MRJA Radiology, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51381(U))

Reported in New York Official Reports at MRJA Radiology, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51381(U))

MRJA Radiology, P.C., a/a/o Jonathan Scarlett, Plaintiff-Respondent,

against

Praetorian Insurance Company, Defendant-Appellant.

Defendant appeals from an order the Civil Court of the City of New York, Bronx County (Gerald Lebovits, J.), entered July 17, 2014, which, upon reargument, adhered to its prior order entered November 4, 2013 (same court and Judge), denying defendant’s motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Gerald Lebovits, J.), entered July 17, 2014, reversed, with $10 costs, motion granted and complaint dismissed. The Clerk is directed to enter judgment accordingly.

Defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the plaintiff-provider’s claim for first-party no-fault benefits by establishing that it timely and properly mailed the notices for independent medical examinations (IMEs) to plaintiff’s assignor and his attorney, and that the assignor failed to appear (see American Tr. Ins. Co. v Lucas, 111 AD3d 423 [2013]; American Tr. Ins. Co. v Solorzano, 108 AD3d 449 [2013]). Contrary to Civil Court’s determination, defendant submitted competent evidence of the assignor’s nonappearance in the form of an affirmation of the scheduled examining physician and a sworn affidavit of an employee of defendant’s third-party IME scheduler, setting forth facts sufficient to demonstrate the affiants’ personal knowledge of the assignor’s repeated failures to appear for the IMEs and the office practices and policies when an assignor fails to appear for a scheduled IME (see American Tr. Ins. Co. v Lucas, 111 AD3d at 424; Harmonic Physical Therapy v Encompass Home and Auto Ins. Co. 47 Misc 3d 146[A], 2015 NY Slip Op 50733[U][App Term, 1st Dept 2015]).

In opposition, plaintiff did not specifically deny the assignor’s nonappearance or otherwise raise a triable issue with respect thereto, or as to the mailing or reasonableness of the underlying notices (see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 [2011], lv denied 17 NY3d 705 [2011]). “Accordingly, when [plaintiff’s] assignor[] failed to appear for the requested medical exams, [defendant] had the right to deny all claims retroactively to the date of loss, regardless of whether the denials were timely issued” (American Tr. Ins. Co. v Lucas, 111 AD3d at 424), and even though defendant initially denied [*2]the claims on different grounds (see Unitrin, 82 AD3d at 560).

The order purporting to deny defendant’s motion to reargue addressed the merits and, in doing so, in effect, granted defendant’s motion and, therefore, the appeal taken therefrom is properly before this Court (see Jackson v Leung, 99 AD3d 489, 490 [2012]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.


I concur I concur I concur
Decision Date: September 29, 2015
T & J Chiropractic, P.C. v MVAIC (2015 NY Slip Op 51445(U))

Reported in New York Official Reports at T & J Chiropractic, P.C. v MVAIC (2015 NY Slip Op 51445(U))

[*1]
T & J Chiropractic, P.C. v MVAIC
2015 NY Slip Op 51445(U) [49 Misc 3d 132(A)]
Decided on September 28, 2015
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected in part through October 6, 2015; it will not be published in the printed Official Reports.


Decided on September 28, 2015
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-692 Q C

T & J Chiropractic, P.C. as Assignee of Orlando St. Paul, Appellant,

against

MVAIC, Respondent.


Appeal from an order of the Civil Court of the City of New York, Queens County (Larry Love, J.), entered March 7, 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; and it is further,

ORDERED that, on the court’s own motion, counsel for the respective parties are directed to show cause why an order should or should not be made and entered imposing such sanctions and costs, if any, against plaintiff’s counsel pursuant to Rules of the Chief Administrator of the Courts (22 NYCRR) § 130-1.1 (c) as this court may deem appropriate, by each filing an affidavit or affirmation on that issue in the office of the clerk of this court and serving one copy of same on each other on or before October 15, 2015; and it is further,

ORDERED that the clerk of this court, or his designee, is directed to serve a copy of this decision and order to show cause by regular mail upon counsel for the respective parties.

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 the cross motion by defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) for summary judgment dismissing the complaint.

