Vit Acupuncture, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 52000(U))

Reported in New York Official Reports at Vit Acupuncture, P.C. v Praetorian Ins. Co. (2013 NY Slip Op 52000(U))

[*1]
Vit Acupuncture, P.C. v Praetorian Ins. Co.
2013 NY Slip Op 52000(U) [41 Misc 3d 139(A)]
Decided on November 26, 2013
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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 26, 2013

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-2211 K C.
Vit Acupuncture, P.C. as Assignee of SHERITA DESELLE, Respondent, —

against

Praetorian Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered February 15, 2011. 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 reversed, with $30 costs, 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, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. Insofar as is relevant to this appeal, the Civil Court denied defendant’s cross motion.

In support of its cross motion, defendant submitted an affidavit by a supervisor of Media Referral, Inc., a company retained by defendant to schedule independent medical examinations (IMEs), which sufficiently established that the IME requests 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 also submitted, among other things, an affidavit by the doctor who was to perform the physiatrist/PMR IMEs, as well as an affidavit by the chiropractor who was to perform the chiropractic IMEs, which were sufficient to establish that plaintiff’s assignor had [*2]failed to appear for those duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). In addition, an affidavit executed by defendant’s claims examiner demonstrated that the denial of claim forms, which denied plaintiff’s claims based on plaintiff’s assignor’s nonappearance at the IMEs, had been timely mailed (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; Delta Diagnostic Radiology, P.C., 17 Misc 3d 16). Consequently, defendant established its entitlement to summary judgment dismissing the complaint (Stephen Fogel Psychological, P.C., 35 AD3d at 722; see also Insurance Department Regulations [11 NYCRR] § 65-1.1).

Accordingly, the order, insofar as appealed from, is reversed and defendant’s cross motion for summary judgment dismissing the complaint is granted.

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: November 26, 2013

Alev Med. Supply, Inc. v Praetorian Ins. Co. (2013 NY Slip Op 51999(U))

Reported in New York Official Reports at Alev Med. Supply, Inc. v Praetorian Ins. Co. (2013 NY Slip Op 51999(U))

[*1]
Alev Med. Supply, Inc. v Praetorian Ins. Co.
2013 NY Slip Op 51999(U) [41 Misc 3d 139(A)]
Decided on November 26, 2013
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 November 26, 2013

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-1328 Q C.
Alev Medical Supply, Inc. as Assignee of HANNA DEVON, Respondent, —

against

Praetorian Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered March 1, 2011. 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 moved for summary judgment dismissing the complaint, alleging that the claims at issue had been timely denied because the medical supplies at issue were not medically necessary. Defendant appeals from an order of the Civil Court which denied its motion.

The papers submitted by defendant in support of its motion were sufficient to establish that defendant had 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]) the denial of claim forms at issue, which denied the claims on the ground of lack of medical necessity. Moreover, defendant submitted a sworn peer review report which set forth a factual basis and medical rationale for the reviewer’s determination that there was no medical necessity for the medical supplies at issue. In [*2]opposition, plaintiff submitted an affirmation by a doctor which failed to meaningfully refer to, let alone rebut, the conclusions set forth in the peer review report (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). Therefore, defendant’s motion for summary judgment dismissing the complaint should have been granted (see A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).

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

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: November 26, 2013

Jacoby Chiropractic, P.C. v Redland Ins. Co. (2013 NY Slip Op 51998(U))

Reported in New York Official Reports at Jacoby Chiropractic, P.C. v Redland Ins. Co. (2013 NY Slip Op 51998(U))

[*1]
Jacoby Chiropractic, P.C. v Redland Ins. Co.
2013 NY Slip Op 51998(U) [41 Misc 3d 139(A)]
Decided on November 26, 2013
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 November 26, 2013

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-1327 Q C.
Jacoby Chiropractic, P.C. as Assignee of RAQUEL GONZALEZ-POLANCO, Respondent, —

against

Redland Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered March 25, 2011. 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 reversed, with $30 costs, 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, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court denied both motions, finding that plaintiff had established its prima facie entitlement to summary judgment, that defendant had timely denied the claims based upon plaintiff’s assignor’s failure to appear for independent medical examinations (IMEs), and that defendant had timely and properly requested IMEs. Thus, the only issue for trial was “the no-show of the assignor at the IMEs.”

In support of its cross motion, defendant submitted an affidavit by the healthcare professional retained to perform the IMEs which established that plaintiff’s assignor had failed to appear at IMEs on June 12, 2009 and June 25, 2009. As an appearance at an IME is a condition precedent to an insurer’s liability on a policy (see Insurance Department Regulations [11 [*2]NYCRR] § 65-1.1; Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]) and plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, defendant’s cross motion for summary judgment dismissing the complaint is granted.

