Huntington Regional Chiropractic, P.C. v Mercury Cas. Co. (2015 NY Slip Op 51900(U))

Reported in New York Official Reports at Huntington Regional Chiropractic, P.C. v Mercury Cas. Co. (2015 NY Slip Op 51900(U))

[*1]
Huntington Regional Chiropractic, P.C. v Mercury Cas. Co.
2015 NY Slip Op 51900(U) [50 Misc 3d 130(A)]
Decided on December 18, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 18, 2015
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS

PRESENT: : IANNACCI, J.P., TOLBERT and GARGUILO, JJ.
2014-1472 N C

Huntington Regional Chiropractic, P.C. as Assignee of Luis Menendez, Respondent,

against

Mercury Casualty Company, Appellant.


Appeal from an order of the District Court of Nassau County, Third District (Scott Fairgrieve, J.), dated June 9, 2014. The order denied defendant’s motion for summary judgment dismissing the complaint, or, in the alternative, to compel a deposition of plaintiff.

ORDERED that the order is modified by providing that the branch of defendant’s motion seeking to compel a deposition of plaintiff is granted; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint or, in the alternative, to compel plaintiff to appear for a deposition and preclude plaintiff from offering evidence in the event plaintiff failed to appear for such deposition. Plaintiff opposed the branch of the motion seeking summary judgment dismissing the complaint on the ground that triable issues of fact exist as to the medical necessity of the services at issue. In opposition to the branch of defendant’s motion seeking to compel a deposition, plaintiff argued that, since it had provided written responses to defendant’s discovery demands, the demand for a deposition was unduly burdensome. By order dated June 9, 2014, the District Court denied defendant’s motion.

Defendant established that the denial of claim forms, which denied the claims on the ground of lack of medical necessity, had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Richard Morgan Do, P.C. v State Farm Mut. Auto. Ins. Co., 22 Misc 3d 134[A], 2009 NY Slip Op 50242[U] [App Term, 9th & 10th Jud Dists 2009]). While the sworn report by the chiropractor/acupuncturist who had performed an independent medical examination set forth a factual basis and medical rationale for his opinion that there was a lack of medical necessity for the services at issue, plaintiff proffered a chiropractor’s affidavit in opposition, which affidavit was sufficient to raise a triable issue of fact as to whether the services were medically necessary (see Zuckerman v City of New York, 49 NY2d 557 [1980]). Consequently, the District Court properly denied the branch of defendant’s motion seeking summary judgment dismissing the complaint.

With respect to the branch of defendant’s motion seeking to compel a deposition of plaintiff, 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 [*2]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]). Here, the deposition of plaintiff was material and necessary to defendant’s defense of the action (see Farshad D. Hannanian, M.D., P.C. v Allstate Ins. Co., 48 Misc 3d 136[A], 2015 NY Slip Op 51133[U] [App Term, 2d, 11th & 13th Jud Dists 2015]; 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]). We note that plaintiff’s contention that a deposition was unnecessary because plaintiff had served written responses to defendant’s discovery demands lacks merit (see New Era Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., 24 Misc 3d 134[A], 2009 NY Slip Op 51396[U] [App Term, 9th & 10th Jud Dists 2009]; cf. Ralph Med. Diagnostics, PC v Mercury Cas. Co., 43 Misc 3d 65 [App Term, 1st Dept 2014]). Consequently, the branch of defendant’s motion seeking to compel plaintiff to appear at a deposition should have been granted. Accordingly, the order is modified by providing that the branch of defendant’s motion seeking to compel a deposition of plaintiff is granted.

Iannacci, J.P., Tolbert and Garguilo, JJ., concur.


Decision Date: December 18, 2015Tsatskis v Interboro Mut. Ins. Co. (2015 NY Slip Op 51891(U))

Reported in New York Official Reports at Tsatskis v Interboro Mut. Ins. Co. (2015 NY Slip Op 51891(U))

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS

Boris Tsatskis, M.D., as Assignee of Afik Azulay, Respondent,

against

Interboro Mutual Insurance Company, Appellant.

