Bedford Park Neurology, P.C. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 52634(U))

Reported in New York Official Reports at Bedford Park Neurology, P.C. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 52634(U))

Bedford Park Neurology, P.C. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 52634(U)) [*1]
Bedford Park Neurology, P.C. v New York Cent. Mut. Fire Ins. Co.
2009 NY Slip Op 52634(U) [26 Misc 3d 128(A)]
Decided on December 23, 2009
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.
Decided on December 23, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : PESCE, P.J., WESTON and RIOS, JJ
2008-2061 Q C.
Bedford Park Neurology, P.C. as assignee of Mario Vasconcellos, Respondent,

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 (Diane A. Lebedeff, J.), entered September 17, 2008. The order, insofar as appealed from, denied the branch of defendant’s motion seeking to dismiss so much of plaintiff’s complaint as sought to recover upon a claim form seeking the sum of $2,992.

ORDERED that the order, insofar as appealed from, is reversed without costs and the branch of defendant’s motion seeking to dismiss so much of plaintiff’s complaint as sought to recover upon a claim form seeking the sum of $2,992 is granted.

In this action to recover assigned first-party no-fault benefits, defendant moved, insofar as is relevant to this appeal, to dismiss so much of plaintiff’s complaint as sought to recover upon a claim form seeking the sum of $2,992, on the ground that plaintiff lacked standing to recover upon said claim because the claim form submitted to defendant identified only a physician as the provider and it neither referenced plaintiff, a professional services corporation, to whom the assignor had assigned his benefits, nor set forth the provider’s relationship to plaintiff. In denying defendant this relief, the Civil Court noted that the claim form contained a handwritten notation, “Bedford Park [sic],” in parentheses, alongside the name of the physician, in the portion of the form labeled provider, and plaintiff had annexed a copy of the assignment in favor of plaintiff as an exhibit to the cross motion brought by plaintiff. Defendant appeals from so much of the order as denied the branch of its motion seeking to dismiss plaintiff’s claim seeking the sum of $2,992.

The claim form at issue sought to recover payment on behalf of the physician who rendered the services and not on behalf of plaintiff. Indeed, while the handwritten notation on the claim form refers parenthetically to “Bedford Park Neurology,” this is not the name of plaintiff professional corporation. Consequently, plaintiff’s belated attempt to establish that the claimant physician was either an employee or principal of plaintiff, and that the claim form contains misinformation, is unavailing (A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co., 22 Misc 3d 70 [App Term, 2d & 11th Jud Dists 2008]). Plaintiff failed to submit a claim form which entitled it to payment, and may not correct the allegedly erroneous claim form once [*2]litigation has commenced (id.; cf. Davydov v Progressive Ins. Co., 25 Misc 3d 19 [App Term, 2d, 11th & 13th Jud Dists 2009]). Accordingly, the branch of defendant’s motion seeking to dismiss so much of plaintiff’s complaint as sought to recover upon a claim form seeking the sum of $2,992 should have been granted (A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co., 22 Misc 3d 70).

Pesce, P.J., Weston and Rios, JJ., concur.
Decision Date: December 23, 2009

Staten Is. Advanced Surgical Supply v GEICO Ins. Co. (2009 NY Slip Op 52633(U))

Reported in New York Official Reports at Staten Is. Advanced Surgical Supply v GEICO Ins. Co. (2009 NY Slip Op 52633(U))

Staten Is. Advanced Surgical Supply v GEICO Ins. Co. (2009 NY Slip Op 52633(U)) [*1]
Staten Is. Advanced Surgical Supply v GEICO Ins. Co.
2009 NY Slip Op 52633(U) [26 Misc 3d 128(A)]
Decided on December 23, 2009
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.
Decided on December 23, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : WESTON, J.P., GOLIA and STEINHARDT, JJ
2008-2037 Q C.
Staten Island Advanced Surgical Supply as assignee of Xiao Min Huang, Respondent,

against

GEICO Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered October 9, 2008, deemed from a judgment of the same court entered November 5, 2008 (see CPLR 5501 [c]). The judgment, entered pursuant to the October 9, 2008 order granting plaintiff’s motion for summary judgment, awarded plaintiff the principal sum of $575.30.