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: November 26, 2013

Alev Med. Supply, Inc. v Praetorian Ins. Co. (2013 NY Slip Op 51995(U))

Reported in New York Official Reports at Alev Med. Supply, Inc. v Praetorian Ins. Co. (2013 NY Slip Op 51995(U))

[*1]
Alev Med. Supply, Inc. v Praetorian Ins. Co.
2013 NY Slip Op 51995(U) [41 Misc 3d 139(A)]
Decided on November 26, 2013
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 November 26, 2013

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-252 Q C.
Alev Medical Supply, Inc. as Assignee of JAREA T. COOK, Respondent, —

against

Praetorian Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered December 8, 2010. 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, the Civil Court denied defendant’s motion for summary judgment, finding that plaintiff had raised a triable issue of fact and stating that the only issue for trial was the medical necessity of the supplies at issue (see CPLR 3212 [g]).

In support of its motion, defendant submitted a sworn peer review report which set forth a factual basis and medical rationale for the reviewer’s determination that there was no medical necessity for the medical supplies at issue. In opposition, plaintiff submitted an affirmation by a doctor which failed to meaningfully refer to, let alone rebut, the conclusions set forth in the peer review report (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). In view of the foregoing, and as [*2]plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is granted (see A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: November 26, 2013

Dream Acupuncture, P.C. v State Farm Fire & Cas. Co. (2013 NY Slip Op 51997(U))

Reported in New York Official Reports at Dream Acupuncture, P.C. v State Farm Fire & Cas. Co. (2013 NY Slip Op 51997(U))

[*1]
Dream Acupuncture, P.C. v State Farm Fire & Cas. Co.
2013 NY Slip Op 51997(U) [41 Misc 3d 139(A)]
Decided on November 26, 2013
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 November 26, 2013
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-1251 K C.

Dream Acupuncture, P.C. as Assignee of CARLOS GAUSE, Appellant, —

against

State Farm Fire & Casualty Company, Respondent.


Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered March 11, 2011. 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, defendant moved for summary judgment dismissing the complaint, alleging that the claims at issue had been timely denied based upon plaintiff’s failure to appear at properly scheduled examinations under oath (EUOs). Plaintiff appeals from an order of the Civil Court which granted defendant’s motion.

Contrary to plaintiff’s first argument on appeal, defendant’s affidavits sufficiently described defendant’s standard practices and procedures for mailing EUO scheduling letters and denial of claim forms (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). [*2]

Contrary to plaintiff’s other argument on appeal, it was not defendant’s burden to demonstrate that the applicable policy condition contains a provision for using EUOs as a method of verifying claims. As we have previously noted, effective April 5, 2002, the mandatory personal injury endorsement contains a provision for EUOs (see Insurance Department Regulations [11 NYCRR] § 65-1.1 [b]). The accident in question occurred on February 9, 2007. Since the policy in this case would have been issued after 2002, it would necessarily have contained a provision for EUOs, and, thus, defendant was not required to produce the policy to establish the existence of such a provision (see Mega Supplies Billing, Inc. v State Farm Mut. Auto. Ins. Co., 33 Misc 3d 136[A], 2011 NY Slip Op 52023[U] [App Term, 2d, 11th & 13th Jud Dists 2011]; Eagle Chiropractic, P.C. v Chubb Indem. Ins. Co., 19 Misc 3d 129[A], 2008 NY Slip Op 50525[U] [App Term, 9th & 10th Jud Dists 2008]). Indeed, “[e]ven if the insurance policy did not contain an EUO provision, the policy would be construed as though it did” (Mega Supplies Billing, Inc., 33 Misc 3d 136[A], 2011 NY Slip Op 52023[U], *1).

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: November 26, 2013Jesa Med. Supply, Inc. v NYC Tr. Auth. (2013 NY Slip Op 52007(U))

Reported in New York Official Reports at Jesa Med. Supply, Inc. v NYC Tr. Auth. (2013 NY Slip Op 52007(U))

[*1]
Jesa Med. Supply, Inc. v NYC Tr. Auth.
2013 NY Slip Op 52007(U) [41 Misc 3d 140(A)]
Decided on November 26, 2013
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 November 26, 2013
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-3037 K C.

Jesa Medical Supply, Inc. as Assignee of STACEYANN COPELAND, Respondent, —

against

NYC Transit Authority, Appellant.


Appeal from an order of the Civil Court of the City of New York, Kings County (Reginald A. Boddie, J.), entered September 22, 2011. The order denied defendant’s motion for summary judgment dismissing the complaint.


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

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

In support of its motion, defendant proffered an affidavit by its claims representative which was sufficient to establish that defendant’s denial of claim forms had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]) and that plaintiff had submitted its claims to defendant more than 45 days after the date the supplies had been provided to plaintiff’s assignor (see Insurance Department [*2]Regulations [11 NYCRR] § 65-1.1). Defendant’s denial of claim forms adequately advised plaintiff of the basis for the denial, and they further advised plaintiff that the late submission of the claims would be excused if plaintiff provided a reasonable justification for the lateness (see Insurance Department Regulations [11 NYCRR] § 65-3.3 [e]).