Appeal from an order of the District Court of Suffolk County, Third District (C. Stephen Hackeling, J.), dated June 26, 2014. The order, insofar as appealed from as limited by the brief, struck defendant’s notice of deposition and denied the branch of defendant’s motion seeking to compel plaintiff to appear for a deposition.

ORDERED that the order, insofar as appealed from, is reversed, without costs, defendant’s notice of deposition is reinstated and the branch of defendant’s motion seeking to compel plaintiff to appear for a deposition is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant served, with its answer, a notice of deposition of plaintiff and demands for responses to interrogatories and for discovery and inspection of documents. Shortly thereafter, defendant moved, insofar as is relevant to this appeal, to compel plaintiff to appear for a deposition on the issue of medical necessity. Plaintiff opposed defendant’s motion and cross-moved for summary judgment and for a protective order. As limited by its brief, defendant appeals from so much of an order of the District Court as struck the notice of deposition and denied the branch of defendant’s motion seeking to compel plaintiff to appear for a deposition.

CPLR 3101 (a) provides that “[t]here shall be full disclosure of all matter material and necessary in the prosecution or defense of an action regardless of the burden of proof” (see Jamaica Med. Plaza, P.C. v Interboro Ins. Co., 39 Misc 3d 131[A], 2013 NY Slip Op 50475[U] [App Term, 2d, 11th & 13th Jud Dists 2013]). Defendant established that it had preserved its defense of lack of medical necessity by timely mailing its denial of claim forms, which raised this defense (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Richard Morgan Do, P.C. v State Farm Mut. Auto. Ins. Co., 22 Misc 3d 134[A], 2009 NY Slip Op 50242[U] [App Term, 9th & 10th Jud Dists 2009]). Contrary to the District Court’s determination, defendant’s service of a notice of deposition together with its other discovery demands did not render the notice “procedurally premature.” Defendant was not required to show, as a prerequisite to a deposition of plaintiff, that plaintiff’s discovery responses were inadequate (see New Era Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., 24 Misc 3d 134[A], 2009 NY Slip Op 51396[U] [App Term, 9th & 10th Jud Dists 2009]). Indeed, “defendant is entitled to conduct such [deposition] notwithstanding the fact that it had also served plaintiff with other discovery demands” (New Era Acupuncture, P.C., 24 Misc 3d 134[A], 2009 NY Slip Op 51396[U], *3; see CPLR 3102; First Aid Occupational Therapy, PLLC v State Farm Mut. Auto. Ins. Co., 21 Misc 3d 128[A], 2008 NY Slip Op 51963[U] [App Term, 2d & 11th [*2]Jud Dists 2008]; Great Wall Acupuncture, P.C. v General Assur. Co., 21 Misc 3d 45, 47 [App Term, 2d & 11th Jud Dists 2008]; see also Woods v Alexander, 267 AD2d 1060, 1061 [1999]; Iseman v Delmar Med.-Dental Bldg., 113 AD2d 276 [1985]; JMJ Contract Mgt. v Ingersoll-Rand Co., 100 AD2d 291 [1984]). ” The CPLR does not set forth any order of priority as to the use of the various disclosure devices. A party is generally free to choose both the discovery devices it wishes to use and the order in which to use them’ ” (New Era Acupuncture, P.C., 24 Misc 3d 134[A], 2009 NY Slip Op 51396[U], *3, quoting Edwards-Pitt v Doe, 294 AD2d 395, 396 [2002]; see Nimkoff v Central Park Plaza Assoc., LLC, 123 AD3d 679 [2014]; Samide v Roman Catholic Diocese of Brooklyn, 16 AD3d 482 [2005]). Here, plaintiff failed to establish that defendant’s notice of deposition and other discovery demands constituted an “unreasonable annoyance,” would cause unnecessary expense or would otherwise prejudice plaintiff (see CPLR 3103). Consequently, the District Court erred in striking defendant’s notice of deposition and denying the branch of defendant’s motion seeking to compel plaintiff to appear for a deposition.

