserved.
This Court held in the March 27, 2024 decision that the Defendant did not meet its burden of proof to establish that the Assignor failed to appear for the two scheduled EUOs. This Court held that the Defendant did not submit an affidavit or affirmation from an attorney present to conduct the EUO, only transcripts of the EUO.
Here, Defendant alleges that this Court misapprehended facts or law when issuing the Order dated March 27, 2024, because the Court overlooked the affidavit of Richard Aitken, Esq. In his affidavit, Mr. Aitken states that “[o]n December 7, 2022, FELIX JUMA DIAZ failed to appear for the examination under oath. Accordingly, I, a partner with the law firm of Bruno, Gerbino & Soriano, LLP placed a default statement on the record.”
A motion for leave to reargue shall be based upon matters of fact or law allegedly overlooked or misapprehended by the court in determining the prior motion, but shall not include [*2]any matters of fact not offered on the prior motion. CPLR §2221.
“The proponent of a summary judgment motion must make a prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to eliminate any material issues of fact from the case.” (Midfirst Bank v. Agho, 121 AD3d 343, (Sup. Ct., App Div., 2nd Dept., August 13, 2014), citing Winegrad v. New York Univ. Med. Ctr., 64 NY2d 851, 853, [1985]; Zuckerman v. City of New York, 49 NY2d 557, 562 [1980]; Sillman v. Twentieth Century-Fox Film Corp., 3 NY2d 395, 404 [1957]) “The submitted evidence in support of summary judgment must be in a form admissible at trial.” (Midfirst Bank v. Agho, 121 AD3d 343, [2014]) emphasis added.
An affidavit/affirmation from an attorney attesting the nonappearance of a plaintiff at an examination under oath (EUO) is of no probative value if it lacks personal knowledge of the plaintiff’s nonappearance. (Alrof, Inc. v. Safeco Nat. Ins. Co., 39 Misc 3d 130[A] [App. Term 2013].) In Alrof, the Court opined the affidavit submitted by defense counsel was of no probative value because his “personal knowledge” came from a review of the file. An affirmation submitted by an attorney, who was present in his office to conduct plaintiff’s EUO on the scheduled dates, is sufficient to establish that plaintiff had failed to appear. (Nat. Therapy Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co., 42 Misc 3d 137[A], 986 N.Y.S.2d 866 [App. Term 2014].)
The Court in New Capital Supply, Inc. v. State Farm Mut. Auto. Ins. Co., (45 Misc 3d 758 [NY County, 2014]) superbly explained the Appellate Term’s rulings in Alrof and its progeny. The elements of the proper attorney affidavit include a statement of personal knowledge that the attorney was present in the office to conduct the EUO of the witnesses on the schedule dates; that no one affiliated with the witness appeared for the EUO on those dates; that had the witness appeared for the scheduled EUO the affirmant, or an attorney the affirmant assigned that day, would have conducted the EUO of the witness. New Capital Supply, Inc. v. State Farm Mut. Auto. Ins. Co., 45 Misc 3d 758, 760-762.
In this matter, the affidavit of Richard C. Aitken Esq., the Defendant’s attorney, does not state that he was present at the time the EUO was scheduled to take place. Paragraph’s 4 and 6 of the affirmation state:
“On (relevant date) Felix Juma Diaz failed to appear for the examination under oath. Accordingly, I, a partner with the law firm of Bruno, Gerbino & Soriano, LLP, placed a default statement on the record. A certified copy of the default statement is annexed hereto as Exhibit G”.
The affidavit only states that the attorney placed a default statement on the record. Such a statement could have been made virtually, and therefore the deponent may not personally observe whether the witness attended. The act of placing the statement on the record does not mean the deponent was present at the scheduled time and location for the EUO. Without stating the attorney was present to observe the non-appearance, the declaration that the witness failed to appear is nothing more than a hearsay conclusory statement. The defense attorney’s statement did not meet the criteria described in New Capital Supply, Inc., et. al. above.
Furthermore, the transcript of EUO statement itself is not admissible evidence to be considered for a summary judgment motion. Charles Deng Acupuncture P.C. v. Titan Insurance Co., 74 Misc 3d 137(A) (Sup. Ct., App. Term, 2,11,13 Jud. Dist., April 1, 2022). While a deposition may be introduced as evidence provided the provisions of CPLR §3116 & §3117, the deponent did not submit a foundation for consideration of the transcript. Without such a [*3]foundation the document is hearsay, and therefore not admissible evidence to be considered regarding the summary judgment motion. Therefore, the Court cannot rely on the statements made within the default statement transcript as evidence or proof that the attorney was present in the office at the time the EUO was scheduled to take place.