Since plaintiff and its assignor were aware of the identity of the owner of the vehicle which had struck the assignor, plaintiff, as assignee, was required to exhaust its remedies against the vehicle’s owner before seeking relief from MVAIC (Hauswirth v American Home Assur. Co., 244 AD2d 528 [1997]; Modern Art Med., P.C. v MVAIC, 22 Misc 3d 126[A], 2008 NY Slip Op 52586[U] [App Term, 2d & 11th Jud Dists 2008]; Doctor Liliya Med., P.C. v MVAIC, 21 Misc 3d 143[A], 2008 NY Slip Op 52453[U] [App Term, 2d & 11th Jud Dists 2008]). Here, plaintiff did not demonstrate that it had exhausted its remedies against the owner of the vehicle.

We conclude that sanctions may be warranted for the conduct of counsel for plaintiff, as that conduct appears to be frivolous (see Gihon, LLC v 501 Second St., LLC, 103 AD3d 840 [2013]; Martin v Burns, 77 AD3d 633, 635 [2010]). As relevant here, frivolous conduct includes the assertion of arguments that are “completely without merit in law and [which] cannot be supported by a reasonable argument for an extension, modification or reversal of existing law” (Rules of the Chief Administrator of the Courts [22 NYCRR] § 130-1.1 [c] [1]), and the assertion of “material factual statements that are false” in the brief filed by counsel on behalf of [*2]plaintiff (Rules of the Chief Administrator of the Courts [22 NYCRR] § 130-1.1 [c] [3]; see Korbel v Zoning Bd. of Appeals of Town of Horicon, 28 AD3d 888, 889-890 [2006]).

Counsel for plaintiff asserts in the appellant’s brief submitted to this court that:

“To the extent Defendant proffered a purported police report, within Exhibit F’ to its motion, same was inadmissible. In particular, the document was not certified. Moreover, Defendant did not proffer an affidavit to set forth a foundation for its admissibility, authenticity or accuracy.”

However, a review of the record reveals that the affirmation of defendant’s counsel states “A copy of the certified Police Accident Report is annexed hereto as Exhibit F’.” In addition, each page of the police report annexed to defendant’s motion at Exhibit “F” bears a stamp which states “This is to certify that this document is a true and complete copy of a record on file in the New York State Department of Motor Vehicles, Albany, New York” and the signature of the Commissioner of Motor Vehicles is stamped onto each page as well.

Accordingly, we direct counsel for the respective parties to show cause why sanctions should or should not be imposed against plaintiff’s counsel (see Martin v Burns, 77 AD3d at 635).

In light of the foregoing, the order is affirmed.

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


Decision Date: September 28, 2015Ultimate Health Prods., Inc. v MVAIC (2015 NY Slip Op 51446(U))

Reported in New York Official Reports at Ultimate Health Prods., Inc. v MVAIC (2015 NY Slip Op 51446(U))

[*1]
Ultimate Health Prods., Inc. v MVAIC
2015 NY Slip Op 51446(U) [49 Misc 3d 132(A)]
Decided on September 28, 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 September 28, 2015
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-1282 Q C

Ultimate Health Products, Inc. as Assignee of Nicole Toussaint, Appellant,

against

MVAIC, Respondent.


Appeal from an order of the Civil Court of the City of New York, Queens County (Larry Love, J.), entered April 15, 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; and it is further,

ORDERED that, on the court’s own motion, counsel for the respective parties are directed to show cause why an order should or should not be made and entered imposing such sanctions and costs, if any, against plaintiff’s counsel pursuant to Rules of the Chief Administrator of the Courts (22 NYCRR) § 130-1.1 (c) as this court may deem appropriate, by each filing an affidavit or affirmation on that issue in the office of the clerk of this court and serving one copy of same on each other on or before October 15, 2015; and it is further,

ORDERED that the clerk of this court, or his designee, is directed to serve a copy of this decision and order to show cause by regular mail upon counsel for the respective parties.

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 the cross motion by defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) for summary judgment dismissing the complaint.

