Reported in New York Official Reports at Ema Acupuncture, P.C. v Geico Ins. Co. (2014 NY Slip Op 50415(U))
| Ema Acupuncture, P.C. v Geico Ins. Co. |
| 2014 NY Slip Op 50415(U) [42 Misc 3d 150(A)] |
| Decided on March 11, 2014 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2012-369 K C.
against
Geico Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered December 20, 2011. The order granted plaintiff’s motion for summary judgment and denied defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order is modified by providing that the branch of plaintiff’s motion seeking summary judgment on so much of the complaint as sought to recover the sum of $154.29 for the initial acupuncture visit on January 6, 2009 is granted and plaintiff’s motion is otherwise denied, and by further providing that the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the remaining claims are granted; 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, and defendant cross-moved for summary judgment dismissing the complaint, arguing that it had properly used the workers’ compensation fee schedule applicable to chiropractors who render the same services as acupuncturists to reimburse plaintiff for the acupuncture services plaintiff had rendered. The Civil Court granted plaintiff’s motion and denied defendant’s cross motion.
Contrary to defendant’s contention, the affidavit submitted by plaintiff’s owner was sufficient to establish plaintiff’s prima facie entitlement to summary judgment (see 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]).
Defendant did not raise any issue warranting the dismissal of plaintiff’s claim for $154.29 for the initial acupuncture visit on January 6, 2009, billed for under fee schedule treatment code 99205 (cf. Rogy Medical, P.C. v Mercury Cas. Co., 23 Misc 3d 132[A], 2009 NY Slip Op 50732[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). Accordingly, we do not disturb so much of the order appealed from as granted the branch of plaintiff’s motion seeking summary judgment on so much of the complaint as sought to recover upon this claim, and which denied defendant’s cross motion insofar as it sought summary judgment dismissing that portion of the complaint. Defendant’s contention that plaintiff is barred from recovering attorney’s fees with respect thereto pursuant to Insurance Department Regulations (11 NYCRR) § 65-4.6 (i) lacks merit.
As to plaintiff’s remaining claims, defendant demonstrated that it had fully paid plaintiff for those services in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d, 11th & 13th Jud Dists 2009]). In opposition, plaintiff relied upon an affirmation from plaintiff’s counsel which failed to establish the existence of a triable issue of [*2]fact.
Accordingly, the order is modified by providing that the branch of plaintiff’s motion seeking summary judgment on so much of the complaint as sought to recover the sum of $154.29 for the initial acupuncture visit on January 6, 2009 is granted and plaintiff’s motion is otherwise denied, and by further providing that the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the remaining claims are granted; as so modified, the order is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: March 11, 2014
Reported in New York Official Reports at Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50413(U))
| Clinton Place Med., P.C. v New York Cent. Mut. Fire Ins. Co. |
| 2014 NY Slip Op 50413(U) [42 Misc 3d 150(A)] |
| Decided on March 11, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
.
against
New York Central Mutual Fire Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County (Maureen A. Healy, J.), entered November 23, 2011. The order, insofar as appealed from, denied defendant’s motion for summary judgment, granted the branches of plaintiff’s cross motion seeking summary judgment upon the third, fourth, sixth and seventh causes of action, and found that the only triable issue of fact for trial with respect to the remaining first, second and fifth causes of action was whether defendant had timely mailed proper independent medical examination scheduling letters to plaintiff. So much of the appeal as is from the portion of the order which denied the branches of defendant’s motion seeking summary judgment dismissing the third, fourth, sixth and seventh causes of action, and granted the branches of plaintiff’s cross motion seeking summary judgment upon those causes of action, is deemed to be from a judgment of the same court entered December 23, 2011 awarding plaintiff the principal sum of $1,255.33 (see CPLR 5512 [a]).
ORDERED that the judgment is affirmed, without costs; and it is further,
ORDERED that the order, insofar as reviewed on direct appeal, is reversed, without costs, and the branches of defendant’s motion seeking summary judgment dismissing plaintiff’s first, second and fifth causes of action are granted.
