Great Health Care Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51224(U))

Reported in New York Official Reports at Great Health Care Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51224(U))

Great Health Care Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51224(U)) [*1]
Great Health Care Chiropractic, P.C. v Praetorian Ins. Co.
2015 NY Slip Op 51224(U) [48 Misc 3d 139(A)]
Decided on August 5, 2015
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This opinion is uncorrected and will not be published in the printed Official Reports.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 August 5, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-741 Q C
Great Health Care Chiropractic, P.C. as Assignee of BRIAN CUMMINGS, Appellant,

against

Praetorian Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Barry A. Schwartz, J.), entered February 28, 2013. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that it had timely and properly denied the claim at issue based upon plaintiff’s assignor’s failure to appear for duly scheduled independent medical examinations (IMEs). The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

Contrary to plaintiff’s arguments on appeal, the evidence submitted by defendant in support of its cross motion was sufficient to demonstrate that the denial of claim form had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]) and that plaintiff’s assignor had failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). As an assignor’s appearance at a duly scheduled IME “is a condition precedent to the insurer’s liability on the policy” (id. at 722), the Civil Court properly denied plaintiff’s motion and granted defendant’s cross motion. In light of the foregoing, we do not reach plaintiff’s remaining contentions.

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: August 05, 2015
Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins. (2015 NY Slip Op 51220(U))

Reported in New York Official Reports at Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins. (2015 NY Slip Op 51220(U))

Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins. (2015 NY Slip Op 51220(U)) [*1]
Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins.
2015 NY Slip Op 51220(U) [48 Misc 3d 139(A)]
Decided on August 5, 2015
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 August 5, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-655 K C
Neptune Medical Care, P.C. as Assignee of LESLEYANN WATSON, Respondent, August 5, 2015

against

Ameriprise Auto & Home Insurance, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered December 6, 2012. The order denied defendant’s motion for summary judgment dismissing the complaint and granted 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, defendant moved for summary judgment dismissing the complaint, alleging that the claim at issue had been timely and properly denied based upon plaintiff’s failure to appear at duly scheduled examinations under oath (EUOs). Plaintiff opposed the motion and cross-moved for summary judgment. The Civil Court denied defendant’s motion on the ground that defendant had not requested the EUOs in a timely manner, and granted plaintiff’s cross motion for summary judgment.

Pursuant to the No-Fault Regulations, “any additional verification required by the insurer to establish proof of claim shall be requested within 15 business days of receipt of the [NF-3]” (11 NYCRR 65-3.5 [b] [emphasis added]). Defendant did not request that plaintiff appear for an EUO until more than 15 business days, and even more than 30 calendar days (see generally 11 NYCRR 65-3.8 [l] [providing that deviations from the verification time frames reduce the 30 days to pay or deny the claim by the same number of days that the request was late]), after it had received the bills at issue. Thus, even if the EUO scheduling letters were timely with respect to any other pending claims which may exist but are not before us, thRey were untimely with respect to the bills at issue. Indeed, this would be true even if defendant had tolled the 30-day period within which it was required to pay or deny the bills at issue, by timely requesting verification pursuant to 11 NYCRR 65-3.8 (a), as the Regulations do not provide that such a toll grants an insurer additional opportunities to make requests for verification that would otherwise be untimely. Consequently, the EUO scheduling letters were nullities with respect to the bills at issue and, therefore, defendant’s motion for summary judgment was properly denied (see O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134[A], 2015 NY Slip Op 50476[U] [App Term, 2d, 11th & 13th Jud Dists 2015]).

Contrary to defendant’s argument, it did not demonstrate any toll of the 30-day period [*2]within which it was required to pay or deny the bills at issue. Since the record demonstrates that defendant received, but did not timely deny, these bills, plaintiff’s cross motion for summary judgment was properly granted (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, 11th & 13th Jud Dists 2011]).

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: August 05, 2015

Delta Diagnostic Radiology, P.C. v Allstate Ins. Co. (2015 NY Slip Op 51216(U))

Reported in New York Official Reports at Delta Diagnostic Radiology, P.C. v Allstate Ins. Co. (2015 NY Slip Op 51216(U))

Delta Diagnostic Radiology, P.C. v Allstate Ins. Co. (2015 NY Slip Op 51216(U)) [*1]
Delta Diagnostic Radiology, P.C. v Allstate Ins. Co.
2015 NY Slip Op 51216(U) [48 Misc 3d 138(A)]
Decided on August 5, 2015
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 August 5, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-389 Q C
Delta Diagnostic Radiology, P.C. as Assignee of CATHERINE WESTE, Appellant, August 5, 2015

against

Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Leslie J. Purificacion, J.), entered September 24, 2012. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

Plaintiff’s moving papers failed to establish either that defendant had failed to deny the claim within the requisite 30-day period or that defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see Insurance Law § 5106 [a]; 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, 11th & 13th Jud Dists 2011]). Thus, plaintiff’s motion for summary judgment was properly denied.

However, as plaintiff argues on appeal, defendant failed to submit sufficient proof that the insurance policy at issue had been cancelled. While defendant submitted a copy of a cancellation letter, it did not submit any proof that the letter had been mailed to its insured as required by Vehicle and Traffic Law § 313 (1) (a). Therefore, defendant should not have been awarded summary judgment dismissing the complaint.