Since plaintiff and its assignor were aware of the identity of the owner of the vehicle in which the assignor had been a passenger at the time of the accident, plaintiff, as assignee, was required to exhaust its remedies against the vehicle’s owner before seeking relief from MVAIC (Hauswirth v American Home Assur. Co., 244 AD2d 528 [1997]; Modern Art Med., P.C. v MVAIC, 22 Misc 3d 126[A], 2008 NY Slip Op 52586[U] [App Term, 2d & 11th Jud Dists 2008]; Doctor Liliya Med., P.C. v MVAIC, 21 Misc 3d 143[A], 2008 NY Slip Op 52453[U] [App Term, 2d & 11th Jud Dists 2008]). Here, plaintiff did not demonstrate that it had exhausted its remedies against the owner of the vehicle.

We conclude that sanctions may be warranted for the conduct of counsel for plaintiff, as that conduct appears to be frivolous (see Gihon, LLC v 501 Second St., LLC, 103 AD3d 840 [2013]; Martin v Burns, 77 AD3d 633, 635 [2010]). As relevant here, frivolous conduct includes the assertion of arguments that are “completely without merit in law and [which] cannot be supported by a reasonable argument for an extension, modification or reversal of existing law” (Rules of the Chief Administrator of the Courts [22 NYCRR] § 130-1.1 [c] [1]), and the [*2]assertion of “material factual statements that are false” in the brief filed by counsel on behalf of plaintiff (Rules of the Chief Administrator of the Courts [22 NYCRR] § 130-1.1 [c] [3]; see Korbel v Zoning Bd. of Appeals of Town of Horicon, 28 AD3d 888, 889-890 [2006]).

Counsel for plaintiff asserts in the appellant’s brief submitted to this court that:

“To the extent Defendant proffered a purported police report, within Exhibit G’ to its motion, same was inadmissible. In particular, the document was not certified. Moreover, Defendant did not proffer an affidavit to set forth a foundation for its admissibility, authenticity or accuracy.”

However, a review of the record reveals that the affirmation of defendant’s counsel states that “A copy of the certified Police Accident Report is annexed hereto as Exhibit G’.” In addition, each page of the police report annexed to defendant’s motion at Exhibit “G” bears a stamp which states “This is to certify that this document is a true and complete copy of a record on,” although the remainder of the sentence does not appear on the photocopy of Exhibit “G” in the record on appeal. Exhibit “G” also contains a stamped signature of Barbara J. Fiala, but her title as Commissioner of Motor Vehicles does not appear on the photocopy of Exhibit “G” in the record on appeal. Moreover, the appellant’s brief further asserts that the transcript of the examination under oath of plaintiff’s assignor did not demonstrate the existence of potential insurance coverage because it was not in admissible form as it was “unsigned and unsworn.” In fact, the transcript states, at the beginning and at the end, directly above the court reporter’s signature, that plaintiff’s assignor was duly sworn by a notary public.

Accordingly, we direct counsel for the respective parties to show cause why sanctions should or should not be imposed against plaintiff’s counsel (see Martin v Burns, 77 AD3d at 635).

In light of the foregoing, the order is affirmed.

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


Decision Date: September 28, 2015Compas Med., P.C. v Fiduciary Ins. Co. of Am. (2015 NY Slip Op 51472(U))

Reported in New York Official Reports at Compas Med., P.C. v Fiduciary Ins. Co. of Am. (2015 NY Slip Op 51472(U))

[*1]
Compas Med., P.C. v Fiduciary Ins. Co. of Am.
2015 NY Slip Op 51472(U) [49 Misc 3d 134(A)]
Decided on September 17, 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 September 17, 2015

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


PRESENT: PESCE, P.J., WESTON and ELLIOT, JJ.
2013-1128 K C
Compas Medical, P.C. as Assignee of Clarence Dupiton, Appellant,

against

Fiduciary Insurance Company of America, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Pamela L. Fisher, J.), entered February 8, 2013. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment.

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 denied plaintiff’s motion for summary judgment.

Because plaintiff failed to establish either that defendant had failed to deny the claim within the requisite 30-day period (see Insurance Law § 5106 [a]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d, 11th & 13th Jud Dists 2011]), plaintiff failed to demonstrate its prima facie entitlement to summary judgment. In view of the foregoing, we need not reach plaintiff’s remaining contentions.