ORDERED that the judgment is reversed without costs, the order granting plaintiff’s motion for summary judgment is vacated, and plaintiff’s motion for summary judgment is denied.

In this action by a provider to recover assigned first-party no-fault benefits, defendant argued, in opposition to a motion by plaintiff for summary judgment,
that plaintiff had failed to establish a prima facie case and that defendant had timely denied plaintiff’s bill on the ground of lack of medical necessity. The Civil Court granted plaintiff’s motion, and defendant appealed. The appeal is deemed to be from the judgment which was subsequently entered (see CPLR 5501 [c]).

Since the affidavit of defendant’s claims representative conceded receipt of the claim in question (see East Acupuncture, P.C. v Electric Ins. Co., 16 Misc 3d 128[A], 2007 NY Slip Op 51281[U] [App Term, 2d & 11th Jud Dists 2007]; Oleg Barshay, D.C., P.C. v State Farm Ins. Co., 14 Misc 3d 74 [App Term, 2d & 11th Jud Dists 2006]) and the affidavit of plaintiff’s billing manager established that the documents annexed to plaintiff’s motion were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]), plaintiff’s prima facie entitlement to summary judgment was established.

In opposition to the motion, defendant established that it had timely mailed its request for verification and subsequent denial of claim form, which denied plaintiff’s claim on the ground of lack of medical necessity, by submitting an affidavit of an employee with knowledge of defendant’s standard office practices or procedures designed to ensure that items were properly [*2]addressed and mailed (see e.g. St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; 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]). Defendant also annexed a copy of the affirmed peer review report setting forth a factual basis and medical rationale for the conclusion that the equipment provided was not medically necessary (see e.g. Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Amaze Med. Supply Inc. v Allstate Ins. Co., 12 Misc 3d 142[A], 2006 NY Slip Op 51412[U] [App Term, 2d & 11th Jud Dists 2006]). As a result, defendant raised a triable issue of fact and, thus, plaintiff’s motion for summary judgment should have been denied.

We decline defendant’s request that we search the record and grant defendant summary judgment (see e.g. New York Univ. Hosp. Rusk Inst. v Government Empls. Ins. Co., 39 AD3d 832 [2007]).

Weston, J.P., Golia and Steinhardt, JJ., concur.
Decision Date: December 23, 2009

Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2009 NY Slip Op 52632(U))

Reported in New York Official Reports at Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2009 NY Slip Op 52632(U))

Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2009 NY Slip Op 52632(U)) [*1]
Quality Rehab & P.T., P.C. v GEICO Ins. Co.
2009 NY Slip Op 52632(U) [26 Misc 3d 127(A)]
Decided on December 23, 2009
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected in part through January 7, 2010; it will not be published in the printed Official Reports.
Decided on December 23, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : WESTON, J.P., GOLIA and STEINHARDT, JJ
2008-2033 Q C.
Quality Rehab and P.T., P.C. as assignee of Phillip Lawson, Respondent,

against

GEICO Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered September 22, 2008. The order, insofar as appealed from as limited by the brief, granted plaintiff’s motion for summary judgment. The appeal is deemed to be from a judgment of the same court entered November 5, 2008 which awarded plaintiff the principal sum of $292.24 (see CPLR 5501 [c]).

ORDERED that the judgment is reversed without costs, so much of the order as granted plaintiff’s motion for summary judgment is vacated, plaintiff’s motion for summary judgment is denied and the matter is remitted to the Civil Court for all further proceedings.

In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court granted plaintiff’s motion for summary judgment and denied defendant’s cross motion for summary judgment. As limited by its brief, defendant appeals from so much of the order as granted plaintiff’s motion for summary judgment. The appeal is deemed to be from the judgment which was subsequently entered (see CPLR 5501 [c]).

On appeal, defendant’s sole contention with respect to plaintiff’s prima facie case is that the affidavit of plaintiff’s billing manager failed to establish that the documents annexed to plaintiff’s motion for summary judgment were admissible as business records. Upon our review of the record, we find that the affidavit was sufficient to establish that the documents annexed to plaintiff’s moving papers were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]).