Accordingly, the order is modified by providing that defendant’s cross motion for summary judgment is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: August 05, 2015
IDF Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 51213(U))

Reported in New York Official Reports at IDF Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 51213(U))

IDF Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2015 NY Slip Op 51213(U)) [*1]
IDF Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co.
2015 NY Slip Op 51213(U) [48 Misc 3d 138(A)]
Decided on August 5, 2015
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 August 5, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-158 K C
IDF Diagnostic Medical, P.C. as Assignee of GIZELLE CUSTODIO and VANESSA DIAZ, Respondent, August 5, 2015

against

New York Central Mutual Fire Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Ingrid Joseph, J.), entered November 20, 2012. The order, insofar as appealed from, denied the branch of defendant’s motion seeking summary judgment dismissing plaintiff’s first cause of action.

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

In this action by a provider to recover assigned first-party no-fault benefits, insofar as is relevant to this appeal, defendant moved for summary judgment dismissing plaintiff’s first cause of action on the ground of lack of medical necessity. Plaintiff opposed the motion on the ground that, among other things, defendant had failed to respond to discovery demands and that defendant’s responses were necessary to oppose defendant’s motion (see CPLR 3212 [f]). Plaintiff also cross-moved to, among other things, compel defendant to provide the requested discovery (see CPLR 3124). In an order entered November 20, 2012, insofar as appealed from, the Civil Court denied the branch of defendant’s motion seeking summary judgment dismissing plaintiff’s first cause of action. The Civil Court held that, since defendant had annexed its discovery responses to its reply papers, plaintiff’s cross motion to compel disclosure was moot and that there was an issue of fact as to medical necessity because defendant had failed to provide, in a timely manner, the medical records which plaintiff had sought, so that plaintiff could respond to the branch of defendant’s motion seeking summary judgment dismissing plaintiff’s first cause of action.

In opposition to defendant’s motion, and in support of its cross motion to compel discovery, plaintiff demonstrated that it had requested from defendant, but had not received in time to oppose defendant’s motion (see CPLR 3212 [f]), the peer review report, the complete set of medical documentation relating to the assignor received by defendant and the complete set of medical documentation provided to defendant’s peer reviewer. In light of the foregoing, defendant is not entitled to summary judgment dismissing plaintiff’s first cause of action (see Metropolitan Diagnostic Med. Care, P.C. v A. Cent. Ins. Co., 42 Misc 3d 133[A], 2013 NY Slip Op 52246[U] [App Term, 2d, 11th & 13th Jud Dists 2013]; see also Alrof, Inc. v Progressive Ins. Co., 34 Misc 3d 29 [App Term, 2d, 11th & 13th Jud Dists 2011]).

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

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: August 05, 2015
South Nassau Orthopedic Surgery & Sports Medicine, P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51211(U))

Reported in New York Official Reports at South Nassau Orthopedic Surgery & Sports Medicine, P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51211(U))

South Nassau Orthopedic Surgery & Sports Medicine, P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51211(U)) [*1]
South Nassau Orthopedic Surgery & Sports Medicine, P.C. v Farm Family Cas. Ins. Co.
2015 NY Slip Op 51211(U) [48 Misc 3d 138(A)]
Decided on August 5, 2015
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 August 5, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-23 Q C
South Nassau Orthopedic Surgery & Sports Medicine, P.C. as Assignee of PETER PAPADIONISOPOULOS, Respondent, August 5, 2015

against

Farm Family Casualty Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Barry A. Schwartz, J.), entered June 18, 2012. The order, insofar as appealed from, denied the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought reimbursement for services rendered between December 2008 and February 2009 and granted the branches of plaintiff’s cross motion seeking summary judgment on that potion of the complaint.

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

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint and plaintiff cross-moved for summary judgment. In an order entered June 18, 2012, insofar as appealed from, the Civil Court denied the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought reimbursement for services rendered between December 2008 and February 2009 and granted the branches of plaintiff’s cross motion seeking summary judgment on that portion of the complaint.

Contrary to defendant’s contention, the affidavit submitted by plaintiff was sufficient to establish plaintiff’s prima facie entitlement to summary judgment with respect to the services at issue (see Insurance Law § 5106 [a]; New Way Med. Supply Corp. v MVAIC, 46 Misc 3d 129[A], 2014 NY Slip Op 51805[U] [App Term, 2d, 11th & 13th Jud Dists 2014]).

Defendant failed to demonstrate that its May 1, 2009 denials were timely with respect to the bills at issue, all of which had been received by defendant between January 7, 2009 and March 12, 2009. Plaintiff’s assignor appeared for an examination under oath (EUO) on March 3, 2009, and no other verification remained outstanding. Consequently, defendant was required to deny each of the bills at issue by the later of the following two dates: 30 days from the date of receipt of the bill or 30 days from March 3, 2009 (see 11 NYCRR 65-3.8 [a] [1] [“No-Fault benefits are overdue if not paid within 30 calendar days after the insurer receives proof of claim, which shall include verification of all of the relevant information requested . . . . In the case of an examination under oath . . . , the verification is deemed to have been received by the insurer on the day the examination was performed.”]), which it failed to do. In view of the foregoing, the [*2]branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought reimbursement for services rendered between December 2008 and February 2009 were properly denied, and the branches of plaintiff’s cross motion seeking summary judgment on that portion of the complaint were properly granted.