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

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


Decision Date: September 17, 2015
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51467(U))

Reported in New York Official Reports at Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51467(U))

[*1]
Compas Med., P.C. v Praetorian Ins. Co.
2015 NY Slip Op 51467(U) [49 Misc 3d 134(A)]
Decided on September 17, 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 September 17, 2015

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


PRESENT: PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-726 Q C
Compas Medical, P.C. as Assignee of Phillip Owasu-Afrique, Appellant,

against

Praetorian Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered February 19, 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. The Civil Court denied plaintiff’s motion, granted the branch of defendant’s cross motion seeking summary judgment dismissing plaintiff’s third cause of action as premature because plaintiff had failed to provide requested verification, and granted the branches of defendant’s cross motion seeking summary judgment dismissing the remaining causes of action due to the failure of plaintiff’s assignor to appear for independent medical examinations (IMEs) and examinations under oath (EUOs).

In support of the branch of defendant’s cross motion seeking summary judgment dismissing plaintiff’s third cause of action, defendant submitted an affidavit by its claims examiner which established that defendant had timely mailed its verification request and follow-up verification request (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 demonstrated prima facie that it had not received the requested verification and thus that plaintiff’s third cause of action is premature (see 11 NYCRR 65-3.8 [a]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]). As plaintiff failed to raise a triable issue of fact, the Civil Court properly granted the branch of defendant’s cross motion seeking summary judgment dismissing this cause of action.

Contrary to plaintiff’s contention, defendant established that the IME and EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16), that plaintiff’s assignor had failed to appear for the duly scheduled IMEs and EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]), and that defendant had timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; Delta [*2]Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16) the claims underlying the remaining causes of action on that ground. Since defendant demonstrated that plaintiff’s assignor had failed to comply with a condition precedent to coverage (Stephen Fogel Psychological, P.C., 35 AD3d at 722) and plaintiff failed to raise a triable issue of fact, defendant was entitled to summary judgment dismissing the remaining causes of action.

Accordingly, the order is affirmed.

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


Decision Date: September 17, 2015
Healing Art Acupuncture, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51465(U))

Reported in New York Official Reports at Healing Art Acupuncture, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51465(U))

[*1]
Healing Art Acupuncture, P.C. v Country Wide Ins. Co.
2015 NY Slip Op 51465(U) [49 Misc 3d 134(A)]
Decided on September 17, 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 September 17, 2015

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


PRESENT: PESCE, P.J., WESTON and ELLIOT, JJ.
2013-594 K C
Healing Art Acupuncture, P.C. as Assignee of Jose Reyes, Appellant,

against

Country Wide Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered December 21, 2012. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is modified by providing that the branch of defendant’s motion seeking summary judgment dismissing the first cause of action 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, defendant moved for summary judgment dismissing the complaint on the ground that defendant had timely and properly denied plaintiff’s claims at issue based on the failure of plaintiff’s assignor to appear for duly scheduled independent medical examinations (IMEs). The Civil Court granted defendant’s motion.

With respect to the branches of defendant’s motion seeking summary judgment dismissing the second through seventh causes of action, the evidence submitted by defendant was sufficient to demonstrate that the denial of claim forms as well as the IME scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), and that plaintiff’s assignor had failed to appear for the 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 granted those branches of defendant’s motion.

As to the first cause of action, the record shows that defendant failed to establish, as a matter of law, that it had timely denied the claim. Thus, the branch of defendant’s motion seeking summary judgment dismissing the first cause of action should have been denied.

Plaintiff’s remaining contentions are not properly before this court, as these arguments are being raised for the first time on appeal, and we decline to consider them (see Joe v Upper Room Ministries, Inc., 88 AD3d 963 [2011]; Gulf Ins. Co. v Kanen, 13 AD3d 579 [2004]).

Accordingly, the order is modified by providing that the branch of defendant’s motion seeking summary judgment dismissing the first cause of action is denied.