In this action by a provider to recover assigned first-party no-fault benefits,
defendant appeals from so much of an order of the Civil Court entered November
23, 2011 as denied defendant’s motion for summary judgment, granted the branches of
plaintiff’s cross motion seeking summary judgment upon the third, fourth, sixth and
seventh causes of action, and found that the only issue of fact for trial with respect to the
remaining first, second and fifth causes of action was whether defendant had timely
mailed proper independent medical examination (IME) scheduling letters to plaintiff. A
judgment was subsequently entered pursuant to the order, awarding plaintiff the principal
sum of $1,255.33.
In support of its motion, defendant submitted an affidavit from an employee of the company that had been retained by defendant to schedule the IMEs. The affidavit established that the IME scheduling letters had been timely mailed to plaintiff’s assignor in accordance with the company’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]). Contrary to the Civil Court’s order, it was not necessary to mail the scheduling letters to plaintiff (see Insurance Department Regulations [11 NYCRR] §§ 65-3.5 [b], [c] 65-3.6 [b]). Since plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, the branches of defendant’s motion seeking summary judgment dismissing plaintiff’s first, second and fifth causes of action should have been granted (see Insurance Department Regulations [11 NYCRR] § 65-1.1; Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]).
With respect to the claims at issue in plaintiff’s third, fourth, sixth and seventh causes [*2]action, defendant failed to show that it had denied the underlying claims or to otherwise raise a triable issue of fact. To the extent that defendant argues that it is nevertheless entitled to summary judgment upon these claims, defendant is mistaken, as defendant’s defense, based upon the assignor’s failure to appear for IMEs, is subject to preclusion if defendant failed to timely deny these claims (see Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 [2d Dept 2009], lv denied 13 NY3d 714 [2009] see also Eastern Star Acupuncture, P.C. v American Tr. Ins. Co., 33 Misc 3d 141[A], 2011 NY Slip Op 52205[U] [App Term, 2d, 11th & 13th Jud Dists 2011] but see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559 [1st Dept 2011], lv denied 17 NY3d 705 [2011]). As a result, there is no basis to disturb the judgment entered upon plaintiff’s third, fourth, sixth and seventh causes action.
Accordingly, the judgment is affirmed, and the order, insofar as reviewed on direct appeal, is reversed and the branches of defendant’s motion seeking summary judgment dismissing plaintiff’s first, second and fifth causes of action are granted.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: March 11, 2014
Reported in New York Official Reports at Martin Plutno v Travelers Ins. Co. (2014 NY Slip Op 50412(U))
| Martin Plutno v Travelers Ins. Co. |
| 2014 NY Slip Op 50412(U) [42 Misc 3d 150(A)] |
| Decided on March 11, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2012-130 Q C.
against
Travelers Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Genine D. Edwards, J.), entered December 15, 2010. The order granted defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order is modified by providing that defendant’s motion for summary judgment dismissing the complaint is granted only with respect to so much of the complaint as sought to recover upon the unpaid portion of the claim for dates of service August 3, 2007 through August 25, 2007; 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 granted defendant’s motion for summary judgment.
Contrary to plaintiff’s contention, the affidavits submitted in support of defendant’s motion for summary judgment were sufficient to establish that defendant had timely denied (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]) plaintiff’s claims either pursuant to the workers’ compensation fee schedule or on the ground of lack of medical necessity. The affidavit submitted by defendant’s employee established that, as to plaintiff’s claim for dates of service August 3, 2007 through August 25, 2007 seeking the sum of $235.90, defendant had paid $134.80 thereof and had denied the remaining $101.10 on the ground that the amount billed by plaintiff exceeded the fees allowed by the workers’ compensation fee schedule. With respect to plaintiff’s remaining claims, defendant submitted a sworn statement by the chiropractor who had performed an independent medical examination (IME), which set forth a factual basis and medical rationale for the chiropractor’s conclusion that there was a lack of medical necessity for further treatment. In view of the foregoing, defendant made a prima facie showing of its entitlement to summary judgment dismissing the complaint.
In opposition to defendant’s motion, plaintiff failed to raise a triable issue of fact with regard to the unpaid portion of the claim for dates of service August 3, 2007— August 25, 2007. Thus, defendant is entitled to summary judgment with respect thereto. However, plaintiff did submit, among other things, a letter of medical necessity sworn to by plaintiff’s treating chiropractor, which was sufficient to raise a triable issue of fact as to the medical necessity of the services rendered (see Zuckerman v City of New York, 49 NY2d 557 [1980] Quality Psychological Servs., P.C. v Mercury Ins. Group, 27 Misc 3d 129[A], 2010 NY Slip Op 50601[U] [App Term, 2d, 11th & 13th Dists 2010]).