Contrary to the finding of the Civil Court, the affidavit of defendant’s claims representative sufficiently established the timely mailing of the denial of claim form, which denied plaintiff’s claim on the ground, among others, that the services rendered were not medically necessary (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]). Also annexed to the motion papers were affirmed independent medical examination reports which set forth a factual basis and medical rationale for the peer reviewers’ [*2]opinions that the medical services provided were not medically necessary (see A.B. Med. Servs., PLLC v American Tr. Ins. Co., 15 Misc 3d 132[A], 2007 NY Slip Op 50680[U] [App Term, 2d & 11th Jud Dists 2007]; Amaze Med. Supply Inc. v Allstate Ins. Co., 12 Misc 3d 142[A], 2006 NY Slip Op 51412[U] [App Term, 2d & 11th Jud Dists 2006]). As a result, plaintiff’s motion for summary judgment should have been denied due to the existence of an issue of fact.

Accordingly, the judgment is reversed, so much of the order as granted plaintiff’s motion for summary judgment is vacated, plaintiff’s motion for summary judgment is denied and the matter is remitted to the Civil Court for all further proceedings.

Weston, J.P., Golia and Steinhardt, JJ., concur.
Decision Date: December 23, 2009

Velen Med. Supply, Inc. v Country-Wide Ins. Co. (2009 NY Slip Op 52630(U))

Reported in New York Official Reports at Velen Med. Supply, Inc. v Country-Wide Ins. Co. (2009 NY Slip Op 52630(U))

Velen Med. Supply, Inc. v Country-Wide Ins. Co. (2009 NY Slip Op 52630(U)) [*1]
Velen Med. Supply, Inc. v Country-Wide Ins. Co.
2009 NY Slip Op 52630(U) [26 Misc 3d 127(A)]
Decided on December 23, 2009
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.
Decided on December 23, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : GOLIA, J.P., PESCE and WESTON, JJ
2008-1847 Q C.
Velen Medical Supply, Inc. a/a/o Damien Dickenson, Respondent,

against

Country-Wide Insurance Company, Appellant.

Appeal from a judgment of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered July 29, 2008. The judgment, entered upon an order of the same court entered May 8, 2008 granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment dismissing the complaint, awarded plaintiff the principal sum of $1,543.

ORDERED that the judgment is reversed without costs, the order entered May 8, 2008 is vacated, plaintiff’s motion for summary judgment is denied and defendant’s cross motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. Defendant opposed plaintiff’s motion and cross-
moved for summary judgment, arguing that plaintiff had failed to make a prima facie showing of its entitlement to judgment as a matter of law and that, in any event, the action was premature due to plaintiff’s failure to provide requested verification. The Civil Court granted plaintiff’s motion and denied defendant’s cross motion, finding, among other things, that defendant had failed to establish that its time to pay or deny plaintiff’s claims had been tolled since defendant’s follow-up verification request had been sent to plaintiff 29 days after the initial request for verification. A judgment was subsequently entered, and this appeal by defendant ensued.

It is undisputed that defendant timely mailed its initial request for verification and that plaintiff failed to provide the information requested. Plaintiff also did not provide the information requested in defendant’s follow-up verification request, which was mailed on the 29th day after the initial verification request, but prior to the expiration of the full 30-day period within which plaintiff was supposed to respond to defendant’s initial request for verification. As the foregoing facts are nearly identical to those in Infinity Health Prods., Ltd. v Eveready Ins. Co. (___ AD3d ___, 2009 NY Slip Op 08585 [2d Dept 2009]), “the 30-day period within which the defendant was required to pay or deny the claim did not commence to run . . . [and] plaintiff’s action is premature” (id. at *2 [citations omitted]). In view of the foregoing, we reach no other [*2]issue.

Accordingly, the judgment is reversed, the order entered May 8, 2008 is vacated, plaintiff’s motion for summary judgment is denied and defendant’s cross motion for summary judgment dismissing the complaint is granted on the ground that the action is premature.