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


Decision Date: September 17, 2015
New Way Med. Supply Corp. v Company (2015 NY Slip Op 51461(U))

Reported in New York Official Reports at New Way Med. Supply Corp. v Company (2015 NY Slip Op 51461(U))

[*1]
New Way Med. Supply Corp. v Country Wide Ins. Co.
2015 NY Slip Op 51461(U) [49 Misc 3d 133(A)]
Decided on September 17, 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 September 17, 2015

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


PRESENT: PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-496 Q C
New Way Medical Supply Corp. as Assignee of Darrel Drechatte, Respondent,

against

Country Wide Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered January 31, 2013, deemed from a judgment of the same court entered February 15, 2013 (see CPLR 5501 [c]). The judgment, entered pursuant to the January 13, 2013 order granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment dismissing the complaint, awarded plaintiff the principal sum of $1,991.99.

ORDERED that the judgment is reversed, with $30 costs, the order entered January 13, 2013 is vacated, plaintiff’s motion for summary judgment is denied and defendant’s cross 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 entered January 13, 2013, which granted plaintiff’s motion for summary judgment and denied defendant’s cross motion for summary judgment dismissing the complaint. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

Defendant submitted sufficient proof to show that the independent medical examination (IME) scheduling letters and the denial of claim forms, which denied the claims on the ground that plaintiff’s assignor had failed to appear for duly scheduled IMEs, 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]). Defendant further demonstrated that plaintiff’s assignor had not appeared for the duly scheduled IMEs and, thus, that plaintiff’s assignor had failed to comply with a condition precedent to coverage (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). As plaintiff failed to raise a triable issue of fact, plaintiff’s motion should have been denied and defendant’s cross motion should have been granted.

Accordingly, the judgment is reversed, the order entered January 13, 2013 is vacated, plaintiff’s motion for summary judgment is denied and defendant’s cross motion for summary judgment dismissing the complaint is granted.

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


Decision Date: September 17, 2015
Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51419(U))

Reported in New York Official Reports at Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51419(U))

[*1]
Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co.
2015 NY Slip Op 51419(U) [49 Misc 3d 130(A)]
Decided on September 17, 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 September 17, 2015

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


PRESENT: PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-50 K C
Metro Health Products, Inc. as Assignee of Nuraldin Whetstone, Appellant,

against

State Farm Mutual Automobile Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Ingrid Joseph, J.), entered November 15, 2012. The order granted defendant’s 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 appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint. The Civil Court found that defendant had timely and properly denied the claims at issue on the ground that plaintiff had failed to comply with a condition precedent to coverage, in that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). On appeal, plaintiff argues that defendant failed to prove that it had mailed its EUO scheduling letters and denial of claim forms, or that plaintiff had failed to appear for the EUOs; that defendant lacked justification for its EUO requests; that defendant’s motion should have been denied pursuant to CPLR 3212 (f), as plaintiff had not received discovery regarding the reasonableness of defendant’s EUO requests; and that defendant failed to prove that plaintiff willfully obstructed defendant’s investigation.

Contrary to plaintiff’s arguments, the affidavits submitted by defendant established that the EUO scheduling letters and the denial of claim forms had been timely mailed in accordance with defendant’s standard office 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]), and the affirmation submitted by defendant’s attorney, who was present in his office to conduct the EUO of plaintiff on the scheduled dates, was sufficient to establish that plaintiff had failed to appear. Furthermore, since plaintiff does not claim to have responded in any way to the EUO requests, its objections regarding the EUO requests will not now be heard (see Viviane Etienne Med. Care, P.C. v State Farm Mut. Auto. Ins. Co., 35 Misc 3d 127[A], 2012 NY Slip Op 50579[U] [App Term, 2d, 11th & 13th Jud Dists 2012]; Crescent Radiology, PLLC v American Tr. Ins. Co., 31 Misc 3d 134[A], 2011 NY Slip Op 50622[U] [App Term, 9th & 10th Jud Dists 2011]). Consequently, discovery relevant to the reasonableness of the EUO requests was not necessary for plaintiff to oppose defendant’s motion (see CPLR 3212 [f]). To the extent plaintiff asserts [*2]that defendant did not demonstrate that plaintiff’s failure to cooperate was willful, defendant complied with the regulations (see 11 NYCRR 65) and there is no requirement to establish willfulness (see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559 [2011]).