Contrary to plaintiff’s argument, defendant was not required to establish that its denial of claim forms constituted evidence in admissible form pursuant to the business records exception to the rule against hearsay as set forth in CPLR 4518. Defendant did not submit the denials as memoranda “of any act, transaction, occurrence, or event” recorded therein (CPLR 4518 [a]; see Five Boro Psychological Servs., P.C. v Progressive Northeastern Ins. Co., 27 Misc 3d 141[A], 2010 NY Slip Op 50991[U] [App Term, 2d, 11th & 13th Jud Dists 2010]; Quality Health Prods., Inc. v NY Cent. Mut. Fire Ins. Co., 27 Misc 3d 141[A], 2010 NY Slip Op 50990[U] [App Term, 2d, 11th & 13th Jud Dists 2010]). Instead, defendant submitted its copies of the denials only to show that these were the denials at issue in this case. Defendant did not try to use the denials to establish, for example, the truth of the stated basis of the denials. Thus, in this context, the denials were not hearsay (see Beal-Medea Prods., Inc. v NY Cent. Mut. Fire Ins. Co., 36 Misc 3d 135[A], 2012 NY Slip Op 51347[U] [App Term, 2d, 11th & 13th Jud Dists 2012]).

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

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: November 26, 2013Eagle Surgical Supply, Inc. v Allstate Indem. Co. (2013 NY Slip Op 52012(U))

Reported in New York Official Reports at Eagle Surgical Supply, Inc. v Allstate Indem. Co. (2013 NY Slip Op 52012(U))

[*1]
Eagle Surgical Supply, Inc. v Allstate Indem. Co.
2013 NY Slip Op 52012(U) [41 Misc 3d 141(A)]
Decided on November 26, 2013
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 November 26, 2013
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2012-120 Q C.

Eagle Surgical Supply, Inc. as Assignee of BARISTA ESTEBAN, Appellant, —

against

Allstate Indemnity Company, 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 12, 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. Defendant’s motion papers set forth that it had timely denied the claims at issue based upon plaintiff’s failure to appear for duly scheduled examinations under oath (EUOs). A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

Plaintiff’s main argument on appeal is that defendant was not entitled to summary judgment because defendant’s first EUO scheduling letter was untimely, resulting in a failure to toll its time to pay or deny the claim and rendering the denial of claim form untimely. Although [*2]this argument is raised for the first time on appeal, it may be considered by this court “since it is one of law appearing on the face of the record and it could not have been avoided had it been raised at the proper juncture” (Navillus Tile, Inc. v George A. Fuller Co., Inc., 83 AD3d 919, 920 [2011]; see also Olim Realty v Lanaj Home Furnishings, 65 AD3d 1318, 1320 [2009]).

A review of the file reveals that defendant received the subject claim form on February 17, 2009 and mailed its first EUO scheduling letter on March 23, 2009, 24 business days later. Requests for additional verification are untimely if not made within 15 business days of the insurer’s receipt of the claim form (see Insurance Department Regulations [11 NYCRR] § 65-3.5 [b]). However, since the first EUO request was nine days late, pursuant to Insurance Department Regulations (11 NYCRR) § 65-3.8 (j), defendant’s time to pay or deny the claim was reduced from 30 calendar days to 21 calendar days. Defendant mailed its denial of claim form 20 days after plaintiff failed to show up for the final scheduled EUO. Accordingly, plaintiff’s argument is without merit.

To the extent plaintiff seeks to argue on appeal that defendant’s EUO request was unwieldy and unduly burdensome, plaintiff does not claim to have responded in any way to the EUO request, and its objections 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]).

Accordingly, the judgment is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: November 26, 2013Canon Chiropractic P.C. v MVAIC (2013 NY Slip Op 52044(U))

Reported in New York Official Reports at Canon Chiropractic P.C. v MVAIC (2013 NY Slip Op 52044(U))

[*1]
Canon Chiropractic P.C. v MVAIC
2013 NY Slip Op 52044(U) [41 Misc 3d 1237(A)]
Decided on November 22, 2013
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.


Decided on November 22, 2013
Civil Court of the City of New York, Kings County


Canon Chiropractic P.C. AAO GEORGE ELLINGTON, Plaintiff,

against

MVAIC, Defendant.




026987-11



Attorneys for Plaintiff:

Gary Tsirelman, P.C.

65 Jay Street, 3d Floor

Brooklyn, NY 11201

Attorneys for Defendant:

Cruz & Gangi

110 William Street, 14th Floor

New York, NY 10038

Katherine A. Levine, J.



The apparently novel issue raised at trial was whether defendant MVAIC (“MVAIC”) had an obligation to independently verify the address of the assignor George Ellington (“assignor,” “applicant” or “Ellington”) after receiving documentation from plaintiff Canon Chiropractic (“plaintiff” “provider” or “Canon”) which listed two different addresses for the assignor. Defendant also contends that it did not have to prove that it timely sent the verification requests to plaintiff since it denied the claim based on lack of coverage.