Golia, J.P., Pesce and Weston, JJ., concur.
Decision Date: December 23, 2009

Preferred Med. Imaging, P.C. v Countrywide Ins. Co. (2009 NY Slip Op 52577(U))

Reported in New York Official Reports at Preferred Med. Imaging, P.C. v Countrywide Ins. Co. (2009 NY Slip Op 52577(U))

Preferred Med. Imaging, P.C. v Countrywide Ins. Co. (2009 NY Slip Op 52577(U)) [*1]
Preferred Med. Imaging, P.C. v Countrywide Ins. Co.
2009 NY Slip Op 52577(U) [25 Misc 3d 144(A)]
Decided on December 18, 2009
Appellate Term, First Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.
Decided on December 18, 2009

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT


PRESENT: McKeon, P.J., Heitler, Hunter, JJ
570628/09.
Preferred Medical Imaging, P.C. a/a/o Nathaniel Leach, Petitioner-Respondent,

against

Countrywide Insurance Company, Respondent-Appellant.

Respondent Countrywide Insurance Company appeals from an order of the Civil Court of the City of New York, New York County (Eileen A. Rakower, J.), dated April 27, 2006, which granted the petition to vacate an arbitration award and awarded petitioner Preferred Medical Imaging, P.C. unpaid no-fault benefits in the principal sum of $912.

Per Curiam.

Order (Eileen A. Rakower, J.), dated April 27, 2006, affirmed, without costs.

Civil Court properly vacated the arbitration award issued in an arbitration proceeding commenced by the provider, Preferred Medical Imaging, P.C., to recover first-party no-fault benefits, since the court correctly concluded that the award was not “supported by a reasonable hypothesis and was … contrary to what could be fairly described as settled law” (Matter of State Farm Mut. Auto. Ins. Co. v Lumbermens Mut. Cas. Co., 18 AD3d 762, 763 [2005], citing Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d 214, 224 [1996]). The arbitrator’s conclusion, which was sustained by the master arbitrator, that the provider was required to establish the medical necessity of the services rendered was contrary to settled law (see e.g. Mary Immaculate Hosp v Allstate Ins. Co., 5 AD3d 742 [2004]; see also Metro. Radiological Imaging, P.C. v Country-Wide Ins. Co., 19 Misc 3d 130[A] [2008]).Respondent-appellant Countrywide Insurance Company’s remaining contentions are without merit.

We note respondent-appellant’s three and a half year delay in perfecting this appeal.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: December 18, 2009

Andromeda Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 52601(U))

Reported in New York Official Reports at Andromeda Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 52601(U))

Andromeda Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 52601(U)) [*1]
Andromeda Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co.
2009 NY Slip Op 52601(U) [26 Misc 3d 126(A)]
Decided on December 15, 2009
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.
Decided on December 15, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : GOLIA, J.P., PESCE and WESTON, JJ
2008-2014 K C.
Andromeda Medical Care, P.C. a/a/o JOHN SOUTHERN, Respondent,

against

NY Central Mutual Fire Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Richard Velasquez, J.), entered June 12, 2008. The order denied defendant’s motion for summary judgment.

ORDERED that the order is reversed without 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 dismissing the complaint. Insofar as is relevant to this appeal, the Civil Court found that there was a triable issue of fact as to whether the alleged accident had occurred. The sole issue raised on appeal is whether defendant made a prima facie showing that plaintiff’s assignor’s injuries did not arise out of an insured incident (see Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, 199 [1997]), such that the burden shifted to plaintiff to raise a triable issue of fact (see Friends of Animals v Associated Fur Mfrs., 46 NY2d 1065 [1979]).

In support of its motion, defendant annexed the affidavit of its insured, who averred that she had not hit any pedestrians. This affidavit was sufficient to demonstrate, prima facie, that “the alleged injur[ies] do[] not arise out of an insured incident” (Central Gen. Hosp., 90 NY2d at 199). Since plaintiff failed to raise a triable issue of fact in opposition to the motion, defendant’s motion for summary judgment should have been granted (see Zuckerman v City of New York, 49 NY2d 557 [1980]).

Golia, J.P., Pesce and Weston, JJ., concur. [*2]
Decision Date: December 15, 2009

Chester Med. Diagnostic, P.C. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 52598(U))

Reported in New York Official Reports at Chester Med. Diagnostic, P.C. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 52598(U))

Chester Med. Diagnostic, P.C. v State Farm Mut. Auto. Ins. Co. (2009 NY Slip Op 52598(U)) [*1]
Chester Med. Diagnostic, P.C. v State Farm Mut. Auto. Ins. Co.
2009 NY Slip Op 52598(U) [26 Misc 3d 126(A)]
Decided on December 15, 2009
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.
Decided on December 15, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : GOLIA, J.P., PESCE and WESTON, JJ
2008-1574 K C.
Chester Medical Diagnostic, P.C. a/a/o FELIX ESTEBEZ, Appellant,

against

State Farm Mutual Automobile Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Lila Gold, J.), entered December 11, 2007. The order granted defendant’s motion to dismiss the complaint.