Accordingly, the order is affirmed.

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


Decision Date: September 17, 2015
Sunlight Med. Care, P.C. v Esurance Ins. Co. (2015 NY Slip Op 51410(U))

Reported in New York Official Reports at Sunlight Med. Care, P.C. v Esurance Ins. Co. (2015 NY Slip Op 51410(U))

[*1]
Sunlight Med. Care, P.C. v Esurance Ins. Co.
2015 NY Slip Op 51410(U) [49 Misc 3d 130(A)]
Decided on September 16, 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 September 16, 2015

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


PRESENT: PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-1490 Q C
Sunlight Medical Care, P.C. as Assignee of Jazmin Ford-Campbell, Appellant,

against

Esurance Insurance Company and Jazmin Ford-Campbell, Respondents.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered June 14, 2013. The order denied plaintiff’s motion for summary judgment and granted a cross motion by defendant Esurance Insurance Company for summary judgment dismissing so much of the complaint as was asserted against it.

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

In this action by a provider to, among other things, recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant Esurance Insurance Company (Esurance) cross-moved for summary judgment dismissing so much of the complaint as was asserted against it, arguing that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs). The Civil Court denied plaintiff’s motion and granted Esurance’s cross motion.

Plaintiff’s sole argument on appeal is that Esurance mailed the EUO scheduling letters to the wrong address, and therefore that plaintiff’s motion should have been granted and Esurance’s cross motion denied. However, the record demonstrates conclusively that Esurance mailed the letters to the address provided by plaintiff on its bills and by plaintiff’s assignor on both her prescribed application for no-fault benefits (NF-2) and her signed assignment of benefits. Thus, plaintiff has not demonstrated that Esurance did not give the assignor proper notice of the EUOs. Consequently, the branch of plaintiff’s motion seeking summary judgment against Esurance was properly denied and Esurance’s cross motion for summary judgment dismissing so much of the complaint as was asserted against it was properly granted.

While plaintiff argues on appeal that the branch of its motion seeking summary judgment against its assignor should have been granted, it offers no reasoning in support of its argument. We note, however, that while plaintiff purports to sue its assignor pursuant to the assignment it received from the assignor, such a cause of action is based upon plaintiff’s own alleged rights against its assignor, and is not properly based upon the assignment.

Accordingly, the order is affirmed.

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


Decision Date: September 16, 2015
Advanced Chiropractic of NY, P.C. v Chubb Indem. Ins. Co. (2015 NY Slip Op 51409(U))

Reported in New York Official Reports at Advanced Chiropractic of NY, P.C. v Chubb Indem. Ins. Co. (2015 NY Slip Op 51409(U))

[*1]
Advanced Chiropractic of NY, P.C. v Chubb Indem. Ins. Co.
2015 NY Slip Op 51409(U) [49 Misc 3d 129(A)]
Decided on September 16, 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 September 16, 2015

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


PRESENT: PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-1125 K C
Advanced Chiropractic of New York, P.C. as Assignee of Marvins Laguerre, Respondent,

against

Chubb Indemnity Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered January 16, 2013. The order denied defendant’s 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, defendant appeals from an order of the Civil Court which denied defendant’s motion for summary judgment dismissing the complaint.

The affidavit by defendant’s claims adjuster was sufficient to establish that defendant did not receive the claims at issue. However, as the affidavit by plaintiff’s billing manager demonstrated that the claim forms had been mailed to defendant, there is an issue of fact as to whether defendant’s time to pay or deny these claims ever began to run (see Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59 [App Term, 2d, 11th & 13th Jud Dists 2014]; cf. Bright Med. Supply Co. v Tri State Consumer Ins. Co., 40 Misc 3d 130[A], 2013 NY Slip Op 51122[U] [App Term, 2d, 11th & 13th Jud Dists 2013]). Consequently, the Civil Court properly denied defendant’s motion for summary judgment dismissing the complaint.

Accordingly, the order is affirmed.

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


Decision Date: September 16, 2015