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

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: August 05, 2015
Starlite Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51209(U))

Reported in New York Official Reports at Starlite Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51209(U))

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

Starlite Acupuncture, P.C. as Assignee of FATIMA HORTON, Appellant, August 5, 2015

against

Praetorian Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered November 21, 2012. The order denied plaintiff’s motion for summary judgment, granted defendant’s cross motion for summary judgment dismissing the complaint, and denied plaintiff’s separate motion for a protective order.

ORDERED that the order is modified by providing that the branches of plaintiff’s motion seeking summary judgment on the first and second causes of action are granted and by further providing that defendant’s cross motion for summary judgment dismissing the complaint is denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, alleging that it had mailed three bills to defendant on March 5, 2010, and that defendant had not timely paid or denied them. Defendant opposed plaintiff’s motion and cross-moved for summary judgment, alleging that it had received one bill on April 5, 2010, and the other two on October 8, 2010, and that it had timely denied the bills based upon plaintiff’s assignor’s failure to appear for duly scheduled examinations under oath and independent medical examinations. Plaintiff separately moved for a protective order with respect to defendant’s notice of examination before trial. The Civil Court denied plaintiff’s motion for summary judgment, granted defendant’s cross motion for summary judgment dismissing the complaint, and denied plaintiff’s separate motion for a protective order.

While defendant demonstrated that it had received copies of the bills upon which the first and second causes of action were based on October 8, 2010, those copies are marked “resubmission.” Defendant did not address the allegations in the affidavit submitted in support of plaintiff’s motion for summary judgment that the bills had been mailed on March 5, 2010, by affirmatively stating that original versions of the bills had not been received earlier, or explaining how these bills had come to be resubmitted. As a result, defendant failed to rebut plaintiff’s prima facie showing that the bills had been submitted and not timely denied. Consequently, plaintiff is entitled to summary judgment on those causes of action and the branches of defendant’s cross motion seeking summary judgment dismissing those causes of action should have been denied (see New Way Med. Supply Corp. v MVAIC, 46 Misc 3d 129[A], 2014 NY Slip Op 51805[U] [App Term, 2d, 11th & 13th Jud Dists 2014]).

Defendant alleges that it received the bill upon which the third cause of action was based on April 5, 2010, while plaintiff alleges that it mailed the bill a month earlier. While it is possible that both of those allegations are true, plaintiff’s proof of mailing raises the possibility that defendant received the bill earlier. Consequently, as there is a triable issue of fact as to when defendant received the bill, and therefore whether it was timely denied, the branch of defendant’s cross motion seeking summary judgment dismissing the third cause of action should have been denied.

We reject plaintiff’s argument that a protective order is warranted under the circumstances presented.

Accordingly, the order is modified by providing that the branches of plaintiff’s motion seeking summary judgment on the first and second causes of action are granted and by further providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: August 05, 2015
Arcadia Imaging, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51208(U))

Reported in New York Official Reports at Arcadia Imaging, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51208(U))

Arcadia Imaging, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51208(U)) [*1]
Arcadia Imaging, P.C. v Praetorian Ins. Co.
2015 NY Slip Op 51208(U) [48 Misc 3d 137(A)]
Decided on August 5, 2015
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 August 5, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-2041 K C
Arcadia Imaging, P.C. as Assignee of Donovan Lewis, Respondent, August 5, 2015

against

Praetorian Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County

(Genine D. Edwards, J.), entered July 18, 2012. 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.

Defendant submitted an affidavit by the president of the company which had been retained by defendant to schedule independent medical examinations (IMEs), which affidavit established that the scheduling letters had been timely mailed in accordance with that office’s standard mailing practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Defendant also submitted affidavits by the healthcare professionals who were to perform the IMEs, which affidavits established that plaintiff’s assignor had failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). An affidavit executed by defendant’s claims examiner sufficiently described the standard mailing practices and procedures to establish the timely mailing of the denial of claim form (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; Delta Diagnostic Radiology, P.C., 17 Misc 3d 16). In view of the foregoing, and since an assignor’s appearance at an IME is a condition precedent to the insurer’s liability on the policy (see Stephen Fogel Psychological, P.C., 35 AD3d at 722), defendant’s motion for summary judgment dismissing the complaint should have been granted. Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: August 05, 2015
Matter of Fiduciary Ins. Co. v American Bankers Ins. Co. of Florida (2015 NY Slip Op 06343)

Reported in New York Official Reports at Matter of Fiduciary Ins. Co. v American Bankers Ins. Co. of Florida (2015 NY Slip Op 06343)

Matter of Fiduciary Ins. Co. v American Bankers Ins. Co. of Florida (2015 NY Slip Op 06343)
Matter of Fiduciary Ins. Co. v American Bankers Ins. Co. of Florida
2015 NY Slip Op 06343 [132 AD3d 40]
July 29, 2015
Hinds-Radix, J.
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, November 4, 2015

[*1]

In the Matter of Fiduciary Insurance Company, Appellant,
v
American Bankers Insurance Company of Florida, Respondent.

Second Department, July 29, 2015

APPEARANCES OF COUNSEL

D’Amato & Lynch, LLP, New York City (Robert D. Lang, David A. Boyar, and Roy T. Caplinger of counsel), for appellant.