The parties stipulated at trial that plaintiff had made its prima facie case by timely mailing its bills and assignment of benefit form to MVAIC and that defendant had timely mailed its request to qualify letters, which defendant refers to as verification requests, to both the provider and assignor, the latter at 135 Kings 1st Walk, Brooklyn, NY 11233.[FN1] The four requests to [*2]qualify to the applicant Jorge Ellington stated that he had not yet met the requirements of a qualified person since there were an number of outstanding items that had not been received, and that upon MVAIC’s receipt of the items, the assignor would be given “consideration to be a covered person.” Among the outstanding items that MVAIC requested from the applicant were an Original Notice of Intention to Make a Claim, fully signed and notarized, a notarized household affidavit, proof of residency, written confirmation of insurance, and a police report. MVAIC mailed almost identical letters to the provider Canon. All the letters ended by stating that”this request for information is necessary to qualify for MVAIC coverage.”

Defendant presented as its witness Laura Figueroa who is a qualification examiner for MVAIC. While she did not generate the letters at issue, she was aware of the practices and procedures for generating letters requesting documents that are needed to qualify the applicant for coverage with MVAIC (“letters to qualify”). When the notice of intention to file a claim comes in she ensures that it is handled in compliance with Regulation 68 and contacts the applicant or his attorney for the necessary documents to qualify. The letters were addressed to both Canon at its address and the applicant at 135 Kings First Walk because that was the address indicated on the bills submitted by plaintiff.

Figueroa testified that she only received medical bills regarding the applicant. She testified that there was no coverage for applicant Ellington because “we never received the notice of intent to make a claim, never received a police report of household affidavit.” In fact, MVAIC never received anything requested in the letters from either the applicant or the provider. Therefore, the applicant was deemed not to be a qualified person and thus, not a covered person.

On cross, Figueroa admitted to receiving the assignment of benefits forms and the medical records from the plaintiff; the assignment of benefits form indicated that the address of the applicant was 135 Kings Forth (sic) Walk, Brooklyn, NY 11233. [FN2] The assignor (applicant) drafted the assignment of benefits and plaintiff Canon generated the bills which contained the Kings First address. This testimony led the Court to state that the “million dollar question” in the case was why would an MVAIC examiner send the letter to qualify to the assigner at the address listed on the bill as opposed to the address listed on the assignment of benefits form and whether there was any procedure in place to ascertain the proper address when the documents revealed two different addresses.

Figueroa responded that the address on the bills was used because that was the first address that the MVAIC person saw. When MVAIC receives documents with two different addresses, its procedure is to investigate by calling the provider or applicant for the proper address and the clerk is supposed to make sure it goes to the right address by calling the medical provider or applicant. She was not sure what happened in this case. If the applicant and the provider give different addresses “there is a problem.” She does not know whether MVAIC [*3]called Canon in this case, there were no notes on this and she did not work on this particular case. Defendant points out in its brief that the assignment of benefits which lists the proper address “was placed in the middle of the package after the medical records and before the doctor’s license.” Plaintiff offered no testimony as to why it put the wrong address on the bills.

At issue is which party bears the burden of ensuring that the qualifying letters are sent to the proper address of the assignor and whether the assignor’s failure to receive the qualifying letters was fatal when it was clear that the plaintiff provider did receive them.The parties also dispute whether defendant even had to prove that it had timely and properly mailed the verification requests since it denied the claim based on lack of coverage.

MVAIC was created to “provide no-fault benefits for qualified persons for basic economic loss arising out of the use and operation in this state of an uninsured motor vehicle” Insurance Law § 5201). The intent was to afford injured parties the same protections that exist when a tortfeasor involved in a motor vehicle accident been covered by insurance . Englington Med., P.C. v. Motor Veh. Acc. Indem. Corp., 81 AD3d 223, 227-28 (2d Dept. 2011). See, Morisi v Motor Veh. Acc. Indem. Corp., 19 AD2d 727(2d Dept. 1963). The statutory provisions creating and regulating MVAIC should be liberally construed to serve those ends. Englington supra at 228. See, Mtr of Dixon v Motor Veh. Acc. Indem. Corp., 56 AD2d 650, 651 (2nd Dept. 1977).