Accordingly, the order is modified by providing that defendant’s motion for summary judgment dismissing the complaint is granted only with respect to so much of the complaint as sought to recover upon the unpaid portion of the claim for dates of service August 3, 2007 [*2]through August 25, 2007.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: March 11, 2014
Reported in New York Official Reports at Eagle Surgical Supply, Inc. v Allstate Prop. & Cas. Ins. Co. (2014 NY Slip Op 50411(U))
| Eagle Surgical Supply, Inc. v Allstate Prop. & Cas. Ins. Co. |
| 2014 NY Slip Op 50411(U) [42 Misc 3d 149(A)] |
| Decided on March 11, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2012-124 Q C.
against
Allstate Property & Casualty Insurance Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered November 17, 2011, deemed from a judgment of the same court entered December 14, 2011 (see CPLR 5501 [c]). The judgment, entered pursuant to the November 17, 2011 order granting defendant’s motion for summary judgment, dismissed the complaint.
ORDERED that the judgment 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. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).
On appeal, plaintiff argues that the affidavits submitted by defendant failed to establish that defendant’s employees possessed sufficient personal knowledge to demonstrate that defendant’s denial of claim form had been timely mailed. This argument is improperly raised for the first time on appeal.
Plaintiff further argues that one of the affidavits submitted by defendant in order to prove that the denial of claim form had been timely mailed should not have been considered because it did not comply with CPLR 2309 (c). However, that argument is raised for the first time on appeal, and is therefore waived (see Mani Med., P.C. v NY Cent. Mut. Ins. Co., 19 Misc 3d 128[A], 2008 NY Slip Op 50508[U] [App Term, 2d & 11th Jud Dists 2008] Infinity Health Prods. Ltd. v State Farm Mut. Auto. Ins. Co., 16 Misc 3d 135[A], 2007 NY Slip Op 51611[U] [App Term, 2d & 11th Jud Dists 2007]). In any event, such defect is not fatal, as plaintiff was not prejudiced thereby (Matos v Salem Truck Leasing, 105 AD3d 916 [2013] Rivers v Birnbaum, 102 AD3d 26, 44 [2012]).
Accordingly, the judgment is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: March 11, 2014
Reported in New York Official Reports at VG Acupuncture, P.C. v Interboro Ins. Co. (2014 NY Slip Op 50410(U))
| VG Acupuncture, P.C. v Interboro Ins. Co. |
| 2014 NY Slip Op 50410(U) [42 Misc 3d 149(A)] |
| Decided on March 11, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-2994 K C.
against
Interboro Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Reginald A. Boddie, J.), entered October 20, 2011. The order denied plaintiff’s unopposed motion for leave to enter a default judgment.
ORDERED that the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved, pursuant to CPLR 3215, for leave to enter a default judgment based upon defendant’s failure to appear in the action or answer the complaint. The motion was unopposed. The Civil Court denied plaintiff’s motion, finding that plaintiff had not established its prima facie case.
Plaintiff’s moving papers failed to establish either that defendant failed to pay or deny the claim within the requisite 30-day period (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., ___ AD3d ___, 2013 NY Slip Op 08430 [2d Dept 2013]), or that defendant 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]). As a result, the order is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: March 11, 2014
Reported in New York Official Reports at Compas Med., P.C. v MVAIC (2014 NY Slip Op 50414(U))
[*1]| Compas Med., P.C. v MVAIC |
| 2014 NY Slip Op 50414(U) [42 Misc 3d 150(A)] |
| Decided on March 11, 2014 |
| 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. |
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
.
against
MVAIC, Appellant.
Appeal from a judgment of the Civil Court of the City of New York, Kings County
(Katherine A. Levine, J.), entered October 17, 2011. The judgment, after a nonjury trial,
awarded plaintiff the principal sum of $4,366.80.
ORDERED that the judgment is reversed, with $30 costs, and the matter is remitted to the Civil Court for the entry of judgment in favor of defendant dismissing the complaint.