Kral Clerkin Redmond Ryan Perry & Van Etten, LLP, Melville (Leonard Porcelli of counsel), for respondent.

{**132 AD3d at 41} OPINION OF THE COURT

Hinds-Radix, J.

In the fall of 2006, a taxi insured by the petitioner was involved in a collision with a horse. The rider of the horse was seriously injured, and the petitioner paid him nearly $60,000 in no-fault benefits. The petitioner then sought reimbursement of the no-fault benefits that it had paid to the rider by filing a demand for mandatory arbitration against the respondent, American Bankers Insurance Company of Florida (hereinafter{**132 AD3d at 42} American Bankers), the carrier that provided commercial liability coverage to the stables where the horse was boarded. The arbitrator denied the petitioner’s claim, finding, in essence, that the petitioner could not recoup payment from American Bankers because American Bankers was not a motor vehicle insurer subject to the mandatory arbitration provisions of Insurance Law § 5105 and its implementing regulations. We conclude that the arbitrator had the authority to determine this threshold issue, and that the determination had a rational basis.

The facts underlying the commencement of this proceeding are not in dispute. On October 8, 2006, Jared Johnson was riding a horse named Romeo on a path alongside of North Conduit Avenue in Queens when Romeo suddenly bolted into the roadway, and collided with a taxi owned and operated by Parjit Singh. Johnson was thrown from the horse, and suffered serious injuries, including skull fractures and a broken leg. On the date of the accident, Singh’s taxi was insured by the petitioner, Fiduciary Insurance Company. Johnson filed a claim with the petitioner seeking to recover first-party benefits, more commonly known as “no-fault” benefits, under Insurance Law § 5103. The petitioner ultimately paid Johnson a total of $59,906.97 in no-fault benefits.

Romeo was owned by Julius Stanton, who had no insurance coverage in effect for the horse on the date of the accident. Stanton boarded Romeo at Cedar Lane Stables (hereinafter Cedar Lane), a facility owned by the City of New York, and licensed to the Federation of Black Cowboys, [*2]Inc. (hereinafter the Cowboys). Cedar Lane and the Cowboys (hereinafter together the insureds) were insured by American Bankers under a commercial liability policy that provided no-fault coverage only for accidents arising from the use of “mobile equipment,” a category that includes various types of machinery not generally used for travel on public roads. More specifically, the policy afforded supplemental coverage to the insureds for “all sums for which an insured is legally liable for bodily injury or property damages resulting” from its mobile equipment, including no-fault insurance coverage required by any insurance law. The subject accident, however, did not involve mobile equipment owned by the insureds, but, rather, a horse that the insureds merely boarded at their stables.

Following the accident, Johnson commenced an action to recover damages for personal injuries against several parties{**132 AD3d at 43} including the City, the Cowboys, and Singh. In an order dated November 30, 2009, the Supreme Court awarded summary judgment to the City, the Cowboys, and Singh dismissing the complaint insofar as asserted against them, based upon the doctrine of primary assumption of risk.

On October 19, 2012, nearly two years after Johnson’s action was dismissed against the insureds, the petitioner sought reimbursement of the no-fault benefits that it had paid him by filing a demand for mandatory arbitration against American Bankers pursuant to Insurance Law § 5105. That statute allows an insurer that has paid no-fault benefits to obtain mandatory arbitration to recoup its loss from the insurer of the party actually at fault for the accident.[FN*] In its arbitration demand, the petitioner asserted that its insured, Singh, was not at fault for the accident because he had done nothing to cause the horse to “attack” his taxi, and that the insureds had negligently created “an extremely hazardous situation” by permitting the horse to travel upon “a riding path so close to a roadway without any barricade.” American Bankers did not file a response to the demand or otherwise participate in the arbitration.

In an award dated December 12, 2012, the arbitrator ruled that the petitioner could not obtain reimbursement from American Bankers because it had “failed to provide substantiation that [American Bankers] is [a] motor vehicle insurer that could be held liable under Section 5105 of Insurance Law.” The arbitrator added that, therefore, “[t]he proper forum would have been litigation.”

About three months later, on March 11, 2013, the petitioner commenced the instant proceeding pursuant to CPLR 7511 (b) to vacate the arbitration award, contending that the arbitrator erred in sua sponte raising an affirmative defense on behalf of American Bankers, which had elected not to appear in the arbitration proceeding. The petitioner further argued that, in any event, American Bankers was an insurer subject to mandatory arbitration of claims against it arising from an accident involving a motor vehicle for hire.

In opposition to the petition, American Bankers asserted that the arbitrator’s determination had a rational basis, and{**132 AD3d at 44} cross-petitioned pursuant to CPLR 7511 (e) to confirm the award.

In the order appealed from, the Supreme Court denied the petition to vacate the arbitration award, granted the cross petition, and confirmed the award. The court began its analysis by noting that

“[t]here are two types of no-fault disputes between insurers that are subject to mandatory arbitration: loss transfer and priority of payment (see Insurance Law § 5105; 11 NYCRR 65-3.12; 11 NYCRR 65-4.11). The arbitration procedures established pursuant to section 5105 of the Insurance Law apply to disputes over priority of payment among insurers who are liable for the payment of first-party benefits (see Insurance Law § 5105 [a] [b]; 11 NYCRR [65-]3.12 [b]).”