MVAIC must pay first-party no-fault benefits to a qualified person for basic economic loss arising out of the use or operation in this state of an uninsured motor vehicle. Pursuant to Insurance Law §5221(b)(2) “only qualified person[s]’ are entitled to MVAIC no-fault coverage.” See, Mtr of MVAIC v Aetna Cas. & Sur. Co., 89 NY2d 214, 221 (1996). In order for someone who has allegedly been injured (the assignor) to be a “covered person” person under Insurance Law § 5221(b)(2), and hence be eligible for no fault benefits, the person must be a “qualified person” as that term is defined under Ins. Law §5202(b) and must have complied with all of the requirements contained in Insurance Law §5208. First Help Acupuncture, P.C. v. MVAIC, 2012 NY Slip Op 51643(U), 36 Misc 3d 148(a) (App. Term, 2d Dept. 2012). See, Olmecs Medical Supplies, Inc. v. MVAIC, 2013 NY Slip Op 50218(U), 38 Misc 3d 140(A) (App. Term, 2d Dept. 2013). Among the requirements of Ins. Law §5208 is the submission of a timely sworn notice of intention to make a claim to MVAIC. Olmecs, supra , and the filing of an accident report within 24 hours of the occurrence unless it was “not reasonably possible to make such a report or that it was made as soon as was reasonably possible.” Howard M. Rombon v. MVAIC, 2008 NY Slip Op 52128(U), 21 Misc 3d 131 (A) (App. Ter, 2d & 11th Jud. Dists. 2008). See, Canty v. MVAIC 95 A..D. 2d 509, 511 (2d Dept. 1983). See also, Akita Med. Acupuncture, P.C. v. MVAIC, 14 Misc 3d 405, 408 (Nassau Cty. Dist. Ct. 2006) (failure of claimant to verify that the alleged accident ever occurred or that it was reported to the police within 24 hours disqualifies claimant from receiving MVAIC benefits”).

Where any of these requirements have not been met, the plaintiff’s assignor is not a qualified person and thus, not a covered person. See, AP Orthopedic & Rehabilitation P.C. v. [*4]MVAIC, 2011 NY Slip Op 51448(U), 32 Misc 3d 133(A) (App. Term, 2d Dept 2011) (assignor’s failure to provide MVAIC with proof that she was a resident of the State of New York when the accident occurred); See, RAZ Acupuncture, P.C. v MVAIC, 2009 NY Slip Op 52362(U), 25 Misc 3d 138(A) (App Term, 2d, Dists 2009); Five Boro Psychological Servs., P.C. v MVAIC, 2010 NY Slip Op 50647(U), 27 Misc 3d 131(A) (App Term, 2d, 11th & 13th Jud Dists. 2010); (Insurance Law § 5221 (b) (2); Howard M. Rombon, Ph.D., P.C. v MVAIC, supra. Consequently, a condition precedent to the right to apply for payment of no-fault benefits from MVAIC has not been satisfied and a defendant insurer is entitled to summary judgment. See, Five Boro Psychological Servs., P.C. v MVAIC, supra, Akita Medical, supra. In fact, in Olmacs, the Appellate Term held that a plaintiff medical provider does not even make out its prima facie case where it fails to prove that a timely sworn notice of intention to make claim was tendered to MVAIC, as this document is necessary for plaintiff to demonstrate that its assignor was eligible to recover no fault benefits from MVAIC.

Here, plaintiff failed to make out its prima facie case since the record is clear that the assignor never submitted the original notarized Notice of Intention to make a claim, a copy of the police report or other requested items to MVAIC. Thus, the assignor is not a qualified person and is not a covered person under the No – Fault Law. Even assuming that the recent Olmacs case does not require the plaintiff to prove that the assignor is a qualified person on its prima facie case, it is clear that once the defendant establishes that the assignor has not submitted the requisite forms to qualify, the burden switches to the plaintiff medical provider to present evidence that “that it had availed itself of the opportunity” to present the evidence. Cf Jamaica Medical Supply v. NY City Transit Authority, 2012 NY Slip Op 51660(U), 36 Misc 3d 150(A) (App. Term, 2d Dept. 2012). Here, plaintiff offered no such evidence.

MVAIC’s instant lack of coverage defense is not subject to the 30 day preclusion rule and may be raised at any time. MVAIC v. Interboro Medical Care & Diagnostic P.C., 73 AD3d 667 (2d Dept. 2010); Family Care Acupuncture P.C. 2010 NY Slip Op 51414(U), 28 Misc 3d 1220(A) (Civil Ct., NY Co. 2010). See, Kipor Medicine P.C. v. MVAIC, 23 Misc 3d 948 (Civil Ct., Kings Co. 2009). Therefore, defendant correctly argues that it did not have timely mail the qualifying letters in order to preserve its defense of lack of coverage.

Plaintiff seeks to avoid the ramifications of non-coverage by placing the blame for the assignor’s non-compliance with Insurance Law §5208 upon defendant since MVAIC mailed the qualifying letters to the wrong address. However, it was plaintiff’s negligence in the first instance, by placing the wrong address on the bills, which caused defendant to mail the letters to the wrong address. MVAIC never received any communications directly from the assignor. The fact that the assignment of benefits form, which was filled out by the assignor and which contained his proper address, was nestled amidst numerous bills with the wrong address is besides the point. MVAIC sent four duplicative notices to Canon apprizing it that the assignor had not yet met the requirements of a qualified person and listing the items that were still [*5]outstanding. These letters clearly put Canon on notice that its assignor was not complying with the reporting requirements so that he could qualify as a covered person. These repetitive notices should have triggered the same question that plaintiff argues defendant ignored – did plaintiff provide the proper address to the assignor or was there another address that should have been utilized?