Decision
For these reasons, the Court finds that the affidavit of Mr. Aitken was not overlooked when determining the prior motion because, as stated in the decision, the attorney affidavit did not establish the attorney was present at the time scheduled for the EUO.
Accordingly, Defendant’s motion to reargue is DENIED. The Court’s decision dated March 27, 2024 denying the Defendant’s motion for summary judgment stands.
This is the Decision and Order of the Court.
Reported in New York Official Reports at Rombom v Liberty Mut. Ins. Co. (2025 NY Slip Op 25040)
[*1]Rombom v Liberty Mut. Ins. Co. |
2025 NY Slip Op 25040 |
Decided on February 14, 2025 |
Appellate Term, Second Department |
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
This opinion is uncorrected and subject to revision before publication in the printed Miscellaneous Reports. |
Decided on February 14, 2025
PRESENT: : CHEREÉ A. BUGGS, J.P., LISA S. OTTLEY, JOANNE D. QUIÑONES, JJ
2024-492 Q C
against
Liberty Mutual Insurance Company, Respondent.
Glinkenhouse Queen, Esqs. (Alan Queen of counsel), for appellant. Martyn, Smith, Murray & Yong, Esqs. (Thomas M. Martyn and Danny Miller of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Ira R. Greenberg, J.), dated April 12, 2024. The order granted the branch of defendant’s motion seeking, in effect pursuant to CPLR 5015 (a) (4), to vacate a judgment of that court (Alan J. Schiff, J.) entered June 2, 2023 upon defendant’s failure to oppose plaintiff’s motion to enter judgment pursuant to CPLR 5003-a.
ORDERED that the order is reversed, without costs, the branch of defendant’s motion seeking, in effect pursuant to CPLR 5015 (a) (4), to vacate the judgment entered June 2, 2023 is denied, and the matter is remitted to the Civil Court to determine the remaining branches of defendant’s motion.
Plaintiff commenced this action in 1995 to recover assigned first-party no-fault benefits. In December 1997, the parties agreed to settle the matter for $885.54, and plaintiff tendered a general release, executed by himself and counsel, and a stipulation of discontinuance to defendant’s counsel. It is uncontroverted that, on March 9, 1998, the stipulation of [*2]discontinuance was filed by defendant’s counsel [FN1] in the Queens County Civil Court clerk’s office without paying plaintiff the sum due him, which sum remains unpaid.
In June 2017, after plaintiff applied to the clerk for the entry of a judgment, in effect pursuant to CPLR 5003-a (e), the clerk rejected the application because, in relevant part, the signed stipulation of discontinuance had been filed. Plaintiff challenged this rejection in a CPLR article 78 proceeding to compel the clerk to enter judgment and, by order entered August 20, 2020, the Supreme Court, Queens County (Pam Jackman Brown, J.), dismissed the article 78 proceeding as time-barred. In April 2021, plaintiff moved in the Civil Court for leave to enter a judgment with interest pursuant to CPLR 5003-a, which motion was granted (Alan J. Schiff, J.) on default. A judgment in the amount of $376,022.05 was entered against defendant on June 2, 2023.
In October 2023, defendant moved, among other things, in effect pursuant to CPLR 5015 (a) (1) and (4), to vacate the default judgment. In an order dated April 12, 2024, the Civil Court (Ira R. Greenberg, J.) granted the branch of defendant’s motion seeking to vacate the default judgment pursuant to CPLR 5015 (a) (4), holding that because the stipulation of discontinuance had been filed by defendant on March 9, 1998, the action was terminated and the court was without jurisdiction to consider plaintiff’s CPLR 5003-a motion.
At the outset, we note that, “[w]hen a defendant moves to vacate a default judgment pursuant to CPLR 5015 (a) (4) and (a) (1), the court is required to resolve the CPLR 5015 (a) (4) jurisdictional question before determining whether it is appropriate to grant a discretionary vacatur pursuant to CPLR 5015 (a) (1)” (see LVNV Funding, LLC v Alvarado, 83 Misc 3d 136[A], 2024 NY Slip Op 51203[U], *1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2024]).