Accordingly, the order, insofar as appealed from, is reversed, defendant’s notice of deposition is reinstated and the branch of defendant’s motion seeking to compel plaintiff to appear for a deposition is granted.

Marano, P.J., Garguilo and Connolly, JJ., concur.


Decision Date: December 15, 2015
Promed Orthocare Supply, Inc. v AIG Advantage Ins. Co. (2015 NY Slip Op 51886(U))

Reported in New York Official Reports at Promed Orthocare Supply, Inc. v AIG Advantage Ins. Co. (2015 NY Slip Op 51886(U))

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

Promed Orthocare Supply, Inc. as Assignee of Edriss Noel, Respondent,

against

AIG Advantage Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered July 30, 2013. The order, insofar as appealed from, denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is affirmed, without costs. In this action to recover assigned first-party no-fault benefits, after plaintiff moved for summary judgment, defendant commenced a declaratory judgment action in the Supreme Court, Nassau County, against, among others, various medical providers, including plaintiff herein, seeking a declaration that defendant had no duty to provide coverage with respect to the accident from which the claims at issue in this action arose. By order dated March 15, 2010, the Supreme Court granted, on default, defendant’s motion for the entry of a declaratory judgment. Defendant subsequently cross-moved for summary judgment dismissing the complaint in the case at bar on the ground that this action is barred by the doctrines of res judicata and collateral estoppel by virtue of the March 2010 Supreme Court order in the declaratory judgment action. By order entered July 30, 2013, the Civil Court, among other things, denied defendant’s cross motion.

Upon a review of the record, we find that since the March 2010 Supreme Court order in the declaratory judgment action merely granted the entry of a declaratory judgment, but failed to make a statement declaring the rights of the parties involved (see Hirsch v Lindor Realty Corp., 63 NY2d 878, 881 [1984]; Suburban Bindery Equip. Corp. v Boston Old Colony Ins. Co., 150 AD2d 767 [1989]; Metro Health Prods., Inc. v Nationwide Ins., 48 Misc 3d 85 [App Term, 2d, 11th & 13th Jud Dists 2015]), the Supreme Court order cannot be considered a conclusive final determination and, thus, can have no preclusive effect in the instant no-fault action (see Metro Health Prods., Inc. v Nationwide Ins , 48 Misc 3d 85; cf. Vital Meridian Acupuncture, P.C. v Republic W. Ins. Co., 46 Misc 3d 147[A], 2015 NY Slip Op 50222[U] [App Term, 2d, 11th & 13th Jud Dists 2015]; EBM Med. Health Care, P.C. v Republic W. Ins., 38 Misc 3d 1 [App Term, 2d, 11th & 13th Jud Dists 2012]).

Accordingly, the order entered July 30, 2013, insofar as appealed from, is affirmed.

Weston, J.P., Aliotta and Elliot, JJ., concur.


Decision Date: December 15, 2015
GBI Acupuncture, P.C. v Geico Ins. Co. (2015 NY Slip Op 51882(U))

Reported in New York Official Reports at GBI Acupuncture, P.C. v Geico Ins. Co. (2015 NY Slip Op 51882(U))

[*1]
GBI Acupuncture, P.C. v Geico Ins. Co.
2015 NY Slip Op 51882(U) [50 Misc 3d 128(A)]
Decided on December 14, 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 December 14, 2015

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


PRESENT: : ALIOTTA, J.P., PESCE and SOLOMON, JJ.
2014-1321 Q C
GBI Acupuncture, P.C. as Assignee of Murrain Cook, Terrence G., Appellant,

against

Geico Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Sally E. Unger, J.), dated May 1, 2014. 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.