This conclusion is bolstered by the law governing assignment of benefits. As an assignee, plaintiff assumed all the responsibilities of its assignor, especially after it had repeatedly been notified by MVAIC that its assignor still had not met the requirements of a qualified person. The assignment of no fault benefits divests eligible injured persons of their interest in no fault benefits and makes them non-parties to actions commenced by their assignees Doshi Diagnostic Imaging Servs.v State Farm Ins. Co., 16 Misc 3d 42 (App. Term (9th & 10 th Jud. Dists 2007). See, Cambridge Medical P.C. v Progressive Cas. Ins Co., 29 Misc 3d 186 (Civil Ct., Richmond Co. 2010). An assignee stands in the shoes of an assignor and thus acquires no greater rights than those of its assignor. NY & Presbyterian Hospital v. Country-Wide Ins. Co., 17 NY3d 586592 (2011); East Acupuncture, P.C. v. Allstate Ins. Co., 61 AD3d 202, 211 (NY App. Div. 2d Dep’t 2009); Family Care Acupuncture, P.C. v. MVAIC., supra, (“Because plaintiff’s assignor . . . never qualified for benefits from MVAIC, his assignee, plaintiff, who stands in his shoes, is not entitled to benefits from defendant either.”)

In fact, in the unique realm of no fault law, the assignment of benefits takes on an extraordinary meaning. Rather than there being simple privity between the assignor (eligible injured person) and the assignee (medical provider), there is “a virtual identity of interests by the very existence of the claim.” Magic Recovery Medical & Surgical Supply Inc. v. State Farm, 27 Misc 3d 67, 73 (App. Term, 2d Dept. 2010). The assignor and medical provider share “the same identity when we view a no-fault claim for medical services.” Id. The assignment demonstrates a complete assignment of rights and interests by the assignor to the provider. Craniofacial Pain Mgmt. v. NY Cent. Mut. Fire Ins. Co., 186 Misc 2d 309, 310 (Civil Ct. Queens Co. 2000). “[T]he assignee of a claim is the real party in interest and he alone can bring suit” Id.

Furthermore, the objective behind the aforementioned law is the efficient and speedy processing of the no-fault claims. In line with this objective, for example, an insurer need not seek verification from the assignor who has divested his interest in no-fault benefits by assigning his rights to his provider. Cambridge Medical, P.C. v Progressive Cas. Ins. Co., 29 Misc 3d 186 (Civil Ct., Richmond Co. 2010). See, Mia Acupuncture, P.C. v Mercury Ins. Co., 26 Misc 3d 39, 894 NYS2d 321 (App Term, 2d, 11th & 13th Jud Dists. 2009).

Finally, the scant case law on the ramifications of sending a notice to the assignor at the wrong address appears to turn on the law of assignment and which party caused the wrong address to be utilized by the defendant in the first instance. In Triangle R. Inc v Clarendon, 2010 NY Slip Op 52159(U), 29 Misc 3d 142(A) (App. Term, 2d Dept. 2010), the court granted [*6]defendant’s motion for summary judgment, despite the fact that copies of verification requests were sent to the assignor at the wrong address. The requests for verification were not rendered a nullity since the requests were sought from the plaintiff provider. In Infinity Health products, Ltd v. Redland Ins. Co., 2013 NY Slip Op 50751(U), 39 Misc 3d 140(A) ( App. Term, 2d Dept 2013), the court found that the defendant had failed to demonstrate that IMEs had been properly scheduled when it mailed the IME scheduling letters to the assignor at the wrong zip code. However, there the plaintiff properly listed the assignor’s zip code in both the claim forms and assignment of benefits form that it submitted to defendant. See also, Advanced Neurological Care, P.C. v. State Farm, 38 Misc 3d 750, 754 (Dist. Ct. Nass. Co., 2012) (when notice is given to a person’s designated agent, that notice is imputed to the agent’s principal under the premise that “an agent owes a duty to his principal to forward the notice”).

Similarly, in the instant matter the assignor assigned the benefits way before plaintiff submitted the claims and way before MVAIC started sending its qualifying letters. As such, plaintiff stepped into the shoes of the assignor and was obliged not only to correctly transmit the assignor’s correct address on its bills to defendant, but to ensure that the assignor complied with its obligation to become a qualified person and hence a covered person entitled to recover no- fault benefits from MVAIC. See, Akita Medical, supra, 14 Misc 3d at 408.

In light of the above ruling, defendant has proven its lack of coverage defense, the assignor is not covered with MVAIC and the case is dismissed.

This constitutes the Decision and Order of the Court.



Dated: November 22, 2013

Katherine A. LevineJudge, Civil Court

Footnotes


Footnote 1:Both parties incorrectly refer to the qualification letters as verification requests. Given the different requirements that come into play when MVAIC is a defendant, the letters to qualify are different than the typical verification requests encountered in No Fault cases.