“The purpose of CPLR 5003-a is to encourage the prompt payment of damages in settled actions” (Pitt v New York City Hous. Auth., 106 AD3d 797, 797-798 [2013]). CPLR 5003-a requires a settling defendant to “pay all sums due to any settling plaintiff within twenty-one days of tender, by the settling plaintiff to the settling defendant, of a duly executed release and a stipulation discontinuing action executed on behalf of the settling plaintiff” (CPLR 5003-a [a]; see Orthotics & Professional Supply, Ltd. v Country-Wide Ins. Co., 77 Misc 3d 130[A], 2022 NY Slip Op 51221[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]). “If the settling defendant fails to pay the sum due under the settlement agreement within 21 days of tender of [a duly executed release and a stipulation discontinuing action executed on behalf of the settling plaintiff], the statute authorizes the plaintiff to enter, without further notice, a judgment in the amount of the settlement, which is to include interest, costs, and disbursements” (Klee v Americas Best Bottling Co., Inc., 76 AD3d 544, 545 [2010]; see CPLR 5003-a [e]). The tender [*3]of a stipulation of discontinuance by a settling plaintiff to a settling defendant is a condition precedent to a plaintiff’s CPLR 5003-a (e) relief when a defendant fails to make prompt payment. Under the circumstances presented, the filing of the stipulation of discontinuance by defendant without it ever paying the sum due to plaintiff did not deprive the court of jurisdiction to entertain plaintiff’s motion for leave to enter a judgment pursuant to CPLR 5003-a (e) (see e.g. Levine v American Multi-Cinema, Inc., 208 AD3d 1230 [2022]; Ishikawa v 3010 Whaleneck Realty Corp., 2023 NY Misc LEXIS 29966 [Sup Ct, Nassau County 2023]; Trinidad v McIntyre, 2021 NY Misc LEXIS 24023 [Sup Ct, Queens County 2021]; Sequinot v Lawrence, 2020 NY Misc LEXIS 49757 [Sup Ct, Westchester County 2020]).
As the Civil Court did not determine the remaining branches of defendant’s motion, including the branch seeking, in effect pursuant to CPLR 5015 (a) (1), to vacate the default judgment, the matter is remitted to the Civil Court for a determination of the remaining branches of defendant’s motion.
Accordingly, the order is the order is reversed, the branch of defendant’s motion seeking, in effect pursuant to CPLR 5015 (a) (4), to vacate the judgment entered June 2, 2023 is denied, and the matter is remitted to the Civil Court to determine the remaining branches of defendant’s motion.
BUGGS, J.P., OTTLEY and QUIÑONES, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: February 14, 2025
Footnote 1: CPLR 3217 (a) (2) provides that “[a]ny party asserting a claim may discontinue it without an order . . . by filing with the clerk of the court . . . a stipulation in writing signed by the attorneys of record for all parties” (emphasis added).
Reported in New York Official Reports at Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50194(U))
[*1]Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. |
2025 NY Slip Op 50194(U) |
Decided on February 14, 2025 |
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 February 14, 2025
PRESENT: : WAVNY TOUSSAINT, P.J., CHEREÉ A. BUGGS, LISA S. OTTLEY, JJ
2023-558 K C
against
State Farm Mutual Automobile Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Rivkin Radler, LLP (Stuart M. Bodoff of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Sandra E. Roper, J.), dated February 16, 2023. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross-motion for summary judgment.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court (Sandra E. Roper, J.) dated February 16, 2023, which granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross-motion for summary judgment. Plaintiff argues on appeal that the order should be reversed and the matter remitted to the Civil Court to decide what plaintiff denominated as an amended cross-motion for summary judgment, which the court declined to consider. The court rejected that submission, which also included amended opposition to defendant’s motion, as “procedurally improper”, citing CPLR 2214. In the alternative, plaintiff argues that defendant’s motion should be denied.
Contrary to plaintiff’s contention on appeal, it was not improper for defendant to seek, during the claim verification stage, information—such as management agreements, W-2 forms, [*2]business-related bank records and lease agreements—for the purpose of determining whether plaintiff was ineligible to collect no-fault benefits due to a failure to meet licensing requirements (see 11 NYCRR 65-3.16 [a] [12]; State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]; Burke 2 Physical Therapy, P.C., as Assignee of Lewis, Destiny v State Farm Mut. Auto. Ins. Co., — Misc 3d &mdash, 2025 NY Slip Op — [appeal No. 2023-961 K C], decided herewith).