Plaintiff’s assignor was injured in a motor vehicle accident while riding in a vehicle which was insured by a New Jersey automobile insurance policy issued by defendant. Thereafter, plaintiff commenced this action to recover, among other things, assigned first-party no-fault benefits for the services it had rendered to its assignor, alleging that its claims were unpaid. Plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint. In support of its cross motion, defendant argued, among other things, that New Jersey law controlled; that New Jersey law and the insurance policy in question require that the matter be submitted to arbitration; and that this “suit is not properly before this court as it has no jurisdiction, and must dismiss the case.” Defendant did not move to compel arbitration. The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

For the reasons stated in Natural Therapy Acupuncture, P.C. as Assignee of Leila Milfort v Geico Ins. Co. (____ Misc 3d ____, 2015 NY Slip Op _____ [appeal No. 2014-1315 Q C], decided herewith), the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.

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


Decision Date: December 14, 2015
Natural Therapy Acupuncture, P.C. v Geico Ins. Co. (2015 NY Slip Op 51881(U))

Reported in New York Official Reports at Natural Therapy Acupuncture, P.C. v Geico Ins. Co. (2015 NY Slip Op 51881(U))

[*1]
Natural Therapy Acupuncture, P.C. v Geico Ins. Co.
2015 NY Slip Op 51881(U) [50 Misc 3d 128(A)]
Decided on December 14, 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 December 14, 2015

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


PRESENT: : ALIOTTA, J.P., PESCE and SOLOMON, JJ.
2014-1316 Q C
Natural Therapy Acupuncture, P.C. as Assignee of Berlinda Adolphe, Appellant,

against

Geico Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses B. Leverett, J.), dated May 20, 2014. 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.

Plaintiff’s assignor was injured in a motor vehicle accident while riding in a vehicle which was insured by a New Jersey automobile insurance policy issued by defendant. Thereafter, plaintiff commenced this action to recover, among other things, assigned first-party no-fault benefits for the services it had rendered to its assignor, alleging that its claims were unpaid. Plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint. In support of its cross motion, defendant argued, among other things, that New Jersey law controlled; that New Jersey law and the insurance policy in question require that the matter be submitted to arbitration; and that this “suit is not properly before this court as it has no jurisdiction, and must dismiss the case.” Defendant did not move to compel arbitration. The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

For the reasons stated in Natural Therapy Acupuncture, P.C. as Assignee of Leila Milfort v Geico Ins. Co. (____ Misc 3d ____, 2015 NY Slip Op _____ [appeal No. 2014-1315 Q C], decided herewith), the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.


Aliotta, J.P, Pesce and Solomon, JJ., concur.
Decision Date: December 14, 2015
Prepetit Med., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51879(U))

Reported in New York Official Reports at Prepetit Med., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51879(U))

[*1]
Prepetit Med., P.C. v Allstate Ins. Co.
2015 NY Slip Op 51879(U) [50 Misc 3d 128(A)]
Decided on December 14, 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 December 14, 2015

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


PRESENT: : ALIOTTA, J.P., PESCE and SOLOMON, JJ.
2014-539 Q C
Prepetit Medical, P.C. as Assignee of Maria Padilla, Appellant,

against

Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Larry Love, J.), entered February 26, 2014. The order, insofar as appealed from, granted the branch of defendant’s motion seeking 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, plaintiff appeals from so much of an order of the Civil Court as granted the branch of defendant’s motion seeking to compel plaintiff to appear for a deposition.

For the reasons stated in Farshad D. Hannanian, M.D., P.C. v Allstate Ins. Co. (48 Misc 3d 136[A], 2015 NY Slip Op 51133[U] [App Term, 2d, 11th & 13th Jud Dists 2015]), the order, insofar as appealed from, is affirmed.