In this action by a provider to recover assigned first-party no-fault benefits, the only issues to be decided at the trial were whether plaintiff’s assignor was a covered person and whether the assignor is eligible to receive first-party no-fault benefits pursuant to an insurance policy.
At the nonjury trial, the assignor’s notice of intention to make claim form was admitted into evidence and the sole witness was an employee of defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC). In the notice of intention to make claim form, the assignor stated that both vehicles involved in the accident were insured by named insurance companies.
Since plaintiff and its assignor were aware of the identity of the owner of the vehicle which plaintiff’s assignor was driving 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] Dr. Abakin, D.C., P.C. v MVAIC, 21 Misc 3d 134[A], 2008 NY Slip Op 52186[U] [App Term, 2d & 11th Jud Dists 2008] Complete Med. Servs. of NY, P.C. v MVAIC, 20 Misc 3d 137[A], 2008 NY Slip Op 51541[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.
Accordingly, the judgment is reversed and the matter is remitted to the Civil Court for the entry of judgment in favor of defendant dismissing the complaint.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: March 11, 2014Bay Ls Med. Supplies, Inc. v Mvaic (2014 NY Slip Op 50417(U))
Reported in New York Official Reports at Bay Ls Med. Supplies, Inc. v Mvaic (2014 NY Slip Op 50417(U))
[*1]| Bay Ls Med. Supplies, Inc. v Mvaic |
| 2014 NY Slip Op 50417(U) [42 Misc 3d 150(A)] |
| Decided on March 11, 2014 |
| 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. |
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2012-832 Q C.
against
MVAIC, Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County
(William A. Viscovich, J.), entered January 26, 2012, deemed from a judgment of the
same court entered March 15, 2012 (see CPLR 5501 [c]). The judgment, entered
pursuant to the January 26, 2012 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 $547.50.
ORDERED that the judgment is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) appeals from an order of the Civil Court 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]).
Since defendant raises no issue on appeal with regard to plaintiff’s establishment of its prima facie entitlement to summary judgment, we do not pass upon the propriety of the Civil Court’s implicit determination with respect thereto (see Insurance Law § 5106 [a] Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742 [2004]).
The record establishes that MVAIC’s letters scheduling independent medical examinations (IMEs) of plaintiff’s assignor were mailed more than 30 days after MVAIC had received the claim at issue. As a result, defendant is precluded from raising its proffered defense that plaintiff’s assignor’s failure to appear for duly scheduled IMEs constituted a failure to comply with a condition precedent to coverage (see Essential Acupuncture Servs., P.C. v Ameriprise Auto & Home Ins., 38 Misc 3d 130[A], 2012 NY Slip Op 52404[U] [App Term, 2d, 11th & 13th Jud Dists 2012]). In any event, the denial attached to MVAIC’s cross motion was a general denial, not a specific denial, as it did not set forth an amount of the bill, the date of the bill, or the supplies which were allegedly provided to plaintiff’s assignor. Thus, MVAIC failed to establish that it had issued a denial in response to the bill at issue (see Huntington Hosp. v New York Cent. Mut. Fire Ins. Co., 37 Misc 3d 141[A], 2012 NY Slip Op 52274[U] [App Term, 9th & 10th Jud Dists 2012]). Consequently, even if defendant had timely scheduled the IMEs, defendant failed to establish that it is not precluded from proffering its defense that plaintiff’s assignor failed to comply with a condition precedent to coverage (see Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 [2009]).
Accordingly, the judgment is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
[*2]
Decision Date: March 11,
2014Healing Art Acupuncture, P.C. v MVAIC (2014 NY Slip Op 50422(U))
Reported in New York Official Reports at Healing Art Acupuncture, P.C. v MVAIC (2014 NY Slip Op 50422(U))
[*1]| Healing Art Acupuncture, P.C. v MVAIC |
| 2014 NY Slip Op 50422(U) [42 Misc 3d 151(A)] |
| Decided on March 11, 2014 |
| 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. |
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2012-1220 K C.
against
MVAIC, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County
(Reginald A. Boddie, J.), entered April 27, 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 Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) appeals from an order of the Civil Court which denied defendant’s motion for summary judgment dismissing the complaint.