The court then rejected the petitioner’s argument that the arbitrator had improperly raised and disposed of an affirmative defense by determining that American Bankers was not a motor vehicle insurer liable for the payment of no-fault benefits. Rather, the arbitrator’s determination was that [*3]the petitioner had failed to meet “a threshold part” of its “required showing as the applicant seeking reimbursement under Insurance Law § 5105 and 11 NYCRR [65-]3.12 (b)” that American Bankers was an “insurer” within the meaning of the applicable statute and regulations and, thus, subject to mandatory arbitration of another insurance carrier’s claims against it.

[1] Contrary to the petitioner’s contention, the arbitrator had the authority to rule on the issue of whether the controversy was subject to mandatory arbitration under Insurance Law § 5105 and its implementing regulations. An arbitrator’s authority generally “extends to only those issues that are actually presented by the parties” (Matter of Joan Hansen & Co., Inc. v Everlast World’s Boxing Headquarters Corp., 13 NY3d 168, 173 [2009]). Therefore, an arbitrator is precluded from identifying and considering an affirmative defense that is not pleaded by a party to the arbitration. Here, however, the issue before the arbitrator cannot be characterized as an affirmative defense, such as lack of coverage (see New York Cent. Mut. Fire Ins. Co. v Amica Mut. Ins. Co., 162 AD2d 1009 [1990]). Nor was the issue whether the petitioner satisfied a condition precedent to recovery in a loss-transfer proceeding (see Matter of Allstate Ins. Co. v New York Petroleum Assn. Compensation {**132 AD3d at 45}Trust, 104 AD3d 682 [2013]). Rather, the issue before the arbitrator was the threshold issue of whether American Bankers was an “insurer” subject to the mandatory arbitration procedures of Insurance Law § 5105 and 11 NYCRR 65-3.12 (b) (see Hunter v OOIDA Risk Retention Group, Inc., 79 AD3d 1, 9 [2010]). Furthermore, the fact that American Bankers elected not to participate in the arbitration did not divest the arbitrator of the authority to determine, in the first instance, whether American Bankers was an “insurer” within the meaning of the subject statute and regulation. An arbitrator may hear and determine a controversy upon the evidence produced, notwithstanding the failure of a party to appear (see CPLR 7506 [c]; Matter of Whale Sec. Co. [Godfrey], 271 AD2d 226, 227 [2000]), and since American Bankers did not appear at the arbitration, it did not affirmatively waive the issue of whether it was an “insurer” subject to arbitration by participating in the arbitration and raising other issues to the exclusion of that issue (cf. Matter of United Fedn. of Teachers, Local 2, AFT, AFL-CIO v Board of Educ. of City School Dist. of City of N.Y., 1 NY3d 72, 78 [2003]; Matter of Emerald Claims Mgt. for Ullico Cas. Ins. Co. v A. Cent. Ins. Co., 121 AD3d 481, 482-483 [2014]; Matter of Nelson v Queens Surface Corp., 283 AD2d 577 [2001]).

As noted by the Court of Appeals, a party may not be bound to arbitrate a dispute by mere inaction (see Matter of Commerce & Indus. Ins. Co. v Nester, 90 NY2d 255, 262 [1997]). Therefore, American Bankers’ failure to move to stay arbitration pursuant to CPLR 7503 did not render this dispute arbitrable, where, as here, no agreement to arbitrate was ever made (see id.; Matter of Matarasso [Continental Cas. Co.], 56 NY2d 264, 267 [1982]; Matter of Allstate Ins. Co. v Marke, 121 AD3d 1107 [2014]), and where, as will be discussed, American Bankers was not an insurer subject to the statutory requirement to submit to mandatory arbitration.

[2] Turning to the merits, in this proceeding pursuant to CPLR article 75 to vacate the arbitrator’s award, our judicial review is limited. Since the petitioner sought arbitration pursuant to the mandatory arbitration provision of Insurance Law § 5105, the award may be considered to be one arising from a statutory obligation to arbitrate, notwithstanding the arbitrator’s ultimate determination that American Bankers was not subject to arbitration. Thus, we treat the award as one rendered after compulsory arbitration, and give the petitioner the benefit of affording “closer judicial scrutiny of the arbitrator’s {**132 AD3d at 46}determination under CPLR 7511 (b)” than would be warranted in reviewing an award made after a consensual arbitration (Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d 214, 223 [1996]; see Matter of Public Serv. Mut. Ins. Co. v Fiduciary Ins. Co. of Am., 123 AD3d 933, 934 [2014]; Matter of Philadelphia Ins. Co. [Utica Natl. Ins. Group], 97 AD3d 1153 [2012]). “To be upheld, an award in a compulsory arbitration proceeding must have evidentiary support and cannot be arbitrary and capricious” (Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d at 223 [citations omitted]; see Matter of Santer v Board of Educ. of E. Meadow Union Free Sch. Dist., 23 NY3d 251, 261 [2014]; Matter of Public Serv. Mut. Ins. Co. v Fiduciary Ins. Co. of Am., 123 AD3d 933, 934 [2014]; Matter of State Farm Mut. Auto. Ins. Co. v City of Yonkers, 21 AD3d 1110, 1111 [2005]). Moreover, with respect to determinations of law, the applicable standard in mandatory no-fault arbitrations is whether “any reasonable hypothesis can be found to support the questioned interpretation” (Matter of Shand [Aetna Ins. Co.], 74 AD2d 442, 454 [1980]; see Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d at 224; Matter of Scottsdale Ins. Co. v Motor Veh. Acc. Indem. Corp., 107 AD3d 1003, 1003-1004 [2013]; Matter of State Farm Mut. Auto. Ins. Co. v Lumbermens Mut. Cas. Co., 18 AD3d 762, 763 [2005]; Matter of Hanover Ins. Co. v State Farm [*4]Mut. Auto. Ins. Co., 226 AD2d 533, 534 [1996]; Matter of Empire Mut. Ins. Co. v Jones, 151 AD2d 754 [1989]; Massapequa Gen. Hosp. v Travelers Ins. Co., 104 AD2d 638, 640 [1984]). Keeping our limited scope of judicial review in mind, and upon an application of the relevant law, we conclude that the Supreme Court properly determined that the arbitrator’s award was supported by a “reasonable hypothesis” and was not arbitrary and capricious (see Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d at 224; Matter of Progressive N. Ins. Co. v Sentry Ins. A Mut. Co., 51 AD3d 800, 802 [2008]; Matter of State Farm Mut. Auto. Ins. Co. v Lumbermens Mut. Cas. Co., 18 AD3d at 763).