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


Decision Date: December 14, 2015
Natural Therapy Acupuncture, P.C. v Geico Ins. Co. (2015 NY Slip Op 25425)

Reported in New York Official Reports at Natural Therapy Acupuncture, P.C. v Geico Ins. Co. (2015 NY Slip Op 25425)

Natural Therapy Acupuncture, P.C. v Geico Ins. Co.
2015 NY Slip Op 25425 [50 Misc 3d 107]
Accepted for Miscellaneous Reports Publication
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, March 30, 2016

[*1]

Natural Therapy Acupuncture, P.C., as Assignee of Leila Milfort, Appellant,
v
Geico Ins. Co., Respondent.

Supreme Court, Appellate Term, Second Department, 2d, 11th and 13th Judicial Districts, December 14, 2015

APPEARANCES OF COUNSEL

The Rybak Firm, PLLC, Brooklyn (Damin J. Toell of counsel), for appellant.

Law Office of Printz & Goldstein, Woodbury (Bryan P. Fauci of counsel), for respondent.

{**50 Misc 3d at 108} OPINION OF THE COURT

Memorandum.

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.

Plaintiff’s assignor was injured in a motor vehicle accident while riding in a vehicle which was insured by a New Jersey automobile insurance policy issued by defendant. Thereafter, plaintiff commenced this action to recover, among other things, assigned first-party no-fault benefits for the services it had rendered to its assignor, alleging that its claims were unpaid. Plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint on the ground that the dispute had to be resolved by arbitration. In opposition to plaintiff’s motion and in support of the cross motion, defendant addressed only the merits of plaintiff’s motion, made no arguments in support of its cross motion, and did not move to compel arbitration. The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

Since the insurance policy at issue contains a provision that “[t]he policy and any amendments and endorsements are to be interpreted pursuant to the laws of the state of New Jersey,” New Jersey law applies (see Bay Med. P.C. v GEICO Ins. Co., 41 Misc 3d 145[A], 2013 NY Slip Op 52084[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]).[FN*] In Bay Med. P.C., this court held that dispute resolution is not mandatory pursuant to NJ Stat Ann § 39:6A-5.1 (a), as implemented by NJ Admin Code § 11:3-5.1 (a), which provides that a dispute regarding the recovery of no-fault benefits may be submitted to dispute{**50 Misc 3d at 109} resolution upon the initiative of either party to the [*2]dispute (see also New Jersey Mfrs. Ins. Co. v Bergen Ambulatory Surgery Ctr., 410 NJ Super 270, 272-273, 982 A2d 1, 2-3 [2009]). The insurance policy in question also states that a matter may be submitted to dispute resolution “on the initiative of any party to the dispute.” However, the existence of an option to arbitrate is not a ground for dismissal of a court action; such an option—if exercised by way of a motion to compel arbitration—is a ground to stay the court action (see CPLR 7503 [a]). As defendant has not moved to compel arbitration, defendant’s cross motion for summary judgment dismissing the complaint should have been denied (see Bay Med. P.C. v GEICO Ins. Co., 41 Misc 3d 145[A], 2013 NY Slip Op 52084[U]; Advanced Med. Diagnostics of Queens, P.C. v GEICO Ins. Co., 38 Misc 3d 140[A], 2013 NY Slip Op 50219[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]).

Inasmuch as plaintiff failed to establish, in the first instance, the medical necessity of the services rendered (see Elkins v New Jersey Mfrs. Ins. Co., 244 NJ Super 695, 583 A2d 409 [1990]) and failed to show that defendant did not properly pay any claim within 60 days after it had been furnished with written notice of the fact of a covered loss and the amount of same (see NJ Stat Ann § 39:6A-5 [g]), under New Jersey law, plaintiff’s motion for summary judgment was properly denied.

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

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

Footnotes

Footnote *:Contrary to plaintiff’s contention, the underwriter’s affidavit that defendant submitted in support of its cross motion laid a sufficient foundation to allow consideration of the exhibits annexed to the cross motion.