Since plaintiff and its assignor were aware of the identity of the owner of the vehicle which plaintiff’s assignor was driving 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] Dr. Abakin, D.C., P.C. v MVAIC, 21 Misc 3d 134[A], 2008 NY Slip Op 52186[U] [App Term, 2d & 11th Jud Dists 2008] Complete Med. Servs. of NY, P.C. v MVAIC, 20 Misc 3d 137[A], 2008 NY Slip Op 51541[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.
Accordingly, the order is reversed and MVAIC’s motion for summary judgment dismissing the complaint is granted.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: March 11, 2014Hillside Open MRI, P.C. v Praetorian Ins. Co. (2014 NY Slip Op
50408(U))
Reported in New York Official Reports at Hillside Open MRI, P.C. v Praetorian Ins. Co. (2014 NY Slip Op 50408(U))
| Hillside Open MRI, P.C. v Praetorian Ins. Co. |
| 2014 NY Slip Op 50408(U) [42 Misc 3d 149(A)] |
| Decided on March 10, 2014 |
| 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. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS
PRESENT: : NICOLAI, P.J., IANNACCI and TOLBERT, JJ
2012-1617 N C.
against
Praetorian Insurance Company, Respondent.
Appeal from an order of the District Court of Nassau County, First District (Terence P. Murphy, J.), entered June 1, 2012. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion to compel defendant to respond to plaintiff’s discovery demands.
ORDERED that the order is reversed, without costs, defendant’s motion for summary judgment dismissing the complaint is denied with leave to renew after the completion of discovery, plaintiff’s cross motion to compel defendant to respond to plaintiff’s discovery demands is granted, and defendant is directed to serve responses to plaintiff’s discovery demands within 60 days of the date of this decision and order.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint. Plaintiff opposed the motion on the ground that defendant had failed to respond to plaintiff’s discovery demands and that defendant’s responses were necessary to oppose defendant’s motion (see CPLR 3212 [f]). Plaintiff also cross-moved to compel defendant to provide the requested discovery (see CPLR 3124). The District Court granted defendant’s motion and denied plaintiff’s cross motion.
“CPLR 3212 (f) provides, in relevant part, that a court may deny a motion for summary judgment should it appear from affidavits submitted in opposition to the motion that facts essential to justify opposition may exist but cannot then be stated. This is especially so where the opposing party has not had a reasonable opportunity for disclosure prior to the making of the motion” (Jones v American Commerce Ins. Co., 92 AD3d 844, 845 [2012] [internal quotation marks and citations omitted]). Here, in support of its motion for summary judgment dismissing the complaint on the ground of lack of medical necessity, defendant alleged that it had timely denied plaintiff’s claims on that ground based on two peer review reports. 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, the medical documentation underlying defendant’s decision to deny the claims based on lack of medical necessity, and that plaintiff needed such discovery to oppose defendant’s motion (see Metropolitan Diagnostic Med. Care, P.C. v A. Cent. Ins. Co., ___ Misc 3d ___[A], 2013 NY Slip Op 52246[U] [App Term, 2d, 11th & 13th Jud Dists 2013] Alrof, Inc. v Progressive Ins. Co., 34 Misc 3d 29 [App Term, 2d, 11th & 13th Jud Dists 2011] compare Elmont Open MRI & Diagnostic Radiology, P.C. v Travelers Indem. Co., 30 Misc 3d 126[A], 2010 NY Slip Op 52223[U] [App Term, 9th & 10th Jud Dists 2010]). Consequently, defendant’s motion should have been denied with leave to renew following discovery, and plaintiff’s cross motion granted (see Metropolitan Diagnostic Med. Care, P.C. v A. Cent. Ins. Co., ___ Misc 3d ___[A], 2013 NY Slip Op 52246[U]).
Accordingly, the order is reversed, defendant’s motion for summary judgment dismissing [*2]the complaint is denied with leave to renew after the completion of discovery, plaintiff’s cross motion to compel defendant to respond to plaintiff’s discovery demands is granted, and defendant is directed to serve responses to plaintiff’s discovery demands within 60 days of the date of this decision and order.
Nicolai, P.J., Iannacci and Tolbert, JJ., concur.