ORDERED that the order is affirmed without costs.

On November 21, 2006, plaintiff, a provider, commenced the instant action to recover assigned first-party no-fault benefits for a claim which was submitted to defendant on April 28, 2000. Defendant moved to dismiss the complaint on the ground that it was time-barred by the six-year statute of limitations. Plaintiff opposed defendant’s motion arguing that since this was defendant’s second pre-answer motion to dismiss, it was procedurally defective. The Civil Court granted defendant’s motion and dismissed the complaint. The instant appeal by plaintiff ensued.

A motion to dismiss a complaint pursuant to CPLR 3211 (a) may be made at any time before service of the responsive pleading is required but no more than one such motion shall be permitted (see CPLR 3211 [e]). Where, as here, the original motion to dismiss the complaint pursuant to CPLR 3211 (a) is not decided on the merits, a subsequent motion to dismiss pursuant to CPLR 3211 (a) does not violate the single motion rule set forth in CPLR 3211 (e) (see Curtis v Chetrit, 243 AD2d 423 [1997]; Breiterman v Haidt, 4 Misc 3d 130[A], 2004 NY Slip Op 50683[U] [App Term, 1st Dept 2004]). Plaintiff’s remaining contention is not preserved for appellate review.

Accordingly, the order granting defendant’s motion to dismiss the complaint is affirmed.

Golia, J.P., Pesce and Weston, JJ., concur. [*2]
Decision Date: December 15, 2009

Mid Atl. Med., P.C. v Electric Ins. Co. (2009 NY Slip Op 52597(U))

Reported in New York Official Reports at Mid Atl. Med., P.C. v Electric Ins. Co. (2009 NY Slip Op 52597(U))

Mid Atl. Med., P.C. v Electric Ins. Co. (2009 NY Slip Op 52597(U)) [*1]
Mid Atl. Med., P.C. v Electric Ins. Co.
2009 NY Slip Op 52597(U) [26 Misc 3d 126(A)]
Decided on December 15, 2009
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.
Decided on December 15, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : GOLIA, J.P., PESCE and WESTON, JJ
2008-1229 K C.
Mid Atlantic Medical, P.C. a/a/o EDWIN NUNEZ, Appellant,

against

Electric Insurance Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Wavny Toussaint, J.), entered February 26, 2008. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment.

ORDERED that 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 which denied its motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint on the ground that plaintiff had failed to submit a timely notice of claim (Insurance Department Regulations [11 NYCRR] § 65-1.1) and that plaintiff had failed to provide a “reasonable justification of the failure to give timely notice” (Insurance Department Regulations [11 NYCRR] § 65-3.3 [e]).

On appeal, plaintiff contends that defendant is not entitled to summary judgment because the affidavit of defendant’s no-fault adjuster is inadmissible inasmuch as it failed to comply with CPLR 2309 (c). However, as this contention is raised for the first time on appeal, it is 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]). Plaintiff further argues that defendant is precluded from relying upon plaintiff’s untimely notice of claim because defendant’s denial of claim form did not advise plaintiff that “late notice will be excused where the applicant can provide reasonable justification of the failure to give timely notice,” as required by Insurance Department Regulations (11 NYCRR) § 65-3.3 (e). Said issue was likewise raised for the first time on appeal, as it differs from plaintiff’s contention in the Civil Court, which did not challenge the sufficiency of defendant’s denial of claim form but, [*2]rather, asserted that defendant did not demonstrate that plaintiff had failed to
provide a reasonable justification for the untimely notice of claim. Consequently, this contention by plaintiff is similarly waived. Accordingly, the order is affirmed.

