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

Appeal from an order of the Civil Court of the City of New York, Kings County (Alice Fisher Rubin, J.), entered July 22, 2010, deemed from a judgment of the same court entered August 16, 2010 (see CPLR 5501 [c]). The judgment, entered pursuant to the July 22, 2010 order granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment dismissing the complaint, awarded plaintiff the principal sum of $1,517.41.

ORDERED that the judgment is reversed, without costs, so much of the July 22, 2010 order as granted plaintiff’s motion for summary judgment and denied the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for claims dated July 19, 2007, August 29, 2007, and October 11, 2007 is vacated, plaintiff’s motion for summary judgment is denied, and the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for claims dated July 19, 2007, August 29, 2007, and October 11, 2007 are granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment dismissing the complaint. A judgment [*2]was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

Plaintiff sought to recover upon six claim forms. As to all of the forms except for a claim form dated June 4, 2007, plaintiff failed to establish its prima facie entitlement to summary judgment, since it did not prove either that defendant had failed to pay or deny the claims within the requisite 30-day period, or that defendant had issued timely denials that were 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]; 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]). As to the June 4, 2007 claim, plaintiff did establish its prima facie entitlement to summary judgment; however, we find that defendant’s proof was sufficient to raise a triable issue of fact as to whether defendant had timely and properly denied the claim on the ground that the fees charged exceeded the amounts set forth in the workers’ compensation fee schedule (see e.g. East Coast Acupuncture, P.C. v New York Cent. Mut. Ins., 18 Misc 3d 139[A], 2008 NY Slip Op 50344[U] [App Term, 2d & 11th Jud Dists 2008]). Thus, plaintiff’s motion for summary judgment should have been denied in its entirety.

Defendant established that it 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 dated July 19, 2007, August 29, 2007, and October 11, 2007, respectively, on the ground of lack of medical necessity. In addition, defendant submitted an affirmed independent medical examination report which demonstrated a prima facie showing of lack of medical necessity for these services, which proof was not rebutted by plaintiff. Accordingly, the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for these three claims should have been granted (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]).

The branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for the three remaining claims were properly denied, as defendant failed to conclusively establish its stated defenses that the fees charged exceeded the amounts set forth in the workers’ compensation fee schedule (see Rogy
Med., 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]) and that there was an unmet personal injury protection deductible.

Accordingly, the judgment is reversed, so much of the July 22, 2010 order as granted plaintiff’s motion for summary judgment and denied the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for claims dated July 19, 2007, August 29, 2007, and October 11, 2007 is vacated, plaintiff’s motion for summary judgment is denied, and the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for claims dated July 19, 2007, August 29, 2007, and October 11, 2007 are granted.

Pesce, P.J., Rios and Aliotta, JJ., concur. [*3]
Decision Date: August 07, 2012

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

Appeal from a judgment of the Civil Court of the City of New York, Kings County (Jules L. Spodek, J.H.O.), entered January 14, 2010. The judgment, after a nonjury trial, awarded plaintiff the principal sum of $2,592.06.

ORDERED that the judgment is reversed, without costs, and the matter is remitted to the Civil Court for a new trial limited to the issue of medical necessity.

At a nonjury trial in this action by a provider to recover assigned first-party no-fault benefits, the parties stipulated that the only issue for trial was the medical necessity of the services provided, and agreed that defendant had the burden of going forward as a result of the stipulation. Defense counsel sought to offer into evidence the deposition transcript of its medical doctor, pursuant to CPLR 3117 (a) (4). The Civil Court refused to permit defendant to do so, and directed that judgment be entered in favor of plaintiff. A judgment was subsequently entered, from which defendant appeals. CPLR 3117 (a) (4) provides that “the deposition of a person authorized to practice medicine may be used by any party without the necessity of showing unavailability or special circumstances, subject to the right of any party to move pursuant to section 3103 to prevent abuse.” There is nothing in the trial record to indicate that plaintiff [*2]moved for a protective order pursuant to CPLR 3103.

While a trial court’s exercise of discretion under CPLR 3117 is reviewable only for “clear abuse” (see Feldsberg v Nitschke, 49 NY2d 636, 643 [1980]), “in exercising its discretion, the trial court may not act arbitrarily or deprive a litigant of a full opportunity to present his case” (id. at 644). In our view, under the circumstances presented, the Civil Court abused its discretion in sua sponte refusing to permit defendant to offer into evidence the deposition testimony of its doctor (see Goldblatt v Avis Rent A Car Sys., 223 AD2d 670 [1996]; Long Is. Anesthesiology Serv. v Solis 114 Misc 2d 561 [Civ Ct, Kings County 1982]). Accordingly, the judgment is reversed and the matter is remitted to the Civil Court for a new trial limited to the issue of medical necessity.