Decision Date: March 10, 2014
Reported in New York Official Reports at Canarsie Chiropractic, P.C. v Auto Club Ins. Assn., AAA Mich. (2014 NY Slip Op 50377(U))
| Canarsie Chiropractic, P.C. v Auto Club Ins. Assn., AAA Mich. |
| 2014 NY Slip Op 50377(U) [42 Misc 3d 1236(A)] |
| Decided on March 10, 2014 |
| Civil Court Of The City Of New York, Kings County |
| Levine, J. |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
Civil Court of the City of New York, Kings County
Canarsie
Chiropractic, P.C., A/A/O HARRY BRENTON, Plaintiff,
against Auto Club Insurance Association, AAA Michigan, Defendant. |
064253-11KI
Attorneys for Plaintiff:
The Rybak Firm, PLLC.
1506 Kings Highway, 2nd Fl
Brooklyn, NY 11229
Attorney for Defendant
Conway, Farrell, Curtin & Kelly, P.C
48 Wall Street
Woodbury, New York 10005
Katherine A. Levine, J.
Plaintiff Canarsie Chiropractic, P.C. (“plaintiff” or “Canarsie Chiropractic”), a medical services company, brings this action pursuant to Insurance Law § 5106(a) to recover monies for medical services provided to its assignor Harry Brenton (“assignor” or “Brenton”), a New York resident, for injuries he allegedly suffered in an automobile accident in New York. The car’s owner, Adama Ndiaye (“Ndiaye”), obtained the insurance policy for the car at issue, as well as for additional cars he owned in Michigan from Defendant Auto Club Insurance Association AAA Michigan (“Auto Club” or “defendant”). Per the policy, the cars were to be driven and principally garaged in that state. [*2]
After several vehicles that Ndiaye owned and insured with Auto Club were involved in auto accidents in New York between 2007 and 2009, the defendant initiated its investigation into Ndiaye’s place of residence. The investigation revealed that Ndiaye was in fact operating a commercial taxi/livery cab service in New York with the insured vehicles, in violation of the insurance policy term mandating that the vehicles be garaged in Michigan. cab service in New York and that all the vehicles were principally garaged in New York. Auto One thereupon obtained a default judgment from the Michigan Circuit Court, Auto Club Ins. Co. v Adama Ndiaye, C/A No: 10-758-CK (Hon. Timothy P. Connors) declaring the policy void ab initio and that plaintiff Auto One was “neither bound by, nor liable to [Ndiaye] or any other person or entity, whether known or unknown, under any contractual provision [of the policy].”
Auto Club moves for summary judgment on the ground that Michigan law applies, since the underlying no fault policy was procured and issued in Michigan to a Michigan resident. Plaintiff opposes the motion and argues that New York law applies since Auto One does business in New York. A conflict of law issue exists since Michigan law voids the policy ab initio when there is fraud in the procurement of the policy where as New York law does not permit an insurance policy to be cancelled retroactively. See, Mtr. of Allstate Ins. Co., (Stolarz), 81 NY2d 219 (1993); Jiminez v. Monadnock Constr., Inc., 109 AD3d 514 (2d Dept. 2012).
In Michigan, the various doctrines of fraud do not require the party asserting fraud to have investigated all assertions and representations made by its contracting partner as a prerequisite to establishing fraud. Titan Ins. Co. v. Hyten, 491 Mich. 547, 557 817 N.W.2d 562 (2012). Rather, the party asserting fraud has a plethora of legal and equitable remedies, including the right to “retroactively avoid contractual obligations through traditional remedies such as cancellation, rescission or reformation.” Id at 558. Therefore, Michigan has long held that an insurer can rescind a policy and declare it void ab initio as against an insured who seeks benefits when the insured procured the policy through fraud, even where the fraud was easily ascertainable. Titan Ins. Co. Supra, 491 Mich. At 555. See also Jackimowicz v. Citizens Ins. Co. of America, 2011 Mich. App. LEXIS 396 (Mich. Ct. App. 2011); Hammoud v. Metropolitan Property and Casualty Ins. Co., 222 Mich. App. 485, 488, 563 N.W.2d 716, 718 (1997).