Golia, J.P., Pesce and Weston, JJ., concur.
Decision Date: December 15, 2009

A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2009 NY Slip Op 52513(U))

Reported in New York Official Reports at A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2009 NY Slip Op 52513(U))

A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2009 NY Slip Op 52513(U)) [*1]
A.B. Med. Servs., PLLC v American Tr. Ins. Co.
2009 NY Slip Op 52513(U) [25 Misc 3d 143(A)]
Decided on December 9, 2009
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.
Decided on December 9, 2009

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS


PRESENT: : TANENBAUM, J.P., MOLIA and IANNACCI, JJ
2008-2203 N C.
A.B. Medical Services, PLLC, D.A.V. CHIROPRACTIC, P.C. and LVOV ACUPUNCTURE, P.C. a/a/o LUC CHARLES, Appellants,

against

American Transit Insurance Company, Respondent.

Appeal from an order of the District Court of Nassau County, Third District (Fred J. Hirsh, J.), entered September 24, 2008. The order, insofar as appealed from as limited by the brief, denied the branch of plaintiffs’ motion seeking summary judgment in favor of plaintiffs D.A.V. Chiropractic, P.C. and Lvov Acupuncture, P.C.; sua sponte, stayed the action with respect to plaintiff A.B. Medical Services, PLLC without determining the branch of plaintiffs’ motion seeking summary judgment in favor of plaintiff A.B. Medical Services, PLLC and granted the branches of defendant’s cross motion for summary judgment dismissing the complaint insofar as asserted by plaintiffs D.A.V. Chiropractic, P.C. and Lvov Acupuncture, P.C.

ORDERED that, on the court’s own motion, the notice of appeal from so much of the order as, sua sponte, stayed the action is treated as an application for leave to appeal from that portion of the order, and leave to appeal from that portion of the order is granted (see UDCA 1702); and it is further,

ORDERED that the appeal by plaintiff D.A.V. Chiropractic, P.C. is dismissed as abandoned; and it is further,

ORDERED that the order, insofar as appealed from and reviewed, is modified by providing that so much of the order as, sua sponte, stayed the action with respect to plaintiff A.B. Medical Services, PLLC without determining the branch of plaintiffs’ motion seeking summary judgment in favor of plaintiff A.B. Medical Services, PLLC is stricken, and the matter is remitted to the District Court for a determination of said branch of plaintiffs’ motion; as so modified, the order is affirmed without costs. [*2]

In this action by providers to recover assigned first-party no-fault benefits for services rendered to their assignors from March 2004 through July 2004, plaintiffs moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint. The District Court, sua sponte, stayed the action as to plaintiff A.B. Medical Services, PLLC (A.B. Med.) without determining the branch of plaintiffs’ motion seeking summary judgment in favor of A.B. Med., so that said plaintiff “can properly dissolve and obtain the appointment of a receiver or liquidation trustee to maintain the action,” denied the branches of plaintiffs’ motion seeking summary judgment in favor of plaintiffs Lvov Acupuncture, P.C. (Lvov) and D.A.V. Chiropractic, P.C. (D.A.V.), and granted the branches of defendant’s cross motion seeking summary judgment dismissing the complaint insofar as asserted by Lvov and D.A.V. The instant appeal by plaintiffs ensued.

For the reasons stated in A.B. Med. Servs., PLLC a/a/o Beauliere v Travelers Indem. Co. (___ Misc 3d ___, 2009 NY Slip Op _____ [Appeal No. 2009-549 N C], decided herewith), leave to appeal from so much of the order as, sua sponte, stayed the action with respect to A.B. Med. without determining the branch of plaintiffs’ motion seeking summary judgment in favor of A.B. Med. is granted, said provision is stricken, and the matter is remitted to the District Court for a determination of said branch of plaintiffs’ motion.

It is uncontroverted that defendant’s denial of claim forms and verification requests were proper and timely. Contrary to Lvov’s contention, the denial of claim forms pertaining to Lvov clearly informed it of the insurer’s position regarding any disputed matter (see Insurance Department Regulations [11 NYCRR] § 65-3.2 [e]), and included the information called for in the prescribed denial of claim form (see Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co., 16 AD3d 564, 565 [2005]; Nyack Hosp. v State Farm Mut. Auto. Ins. Co., 11 AD3d 664, 665 [2004]). As the remaining contentions asserted by Lvov have no merit, the District Court properly denied the branch of plaintiffs’ motion seeking summary judgment in favor of Lvov and granted the branch of defendant’s cross motion seeking summary judgment dismissing the complaint insofar as asserted by Lvov.