New Way Med. Supply Corp. v Infinity Group (2015 NY Slip Op 51880(U))

Reported in New York Official Reports at New Way Med. Supply Corp. v Infinity Group (2015 NY Slip Op 51880(U))

[*1]
New Way Med. Supply Corp. v Infinity Group
2015 NY Slip Op 51880(U) [50 Misc 3d 128(A)]
Decided on December 14, 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 December 14, 2015
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : ALIOTTA, J.P., PESCE and SOLOMON, JJ.
2014-854 Q C

New Way Medical Supply Corp. as Assignee of Obi Emeka, Appellant,

against

Infinity Group, Respondent.


Appeal from an order of the Civil Court of the City of New York, Queens County (Carolyn E. Wade, J.), dated April 1, 2014. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.

In this action by a provider to recover assigned first-party no-fault benefits for supplies furnished to its assignor for injuries he had sustained in a motor vehicle accident on May 19, 2011, defendant moved for summary judgment dismissing the complaint. Defendant argued that a conflict-of-law analysis required the application of Pennsylvania law, pursuant to which there was a lack of coverage based on the cancellation of the underlying Pennsylvania insurance policy on May 12, 2011, due to the nonpayment of a premium. By order dated April 1, 2014, the Civil Court granted defendant’s motion, finding that defendant had established that the Pennsylvania policy had been “properly cancelled prior to the subject collision and therefore there is no coverage available.” On appeal, plaintiff contends, among other things, that defendant’s motion should have been denied because defendant failed to establish that the notice of cancellation had been properly mailed.

At the outset, we note that while, in the Civil Court, plaintiff argued that Pennsylvania law did not control, on appeal, plaintiff has abandoned this argument.

In Pennsylvania, in order for an insurance policy to be cancelled due to the nonpayment of premiums, the “notice of cancellation must be in strict accordance with the provisions of Act 68. An insurance policy may be cancelled by mailing to the named insured, at the address shown in the policy, a written notice of cancellation. If the notice sets forth a time period in which intervening action may negate the cancellation, the cancellation shall not become effective until the expiration of the time period” (Nationwide Ins. Co. v Pennsylvania Ins. Dept., 779 A2d 14, 17 [Pa Cmmw 2001]; see Donegal Mut. Ins. Co. v Pennsylvania Dept. of Ins., 694 A2d 391 [Pa Cmmw 1997]; see also 40 P.S. § 991.2006). Inasmuch as defendant failed to attach a copy of the insurance policy, or the declaration page of the policy, to its motion papers, it is impossible to determine whether the notice of cancellation was mailed to the insured “at the address shown in the policy” (40 P.S. § 991.2006). Consequently, defendant failed to establish as a matter of law that the insurance policy had been properly cancelled as of May 12, 2011 in accordance with [*2]Pennsylvania law and that, therefore, no coverage existed when the accident in question occurred on May 19, 2011.

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.

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


Decision Date: December 14, 2015Matter of Allstate Prop. & Cas. Ins. Co. v New Way Massage Therapy P.C. (2015 NY Slip Op 09184)

Reported in New York Official Reports at Matter of Allstate Prop. & Cas. Ins. Co. v New Way Massage Therapy P.C. (2015 NY Slip Op 09184)

Matter of Allstate Prop. & Cas. Ins. Co. v New Way Massage Therapy P.C.
2015 NY Slip Op 09184 [134 AD3d 495]
December 10, 2015
Appellate Division, First Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, February 10, 2016

[*1]

 In the Matter of Allstate Property and Casualty Insurance Company, Appellant,
v
New Way Massage Therapy P.C., as Assignee of Nancy Febus, Respondent.

Bruno, Gerbino & Soriano, LLP, Melville (Mitchell L. Kaufman of counsel), for appellant.

The Geller Law Group, P.C., Brooklyn (Abraham J. Meir of counsel), for respondent.