“[C]ontrary to plaintiff’s argument, the denial of defendant’s motion for summary judgment in a declaratory judgment action brought in the Supreme Court, Nassau County, has no preclusive effect on this case as it was not a final determination on the merits” (Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 83 Misc 3d 41, 45 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2024]). Thus, we need not consider plaintiff’s contention that the Civil Court erred in declining, on procedural grounds, to consider the subsequent submission of that decision and order in support of plaintiff’s “amended” cross-motion for summary judgment.
Accordingly, the order is affirmed.
The decision and order of this court dated June 14, 2024 (2024 NY Slip Op 50803[U]) is hereby recalled and vacated (see motion decided simultaneously herewith).
TOUSSAINT, P.J., BUGGS and OTTLEY, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: February 14, 2025
Reported in New York Official Reports at Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. (2025 NY Slip Op 50195(U))
[*1]Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. |
2025 NY Slip Op 50195(U) |
Decided on February 14, 2025 |
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 February 14, 2025
PRESENT: : WAVNY TOUSSAINT, P.J., CHEREÉ A. BUGGS, LISA S. OTTLEY, JJ
2023-961 K C
against
State Farm Mutual Automobile Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Rivkin Radler, LLP (Stuart M. Bodoff of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Sandra E. Roper, J.), dated August 23, 2023. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross-motion for summary judgment.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court (Sandra E. Roper, J.) dated August 23, 2023, which granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross-motion for summary judgment. Plaintiff argues on appeal that the order should be reversed and the matter remitted to the Civil Court to decide what plaintiff denominated as an amended cross-motion for summary judgment, which the court declined to consider. The court treated that submission, which also included amended opposition to defendant’s motion, as an unauthorized sur-reply. In the alternative, plaintiff argues that defendant’s motion should be denied.
The record demonstrates that, after serving its cross-moving papers seeking summary judgment and opposing defendant’s motion, plaintiff served an amended cross-motion and [*2]amended opposition to defendant’s motion. Defendant subsequently served papers in further support of its motion for summary judgment and in opposition to both plaintiff’s cross-moving and amended cross-moving papers. As plaintiff’s amended papers were served almost six months before defendant’s reply papers were served, which reply papers addressed the merits of plaintiff’s amended papers, plaintiff’s amended papers were not unauthorized sur-reply papers (see CPLR 2214 [c]). Nevertheless, reversal is not warranted. Neither plaintiff’s initial cross-motion and opposing papers nor its amended papers were sufficient, individually or collectively, to demonstrate the existence of a triable issue of fact, since, “contrary to plaintiff’s argument, the denial of defendant’s motion for summary judgment in a declaratory judgment action brought in the Supreme Court, Nassau County, has no preclusive effect on this case as it was not a final determination on the merits” (Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 83 Misc 3d 41, 45 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2024]).
Contrary to plaintiff’s further contention, it was not improper for defendant to seek, during the claim verification stage, information—such as management agreements, W-2 forms, business-related bank records and lease agreements—for the purpose of determining whether plaintiff was ineligible to collect no-fault benefits due to a failure to meet licensing requirements (see 11 NYCRR 65-3.16 [2] [12]; State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]). Indeed, if, as plaintiff contends, insurance companies should only be able to obtain such information using discovery demands after litigation has ensued, insurance companies would be confronted with a dilemma—to pay the claims for which the plaintiff may not be eligible to receive reimbursement and then commence a suit to recoup such payment (see State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d at 322), or refrain from paying and wait until after plaintiff commences litigation to investigate via discovery whether plaintiff is eligible for reimbursement, which risks the insurance company being held liable for years of interest that would have accrued upon the claims in the interim at the rate of two percent per month (see 11 NYCRR 65-3.9 [a]), plus attorney’s fees (see 11 NYCRR 65-4.6). As plaintiff objected to the verification requests claiming they were nullities, the record establishes that plaintiff did not “provide within 120 calendar days from the date of the initial request either all such verification under [plaintiff’s] control or possession or written proof providing reasonable justification for the failure to comply” (11 NYCRR 65-3.5 [o]). Consequently, the arguments raised on appeal by plaintiff lack merit.
Accordingly, the order is affirmed.
TOUSSAINT, P.J., BUGGS and OTTLEY, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: February 14, 2025