At issue here is the applicability to this controversy of certain provisions of the Comprehensive Automobile Insurance Reparations Act (see L 1973, ch 13), commonly known as the No-Fault Law. Pursuant to the No-Fault Law, every automobile owner must carry automobile insurance covering “basic economic loss” resulting from the use or operation of the vehicle in New York State (Insurance Law § 5102 [a]; see Pommells v Perez, 4 NY3d {**132 AD3d at 47}566, 570-571 [2005]). The No-Fault Law is “aimed at ensuring ‘prompt compensation for losses incurred by accident victims without regard to fault or negligence’ ” (Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498, 504-505 [2015], quoting Matter of Medical Socy. of State of N.Y. v Serio, 100 NY2d 854, 860 [2003]), and alleviating unnecessary burdens on the courts by limiting litigation with respect to such claims (see Pommells v Perez, 4 NY3d at 570-571).

As relevant to this appeal, in certain limited circumstances an insurance carrier that has paid first-party no-fault benefits to an accident victim is afforded the remedy of mandatory intercompany arbitration to recoup those benefits, through a “loss transfer,” from the insurer of the party at fault for the accident (see Insurance Law § 5105; Matter of Emerald Claims Mgt. for Ullico Cas. Ins. Co. v A. Cent. Ins. Co., 121 AD3d at 482; Matter of Progressive Northeastern Ins. Co. [New York State Ins. Fund], 56 AD3d 1111, 1112 [2008]; Matter of State Farm Mut. Auto. Ins. Co. v City of Yonkers, 21 AD3d at 1111). “The No-Fault Automobile Insurance Law defines ‘first party benefits’ as ‘payments to reimburse a person for basic economic loss on account of personal injury arising out of the use or operation of a motor vehicle’ ” (Matter of Johnson v Buffalo & Erie County Private Indus. Council, 84 NY2d 13, 18 [1994], quoting Insurance Law § 5102 [b]). “Basic economic loss” includes necessary expenses incurred by an accident victim for medical treatment, and lost wages (Insurance Law § 5102 [a] [1] [i]; [2]).

Insurance Law § 5105 states, in pertinent part:

“(a) Any insurer liable for the payment of first party benefits to or on behalf of a covered person and any compensation provider paying benefits in lieu of first party benefits . . . has the right to recover the amount paid from the insurer of any other covered person to the extent that such other covered person would have been liable, but for the provisions of this article, to pay damages in an action at law. In any case, the right to recover exists only if at least one of the motor vehicles involved is a motor vehicle weighing more than six thousand five hundred pounds unloaded or is a motor vehicle used principally for the transportation of persons or property for hire. . . .
{**132 AD3d at 48}
“(b) The sole remedy of any insurer or compensation provider to recover on a claim arising pursuant to subsection (a) hereof, shall be the submission of the controversy to mandatory arbitration pursuant to procedures promulgated or approved by the superintendent.”

In 1977, the statute was amended to its present form, which restricts recovery to accidents involving vehicles for hire or vehicles weighing more than 6,500 pounds (see Hunter v OOIDA Risk Retention Group, Inc., 79 AD3d at 10). The scope of recovery was restricted by the 1977 amendment to address concerns that intercompany loss-transfer arbitration proceedings “contribute to overhead costs and delays under the no-fault system and are inconsistent with the basic objective of the no-fault system, which is to eliminate costly investigations and factual determinations concerning fault” (Governor’s Program Bill Mem at 7-8, Bill Jacket, L 1977, ch 892; see Hunter v OOIDA Risk Retention Group, Inc., 79 AD3d at 10).