We note that no issue is raised on appeal regarding so much of the order as granted the branch of defendant’s cross motion seeking summary judgment dismissing the complaint insofar as asserted by D.A.V. Accordingly, the appeal by D.A.V. is deemed abandoned (see e.g. Pizzaro v State of New York, 19 AD3d 891 [2005]) and is, therefore, dismissed.

In remitting the matter for determination of the branch of plaintiffs’ motion seeking summary judgment in favor of A.B. Med., we note that the court similarly did not pass upon the merits of the branch of defendant’s cross motion seeking summary judgment dismissing the complaint insofar as asserted by A.B. Med.

Tanenbaum, J.P., Molia and Iannacci, JJ., concur.
Decision Date: December 09, 2009

Mia Acupuncture, P.C. v Mercury Ins. Co. (2009 NY Slip Op 29509)

Reported in New York Official Reports at Mia Acupuncture, P.C. v Mercury Ins. Co. (2009 NY Slip Op 29509)

Mia Acupuncture, P.C. v Mercury Ins. Co. (2009 NY Slip Op 29509)
Mia Acupuncture, P.C. v Mercury Ins. Co.
2009 NY Slip Op 29509 [26 Misc 3d 39]
Accepted for Miscellaneous Reports Publication
AT2
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, February 24, 2010

[*1]

Mia Acupuncture, P.C., as Assignee of Noel Kellon, Respondent,
v
Mercury Ins. Co., Appellant.

Supreme Court, Appellate Term, Second Department, December 9, 2009

APPEARANCES OF COUNSEL

Picciano & Scahill, P.C., Westbury (Jason Tenenbaum of counsel), for appellant. Ilona Finkelshteyn, P.C., Brooklyn, for respondent.

{**26 Misc 3d at 40} OPINION OF THE COURT

Memorandum.

Ordered that the order is affirmed without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant served various discovery requests, seeking, among other things, to conduct an examination before trial of plaintiff. Subsequently, defendant served plaintiff’s assignor with a notice of deposition and notified plaintiff’s counsel of the deposition request. When the assignor failed to appear for the deposition, defendant moved to dismiss the complaint, arguing that, by virtue of the assignment, party status may be imputed to the assignor and, even if such status could not be so imputed, the assignor was under the plaintiff assignee’s control (see CPLR 3126 [3]). The Civil Court denied the motion, and defendant appealed.

By its terms, the CPLR 3126 (3) dismissal sanction is applicable only to the disclosure violations of parties, not nonparties (see Siegel, NY Prac § 367 [4th ed]). By virtue of their assignment of no-fault benefits to their providers, eligible injured persons have divested themselves of their interest in those benefits, and they are not parties to actions commenced by their assignees (see e.g. Leon v Martinez, 84 NY2d 83, 88 [1994]; Cardtronics, LP v St. Nicholas Beverage Discount Ctr., Inc., 8 AD3d 419, 420 [2004]; 6A NY Jur 2d, Assignments §§ 59, 85). Similarly, a provider’s party status cannot be imputed to the assignor by virtue of an assignment. Thus, since plaintiff’s assignor is not an officer, member or employee of plaintiff or otherwise under plaintiff’s control, the Civil Court properly denied the motion for sanctions as against plaintiff pursuant to CPLR 3126 (Connors, Practice Commentaries, McKinney’s Cons Laws of [*2]NY, Book 7B, CPLR C3101:20; see Doelger, Inc. v L. Fatato, Inc., 7 AD2d 1003 [1959]; National Bank of N. Hudson v{**26 Misc 3d at 41} Kennedy, 223 App Div 680 [1928]; see also Schneider v Melmarkets Inc., 289 AD2d 470 [2001]; Zappolo v Putnam Hosp. Ctr., 117 AD2d 597 [1986]; Andrew Carothers, M.D., P.C. v GEICO Indem. Co., 20 Misc 3d 143[A], 2008 NY Slip Op 51756[U] [App Term, 2d & 11th Jud Dists 2008]; A.M. Med. Servs., P.C. v Allstate Ins. Co., 14 Misc 3d 143[A], 2007 NY Slip Op 50384[U] [App Term, 2d & 11th Jud Dists 2007]).

Rios, J.P., Pesce and Golia, JJ., concur.