Footnote 2:Contrary to plaintiff’s assertion, the actual medical records of Canon do not list the assignor’s address.Ortho Prods. & Equip., Inc. v Interboro Ins. Co. (2013 NY Slip Op 52054(U))

Reported in New York Official Reports at Ortho Prods. & Equip., Inc. v Interboro Ins. Co. (2013 NY Slip Op 52054(U))

[*1]
Ortho Prods. & Equip., Inc. v Interboro Ins. Co.
2013 NY Slip Op 52054(U) [41 Misc 3d 143(A)]
Decided on November 21, 2013
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 November 21, 2013

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


PRESENT: : PESCE, P.J., RIOS and SOLOMON, JJ
2011-551 K C.
Ortho Products & Equipment, Inc. as Assignee of DANIEL ROBINSON, NICHOLAS MANICKCHAND and BRADLEY FORBES, Respondent, —

against

Interboro Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Margaret A. Pui Yee Chan, J.), entered December 17, 2010. The order, insofar as appealed from as limited by the brief, denied the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claims assigned to plaintiff by Daniel Robinson and Bradley Forbes.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claims assigned to plaintiff by Daniel Robinson and Bradley Forbes are granted.

In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court denied defendant’s motion for summary judgment dismissing the complaint. As limited by its brief, defendant appeals from so much of the order as denied the branches of defendant’s motion seeking to dismiss so much of the complaint as sought to recover upon the claims assigned to plaintiff by Daniel Robinson and Bradley Forbes.

Defendant established that it had timely denied the claims at issue (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]) on the ground that each assignor had failed to appear for examinations under oath (EUOs). It [*2]further established that its EUO scheduling letters had been timely mailed and that Mr. Robinson and Mr. Forbes had each failed to appear at either of their duly scheduled EUOs (see Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co., 36 Misc 3d 146[A], 2012 NY Slip Op 51628[U] [App Term, 2d, 11th & 13th Jud Dists 2012]). Such an appearance at an EUO is a condition precedent to an insurer’s liability on a policy (see Insurance Department Regulations [11 NYCRR] § 65-1.1; Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 722 [2006]; Crotona Hgts. Med., P.C. v Farm Family Cas. Ins. Co., 27 Misc 3d 134[A], 2010 NY Slip Op 50716[U] [App Term, 2d, 11th & 13th Jud Dists 2010]). In opposition to defendant’s motion, plaintiff failed to raise a triable issue of fact (see Zuckerman v City of New York, 49 NY2d 557 [1980]).

Accordingly, the order, insofar as appealed from, is reversed and the branches
of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claims assigned to plaintiff by Daniel Robinson and Bradley Forbes are granted.

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

Rios, J., dissents in a separate memorandum.

Rios, J., dissents and votes to affirm the order, insofar as appealed from, in the following memorandum:

For the reasons set forth in my dissent in Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co. (36 Misc 3d 146[A], 2012 NY Slip Op 51628[U] [App Term, 2d, 11th & 13th Jud Dists 2012]), I find that defendant failed to submit evidence from someone with personal knowledge establishing the nonappearance of the assignor for the scheduled examinations under oath. Consequently, in my opinion, the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claims assigned to plaintiff by Daniel Robinson and Bradley Forbes were properly denied.

Accordingly, I would affirm the order, insofar as appealed from.
Decision Date: November 21, 2013

Megacure Acupuncture, P.C. v Lancer Ins. Co. (2013 NY Slip Op 51994(U))

Reported in New York Official Reports at Megacure Acupuncture, P.C. v Lancer Ins. Co. (2013 NY Slip Op 51994(U))

[*1]
Megacure Acupuncture, P.C. v Lancer Ins. Co.
2013 NY Slip Op 51994(U) [41 Misc 3d 139(A)]
Decided on November 21, 2013
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 November 21, 2013

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-663 K C.
Megacure Acupuncture, P.C. as Assignee of ISARADAT JEWDHAN, Appellant, —

against

Lancer Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered November 26, 2010. The order denied defendant’s motion to compel plaintiff to produce Tatyana Kapustina, L.Ac., and Oleg Shargordoskiy for examinations before trial and granted plaintiff’s cross motion for summary judgment.

ORDERED that the order is modified by providing that plaintiff’s cross motion for summary judgment is denied as to so much of the complaint as seeks to recover for claims in the sums of $786.22, $323.96, $605.34, $413.80, $281.98 and $124.14, and by further providing that defendant’s motion to compel is granted to the extent of compelling plaintiff to produce Tatyana Kapustina, L.Ac., and Oleg Shargordoskiy for examinations before trial solely with respect to the issue of plaintiff’s billing practices; 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 to compel plaintiff to produce Tatyana Kapustina, L.Ac., and Oleg Shargordoskiy, plaintiff’s owner and the treating provider, respectively, for examinations before trial (EBTs) regarding plaintiff’s “treatment” and “billing practices,” and plaintiff cross-moved for summary judgment. Defendant opposed plaintiff’s cross motion, arguing that it had timely denied [*2]plaintiff’s claims on the ground that Tatyana Kapustina, L.Ac., and Oleg Shargordoskiy had failed to appear for examinations under oath (EUOs). The Civil Court denied defendant’s motion and granted plaintiff’s cross motion.