Insurance Law § 5105 serves to mitigate the effect of placing the entire burden “of loss on the first-party insurer, even where its insured was not at fault” (Hunter v OOIDA Risk Retention Group, Inc., 79 AD3d at 9), and allows insurers to recover from each other the first-party [*5]no-fault benefits paid to their insureds, allocated on the basis of their relative fault (see id.; Matter of City of Syracuse v Utica Mut. Ins. Co., 61 NY2d 691, 693 [1984]). Since, generally, where a vehicle for hire is involved in an underlying accident, “mandatory arbitration is the sole remedy regarding disputes between insurers over responsibility for payment of first-party benefits,” no action at law lies in such a situation to adjudicate a dispute between insurers over liability for first-party no-fault benefits (State Farm Mut. Auto. Ins. Co. v Nationwide Mut. Ins. Co., 150 AD2d 976, 977 [1989]; see Matter of Philadelphia Ins. Co. [Utica Natl. Ins. Group], 97 AD3d 1153, 1157-1158 [2012]), or disputes over priority of payment of first-party benefits (see Matter of Pacific Ins. Co. v State Farm Mut. Auto. Ins. Co., 150 AD2d 455, 456 [1989]).

The term “insurer” is defined in Insurance Law article 51 as an “insurance company or self-insurer, as the case may be, which provides the financial security required by article six or eight of the vehicle and traffic law” (Insurance Law § 5102 [g] [emphasis added]). In addition, the regulations implementing the No-Fault Law state that they apply to “mandatory arbitration of controversies between insurers, pursuant to the provisions{**132 AD3d at 49} of section 5105 of the Insurance Law, and shall apply to insurers, self-insurers and compensation providers” (11 NYCRR 65-4.11 [a] [1]). Insurers are defined in those regulations as both insurers and self-insurers “as those terms are defined in . . . Part [65 of Title 11 of the NYCRR] and article 51 of the Insurance Law; the Motor Vehicle Accident Indemnification Corporation (MVAIC); any company providing insurance pursuant to section 5103 (g) of the Insurance Law; and compensation providers as defined in section 5102 (1) of the Insurance Law” (11 NYCRR 65-4.11 [a] [1]).

Insurance Law § 5105 (b), which provides that the “sole remedy of any insurer or compensation provider to recover” first-party benefits on a no-fault claim “shall be the submission of the controversy to mandatory arbitration” (see Eagle Ins. Co. v ELRAC, Inc., 291 AD2d 272, 273 [2002]; Matter of Pacific Ins. Co. v State Farm Mut. Auto. Ins. Co., 150 AD2d at 456), is binding only upon insurers or self-insurers, “as those terms are defined in . . . Part [65 of Title 11 of the NYCRR] and article 51 of the Insurance Law” (11 NYCRR 65-4.1; see 65-4.11 [a] [1], [5]), and not to insurance carriers which do not meet those definitions (see Aetna Health Plans v Hanover Ins. Co., 116 AD3d 538 [2014], lv granted 24 NY3d 912 [2015]). Thus, not all insurance carriers that insure those actually involved in an accident are subject to the mandatory arbitration provisions of Insurance Law § 5105 (b) and its implementing regulations. Furthermore, these provisions do “not apply where New York’s no-fault insurance law does not prevent the tortfeasor from being held liable to pay damages in an action at law” (Hunter v OOIDA Risk Retention Group, Inc., 79 AD3d at 12).

Here, the American Bankers’ policy did not provide no-fault insurance coverage for the type of accident underlying this dispute. Moreover, American Bankers did not insure a person, vehicle, or animal involved in the underlying accident, but only the stables at which the animal was boarded. Accordingly, American Bankers cannot be deemed to be an “insurer” as that term is defined by Insurance Law article 51 and the pertinent regulations.

Moreover, Insurance Law § 5105 does not apply here because New York’s No-Fault Law would not preclude American Bankers’ insureds from being held liable to pay damages in an action at law. The decision of this Court in Matter of Purex Indus. v Nationwide Mut. Ins. Co. (110 AD2d 67 [1985]) does not support a contrary result. In that case, this Court ruled that the{**132 AD3d at 50} petitioner was “the self-insured owner of the vehicle involved in the accident” (id. at 69) and, thus, satisfied the statutory definition of an “insurer” that is “subject to mandatory arbitration for adjusting the payment of no-fault benefits between insurers” (id. at 68), since, “[b]ut for the No-Fault Law, petitioner would be liable as an ‘insurer’ to [the respondent’s] insured in an action at law” (id. at 70). Here, on the other hand, the No-Fault Law would not preclude American Bankers’ insureds from being held liable in an action at law (see Hunter v OOIDA Risk Retention Group, Inc., 79 AD3d at 12).

Since American Bankers did not meet the definition of insurer or self-insurer under the No-Fault Law and the regulations promulgated thereunder (see Matter of Purex Indus. v Nationwide Mut. Ins. Co., 110 AD2d at 68-70), the determination of the arbitrator that the claims against it were not subject to compulsory arbitration was supported by a reasonable hypothesis. Accordingly, the Supreme Court properly denied the petition to vacate the arbitrator’s award, and properly granted the cross petition to confirm the award.

The order is affirmed.

Skelos, J.P., Dickerson and Miller, JJ., concur.

Ordered that the order is affirmed, with costs.

Footnotes

Footnote *:However, Insurance Law § 5105 only permits recoupment of no-fault benefits for accidents involving vehicles for hire, such as the taxi insured by the petitioner in this case, or vehicles weighing more than 6,500 pounds, such as trucks.