Order, Supreme Court, New York County (Cynthia S. Kern, J.), entered on or about April 2, 2014, which denied the petition to vacate the award of the master arbitrator, and confirmed the award, unanimously affirmed, with costs.

Whether or not the fee-sharing arrangement at issue constitutes unprofessional conduct (see 8 NYCRR 29.1 [b] [4]), it does not constitute a defense to a no-fault action (compare State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313, 319 [2005] [“insurance carriers may withhold payment for medical services provided by fraudulently incorporated enterprises to which patients have assigned their claims”]). It is solely a matter for the appropriate state licensing board (see e.g. Necula v Glass, 231 AD2d 457 [1st Dept 1996]; see also H & H Chiropractic Servs., P.C. v Metropolitan Prop. & Cas. Ins. Co., 47 Misc 3d 1075, 1078 [Civ Ct, Queens County 2015]). Concur—Mazzarelli, J.P., Richter, Manzanet-Daniels and Kapnick, JJ. [Prior Case History: 2014 NY Slip Op 30874(U).]

Parkview Med. Advanced, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51873(U))

Reported in New York Official Reports at Parkview Med. Advanced, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51873(U))

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

Parkview Medical Advanced, P.C. as Assignee of Allen Haynes, Respondent,

against

Travelers Insurance Company, Appellant.

Appeal from a judgment of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered March 26, 2014. The judgment, entered pursuant to an order entered March 12, 2014 granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment dismissing the complaint, awarded plaintiff the principal sum of $3,939.10.

ORDERED that the judgment is reversed, with $30 costs, so much of the order entered March 12, 2014 as granted the branches of plaintiff’s motion seeking summary judgment on the first through seventh and the ninth causes of action of the complaint and denied the branches of defendant’s cross motion seeking summary judgment dismissing those causes of action is vacated, those branches of plaintiff’s motion are denied, those branches of defendant’s cross motion are granted, and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the first through seventh and the ninth causes of action and in favor of plaintiff on the eighth cause of action, following a calculation of statutory interest and an assessment of attorney’s fees thereon.

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 the action is premature inasmuch as plaintiff had failed to provide requested additional verification of the claims in question. By order entered March 12, 2014, the Civil Court granted plaintiff’s motion and denied defendant’s unopposed cross motion. Defendant appeals from a judgment entered March 26, 2014 pursuant to the March 12, 2014 order.

Inasmuch as defendant raises no issue with respect to plaintiff’s prima facie case, we do not pass upon the propriety of the Civil Court’s determination with respect thereto.

The affidavits of defendant’s claim representative and mail center employee established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) its requests and follow-up requests for additional verification of the claims, with the exception of the claim for $121.18, upon which the eighth cause of action of the complaint was based. As to the first through seventh and the ninth causes of action, defendant demonstrated that it had not received the requested verification, and plaintiff did not oppose defendant’s cross motion. Consequently, the 30-day period within which defendant was [*2]required to pay or deny the claims on those causes of action did not begin to run (see 11 NYCRR § 65-3.8 [a]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]; Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 [2004]; D & R Med. Supply v American Tr. Ins. Co., 32 Misc 3d 144[A], 2011 NY Slip Op 51727[U] [App Term, 2d, 11th & 13th Jud Dists 2011]), and, thus, the first through seventh and the ninth causes of action are premature.

Accordingly, the judgment is reversed, so much of the order entered March 12, 2014 as granted the branches of plaintiff’s motion seeking summary judgment on the first through seventh and the ninth causes of action of the complaint and denied the branches of defendant’s cross motion seeking summary judgment dismissing those causes of action is vacated, those branches of plaintiff’s motion are denied, those branches of defendant’s cross motion are granted, and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the first through seventh and the ninth causes of action and in favor of plaintiff on the eighth cause of action, following a calculation of statutory interest and an assessment of attorney’s fees thereon pursuant to Insurance Law § 5106 and the regulations promulgated thereunder.

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


Decision Date: December 09, 2015