In Titan, supra, the Michigan Supreme Court definitively ruled that an insurer could avail himself of these equitable principles to avoid liability under an insurance policy on the ground of fraud in the procurement notwithstanding that “the fraud might have been easily ascertainable…and the claimant was a third party.” 491 Mich. At 562. The Court reversed precedent which found that the public policy of the state recognizing the right to reimbursement under the no fault law trumped the common law which enabled insurers to obtain traditional forms of relief when they were victims of fraud and that third parties needed to protected. Id at 565- 569. Rather, “(t)hird-party victims of automobile accidents have a variety of means of recourse under the no-fault act (including tort actions), and it is to those means that such person [*3]must look.” Id at 565.
In New York, both the common law and the Insurance Law permit an insurance carrier to rescind and or void an insurance policy where a material misrepresentation was made at the time of the procurement of the policy. Stracar Medical Services v. Nationwide Mut. Ins. Co., 2013 NY Slip Op 50633(U), 39 Misc 3d 1216(A) (Civil Ct., Kings Co. 2013). See, Kiss Construction NY Inc. v. Rutgers Casualty Ins. Co., 61 AD3d 412 (1st Dept. 2009); Ins. Law §3105. However, VTL §313 (1) (a), which prohibits the termination of a contract of insurance until after the insurer mails a notice of termination to the insured, “supplants an insurance carrier’s common law right to cancel a contract of insurance retroactively on the grounds of fraud or misrepresentation and mandates that the cancellation of a contract pursuant to its provisions may only be effected prospectively.” Liberty Mut. Ins. Co. v. McClellan, 127 AD2d 767 (2d Dept. 1987). See, Mtr. Of Met Life Auto & Home v. Aguedelo, 8 AD3d 571, 572 (2d Dept. 2004). This section thus “places the burden on the insurer to discover any fraud before issuing the policy, or as soon as possible thereafter, and protects innocent third parties who may be injured due to the insured’s negligence.” Mtr. Of Ins. Co. v. Kaplan, 274 AD2d 293, 298 (2d Dept. 2000). However, only innocent third parties who are injured are protected and “not a health care provider who deals with the assignor-insured at its peril in accepting an assignment of the insured’s no-fault benefits.” Mtr of Met life, supra, 12 Misc 3d at 11-12.
The insurance carrier may assert as an affirmative defense that the insured misrepresentations and/or fraud in obtaining the policy precludes any recovery by the insured. A.B. Medical Services PLLC v. Commercial Mutual Ins. Co., 12 Misc 3d 8,11-12 (App. Term, 2d Dept. 2006). The defense of fraudulent procurement of an insurance policy is nonwaivable and hence exempt from the 30-day procurement rule, and may be asserted as against health care providers who seek to recover assigned benefits from the insured. AB Medical Services, supra, 12 Misc 3d at 11-12. The insurance company may also bring an action against its insured to recover any losses it incurred by paying benefits under the policy to the innocent third party. Mtr. Of Ins. Co. v. Kaplan, 274 AD2d 293, 298 (2d Dept. 2000).
Here, the assignor was an innocent third party as he was a passenger in a livery car owned by the insured and played no role in the insured’s fraudulent misrepresentation. Therefore, plaintiff health care provider, which stepped into the shoes of the assignor, is an innocent third party in the instant matter.
Traditionally, conflict of law questions relating to contracts were resolved by application of the law of the jurisdiction where the contract was made or was to be performed.” Mtr. of Eagle Ins. Co v. Singletary, 279 AD2d 56, 59 (2nd Dept. 2000). New York has long recognized the use of center of gravity or groupings of contacts as the appropriate analytical approach to choice of law questions in contract cases. Mtr of Midland Ins. Co., 16 NY3d 536 (2011) citing Zurich Ins. Co. v Shearson Lehman Hutton, 84 NY2d 309, 317, 319 (1994). This grouping of [*4]contacts approach establishes which State has the most significant relationship to the transaction and the parties, and allows that state “paramount control over the legal issues arising out of a particular factual context.” Mtr of Midland Ins. Co., supra, 16 NY3d at 543; Jiminez v. Monadnock Constr. Inc., 109 AD3d 514, 516 (2d Dept. 2013). Significant contacts include the place of contracting, negotiation and performance, the location of the subject matter of the contract, and the domicile or place of business of the contracting parties. Mtr. of Allstate Ins. Co. supra, 81 NY2d at 227; Jiminez, supra at 516; Mtr. Of Eagle Ins. Co. v. Singletary, 279 AD2d 56, 58-59 (2nd Dept. 2000).