With respect to plaintiff’s claims for the sums of $114, $300.32, and $931.68, it is undisputed that these claims were not paid or denied within 30 days of their receipt. Nor does defendant assert that the EUOs of Tatyana Kapustina, L.Ac., and Oleg Shargordoskiy were requested, or pending, during that time. We note that defendant’s February 13, 2007 letter purporting to delay payment of the claims was not mailed within 15 days of defendant’s receipt of any of these claims and, in any event, is insufficient to toll the 30-day statutory time period within which a claim must be paid or denied (see ARCO Med. NY, P.C. v Lancer Ins. Co., 34 Misc 3d 135[A], 2011 NY Slip Op 52384[U] [App Term, 2d, 11th & 13th Jud Dists 2011]; Points of Health Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133[A], 2010 NY Slip Op 51338[U] [App Term, 2d, 11th & 13th Jud Dists 2010]). Consequently, defendant failed to demonstrate that these three claims had been timely denied and therefore did not establish that its defenses as to these three claims are not precluded. Thus, the Civil Court properly granted the branches of plaintiff’s cross motion seeking summary judgment as to so much of the complaint as sought to recover upon these claims.

In opposition to the remaining branches of plaintiff’s motion, defendant established that the EUO scheduling letters 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]; ARCO Med. NY, P.C. v Lancer Ins. Co., 37 Misc 3d 136[A], 2012 NY Slip Op 52178[U] [App Term, 2d, 11th & 13th Jud Dists 2012]; ARCO Med. NY, P.C., 34 Misc 3d 135[A], 2011 NY Slip Op 52384[U]), that Tatyana Kapustina, L.Ac., and Oleg Shargordoskiy had failed to appear for the EUOs (see Alrof, Inc. v Safeco Natl. Ins. Co., 39 Misc 3d 130[A], 2013 NY Slip Op 50458[U] [App Term, 2d, 11th & 13th Jud Dists 2013]; ARCO Med. NY, P.C., 34 Misc 3d 135[A], 2011 NY Slip Op 52384[U]) and that the claims had been timely denied on that ground (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; Delta Diagnostic Radiology, P.C., 17 Misc 3d 16; see also Insurance Department Regulations [11 NYCRR] § 65-3.8 [j]; Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294, 300-301 [2007]). Although the follow-up EUO scheduling letter was sent less than 30 days after the initial request (see Insurance Department Regulations [11 NYCRR] § 65-3.6 [b]), where, as here, the verification sought is an EUO, a follow-up request is not premature when sent within 10 days after the failure to appear for the initial scheduled examination (see ARCO Med. NY, P.C., 37 Misc 3d 136[A], 2012 NY Slip Op 52178[A]; ARCO Med., NY, P.C., 34 Misc 3d 135[A], 2011 NY Slip Op 52384[U]).

Consequently, as defendant is not precluded from interposing its defense that plaintiff had failed to comply with a condition precedent to coverage (see Insurance Department Regulations [11 NYCRR] § 65-1.1; Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]; ARCO Med. NY, P.C., 37 Misc 3d 136[A], 2012 NY Slip Op 52178[U]; ARCO Med. NY, P.C., 34 Misc 3d 135[A], 2011 NY Slip Op 52384[U]), the branches of plaintiff’s cross motion seeking summary judgment upon so much of the complaint as sought to recover for claims in the sums of $786.22, $323.96, $605.34, $413.80, $281.98 and $124.14 are denied.

With respect to defendant’s motion to compel plaintiff to produce Tatyana Kapustina, [*3]L.Ac., and Oleg Shargordoskiy for EBTs, a review of the record indicates that defendant preserved its “billing practices” defense by checking box 18 on the NF-10 denial of claim form to assert that plaintiff’s “fees [were] not in accordance with the fee schedule.” However, as defendant’s denial of claim form did not raise any defense based on “treatment,” defendant is precluded from raising any such defense (see e.g. Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556 [2008]). In view of the foregoing, and as defendant established that it had served an EBT notice and that plaintiff had failed to produce Tatyana Kapustina, L.Ac., and Oleg Shargordoskiy for EBTs, defendant’s motion to compel is granted to the extent of compelling plaintiff to produce Tatyana Kapustina, L.Ac., and Oleg Shargordoskiy for EBTs solely with respect to the issue of plaintiff’s billing practices (see Philip v Monarch Knitting Mach. Corp., 169 AD2d 603, 604 [1991]; Blessin v Greenberg, 89 AD2d 862 [1982]; Arco Med. NY, P.C., 37 Misc 3d 136[A], 2012 NY Slip Op 52178[U]).

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: November 21, 2013