Delta Diagnostics Radiology, P.C. v Delos Ins. Co. (2015 NY Slip Op 51135(U))

Reported in New York Official Reports at Delta Diagnostics Radiology, P.C. v Delos Ins. Co. (2015 NY Slip Op 51135(U))

Delta Diagnostics Radiology, P.C. v Delos Ins. Co. (2015 NY Slip Op 51135(U)) [*1]
Delta Diagnostics Radiology, P.C. v Delos Ins. Co.
2015 NY Slip Op 51135(U) [48 Misc 3d 137(A)]
Decided on July 27, 2015
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 July 27, 2015

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


PRESENT: : ELLIOT, J.P., PESCE and SOLOMON, JJ.
2014-368 Q C
Delta Diagnostics Radiology, P.C. as Assignee of CARLY ALOUIDOR, Respondent,

against

Delos Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered January 13, 2014. The order, insofar as appealed from as limited by the brief, denied defendant’s motion to compel plaintiff to appear for a deposition.

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

In this action by a provider to recover assigned first-party no-fault benefits, defendant answered the complaint and served demands for discovery, including a


notice for a deposition of plaintiff. Plaintiff failed to appear for the deposition scheduled by defendant. Thereafter, defendant moved, insofar as is relevant to this appeal, to compel plaintiff to appear for a deposition, and plaintiff opposed the motion. The Civil Court denied defendant’s motion on the ground that defendant had failed to proffer an affidavit from an investigator in support of its motion.

” [A] trial court is given broad discretion to oversee the discovery process’ ” (Maiorino v City of New York, 39 AD3d 601, 601 [2007], quoting Castillo v Henry Schein, Inc., 259 AD2d 651, 652 [1999]; see also Gillen v Utica First Ins. Co., 41 AD3d 647 [2007]). Absent an improvident exercise of that discretion, the court’s determination will not be disturbed on appeal (see Matter of U.S. Pioneer Elecs. Corp. [Nikko Elec. Corp. of Am.], 47 NY2d 914, 916 [1979]; Silberstein v Maimonides Med. Ctr., 77 AD3d 910 [2010]; Stracar Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co., 33 Misc 3d 131[A], 2011 NY Slip Op 51875[U] [App Term, 2d, 11th & 13th Jud Dists 2011]). Upon a review of the record, we find that the Civil Court did not improvidently exercise its discretion.

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

Elliot, J.P., Pesce and Solomon, JJ., concur.


Decision Date: July 27, 2015
Farshad D. Hannanian, M.D., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51133(U))

Reported in New York Official Reports at Farshad D. Hannanian, M.D., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51133(U))

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

Farshad D. Hannanian, M.D., P.C. as Assignee of MAKEDA PINNOCK, Appellant,

against

Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered January 7, 2014. The order, insofar as appealed from, granted the branch of defendant’s motion seeking an order compelling plaintiff’s assignor’s treating provider to appear for a deposition and denied plaintiff’s cross motion for a protective order and sanctions.

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

In this action by a provider to recover assigned first-party no-fault benefits, six days after plaintiff served a motion seeking summary judgment, defendant served a notice of deposition of plaintiff’s assignor’s treating provider. Plaintiff timely objected, arguing, among other things, that disclosure was stayed pursuant to CPLR 3214 (b). Immediately after plaintiff’s assignor’s treating provider failed to appear for the deposition, defendant moved to compel plaintiff to, among other things, produce plaintiff’s assignor’s treating provider for a deposition. Plaintiff cross-moved, inter alia, for a protective order pursuant to CPLR 3013 and to strike defendant’s notice to take deposition on the ground that the notice to take deposition was palpably improper. Insofar as is relevant to this appeal, by order entered January 7, 2014, the Civil Court granted the branch of defendant’s motion seeking to compel plaintiff’s treating provider to appear for a deposition and denied plaintiff’s cross motion. This appeal by plaintiff ensued.

CPLR 3101 (a) provides for “full disclosure of all matter material and necessary in the prosecution or defense of an action, regardless of the burden of proof.” Parties to an action are entitled to reasonable discovery “of any facts bearing on the controversy which will assist preparation for trial by sharpening the issues and reducing delay and prolixity” (Allen v Crowell-Collier Publ. Co., 21 NY2d 403, 406 [1968]; see Traditional Acupuncture, P.C. v State Farm Ins. Co., 24 Misc 3d 129[A], 2009 NY Slip Op 51335[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). Where, as here, defendant is defending this action on the ground that the services rendered lacked medical necessity, the court’s determination that a deposition of plaintiff’s assignor’s treating provider was material and necessary to defendant’s defense was proper (see Great Health Care Chiropractic, P.C. v Interboro Ins. Co., 41 Misc 3d 130[A], 2013 NY Slip Op 51737[U] [App Term, 2d, 11th & 13th Jud Dists 2013]; see also CPLR 3214 [b] [court may grant discovery notwithstanding service of a summary judgment motion]; Reilly v Oakwood Hgts. Community Church, 269 AD2d 582 [2000]). Although plaintiff argued that defendant’s notice to take deposition was palpably improper, plaintiff failed to make such a showing (see e.g. All Boro Psychological Servs., P.C. v Allstate Ins. Co., 39 Misc 3d 9, 12 [App Term, 2d, 11th & [*2]13th Jud Dists 2013]).

Accordingly, the order, insofar as appealed from, is affirmed.Aliotta, J.P., Solomon and Elliot, JJ., concur.


Decision Date: July 27, 2015