In the context of liability insurance contracts, the courts look to the law of the state which the parties understood was to be the principal location of the insured risk. Mtr of Midland Ins. Co. supra 16 N.Y.3rdat 544; Eagle v. Singletary, supra, 279 AD3d at 59; Conflict of Laws § 193. The principle location of the insured risk will be deemed to be the state where the insured is incorporated, domiciled and has its principal place of business. Midland, supra, 16 NY2d at 544. In the case of a noncommercial vehicle insurance, the principal location of the insured risk is the place where the vehicle is to be principally garaged. Eagle Ins. Co., supra, at 57 citing Restatement [Second] of Conflict of Laws, § 193, comment c.
Applying this analytical framework to the facts, Michigan clearly had the most significant contacts. Defendant’s casualty claims representative averred that at the time Ndiaye procured the policy, he provided a Michigan address and stated that the four vehicles registered on his policy were to be garaged in that State. The subject insurance policy was negotiated in and issued to Ndiaye in Michigan and incorporated Michigan law. See, GEICO v. Nichols, 8 AD3d 564 (2d Dept. 2004) (retroactive cancellation of policy under Florida law permitted where the policy was issued in Florida to Florida residents for a vehicle registered in Florida and policy incorporated Florida law; the only connection to New York was that insured was driving car in NY at time of accident); Mtr of Eagle Ins. Co supra (retroactive cancellation of policy under Virginia law for fraudulent misrepresentation permitted where the policy was issued in Virginia to a Virginia resident for a vehicle garaged in Virginia, and the only connection to New York was that the accident occurred in NY and the injured passenger was a NY resident); Careplus Medical Supply Inc v. Selective Insurance Co of America, 25 Misc 3d 48 (App Term, 2d Dept. 2009) (New Jersey law governs where the policy was negotiated and entered into in New Jersey, the insureds lived in New Jersey, and the vehicle was garaged and registered in New Jersey; the only connection to New York was that the accident occurred there); R.E.G Flushing Medical v. Integon Nat. Ins. Co., 2011 NY Slip Op 50975(U), 31 Misc 3d 1234(A) (Dist. Ct., Nass. Co. 2011) (North Carolina law applies where policy was issued to insured in North Carolina, the policy listed a North Carolina address for the insured and the insured certified that his cars were garaged at the address listed).
Applying Michigan law, it is clear that the defendant properly cancelled the policy at issue because of fraud in its procurement. Plaintiff argues that even if Michigan Law applies, the [*5]motion cannot be granted because its out of state affidavit lacks a certificate of conformity required by RPL 299-a (1). This section mandates that an affidavit signed outside of the state by a foreign notary be accompanied by a certificate of conformity certifying that the manner in which the acknowledgment was taken conforms with New York law or other place where the acknowledgment was taken. The certificate must be made by an attorney admitted to practice in New York State who resides in the other jurisdiction, or by an attorney admitted to practice in the other jurisdiction, or any other person deemed qualified by any court of the State of New York. RPL ァ 299-a (1).
Here, the Michigan notary of the public who notarized defendant’s affidavit does not fall within any of the categories allowed by RPL 299-a (1). Nevertheless, the absence of a valid certificate of conformity for an out-of-state affidavit is not a fatal defect and can be cured nunc pro tunc. Fredette v Town of Southampton, 95 AD3d 940, 941 (2nd Dept. 2012); Art of Healing Medicine, P.C. v. Amica Mutual Ins. Co., 2013 NY Slip Op 52014(U), 41 Misc 3d 141(A) (App. Term, 2nd Dept. 2013). Accordingly, the defendant is given 45 days from receipt of this decision to provide a certificate of conformity to this Court and the other side. Upon receipt of proper certificate, this Court will grant the motion for summary judgment and dismiss the case.
This constitutes the Decision and Order of the Court.
DATED: March 10, 2014
_____________________________
KATHERINE A. LEVINE
Acting Justice, Supreme Court