Pesce, P.J., Rios and Solomon, JJ., concur.
Decision Date: August 06, 2012

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

Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), dated September 23, 2010. The order, insofar as appealed from as limited by the brief, in effect, denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, without 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 found that plaintiff had established its prima facie entitlement to summary judgment, that defendant had “established mailing of proper and timely denials,” and that “[t]he sole issue remaining for trial is whether defendant established its [independent medical examination] No Show defense.” Defendant appeals, as limited by its brief, from so much of the order as denied its cross motion.

In support of its cross motion for summary judgment, defendant submitted an affidavit by [*2]an employee of Crossland Medical Services, P.C. (Crossland), the entity which had scheduled the independent medical examinations (IMEs) on behalf of defendant. The affidavit established that the IME scheduling letters had been timely mailed in accordance with Crossland’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]). Defendant also submitted affidavits by the doctors who were to perform the IMEs which established that the assignor had failed to appear for the scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). As 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.

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

Rios, J.P., Pesce and Aliotta, JJ., concur.
Decision Date: August 06, 2012

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

Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered September 8, 2010. The order denied defendant’s motion to dismiss the complaint.

ORDERED that the order is reversed, without costs, and defendant’s motion to dismiss the complaint is granted.

Plaintiff commenced this action to recover assigned first-party no-fault benefits in May of 2008. Defendant defaulted. More than two years later, defendant moved to dismiss the complaint pursuant to CPLR 3215 (c). The Civil Court denied defendant’s unopposed motion and defendant appeals.

Where, as here, a plaintiff fails to initiate proceedings for the entry of judgment within one year after the default, the plaintiff is obligated to offer a reasonable excuse for the delay in moving for leave to enter a default judgment, and must demonstrate that the complaint is meritorious, failing which the court, upon its own initiative or on motion, must dismiss the complaint as abandoned (CPLR 3215 [c]; see e.g. County of Nassau v Chmela, 45 AD3d 722 [2007]; Jones v Corley, 35 AD3d 381 [2006]; Kay Waterproofing Corp. v Ray Realty Fulton, [*2]Inc., 23 AD3d 624, 625 [2005]). Upon a review of the facts, and plaintiff’s failure to submit opposition to defendant’s motion, we find that dismissal of the complaint was required pursuant to CPLR 3215 (c).

Accordingly, the order is reversed and defendant’s motion to dismiss the complaint pursuant to CPLR 3215 (c) is granted.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: August 06, 2012

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

Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered July 27, 2010, deemed from a judgment of the same court entered October 5, 2010 (see CPLR 5501 [c]). The judgment, entered pursuant to the July 27, 2010 order granting defendant’s motion to dismiss the complaint pursuant to CPLR 3211 (a) (1) and (4), dismissed the complaint.

ORDERED that the judgment is reversed, without costs, the order entered July 27, 2010 is vacated, and defendant’s motion to dismiss the complaint is denied.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court entered July 27, 2010 granting defendant’s motion to dismiss the complaint pursuant to CPLR 3211 (a) (1) and (4) on the ground that the action had been commenced by the filing of the summons and complaint (see CCA 400 [a]) in violation of a temporary restraining order (TRO) that had been issued by the Supreme Court in another action involving numerous parties, including the parties to this action. A judgment dismissing the complaint was subsequently entered, from which the appeal is deemed to have been taken (see [*2]CPLR 5501 [c]).

It is undisputed that, at the time plaintiff commenced the instant action, it had not yet been served with the TRO. In support of its motion to dismiss, defendant did not submit any proof that plaintiff was otherwise aware of the existence of the TRO or of its terms. Defendant’s contention, made for the first time on appeal, that plaintiff’s attorney was aware that a TRO was being sought is dehors the record and will not be considered (see Chimarios v Duhl, 152 AD2d 508 [1989]).

Thus, as defendant failed to establish that plaintiff had knowledge, actual or imputed, of the terms of the TRO, defendant did not show that plaintiff was barred by the TRO from commencing the instant action (see Matter of McCormick v Axelrod, 59 NY2d 574, 585 [1983]; People ex rel. Stearns v Marr, 181 NY 463 [1905]; Rosado v Edmundo Castillo Inc., 54 AD3d 278 [2008]; Lathrop v Lathrop, 271 App Div 807 [1946]; 67A NY Jur 2d, Injunctions § 213; 12A Carmody-Wait 2d § 78:230, at 441-442).

We note that plaintiff asserts in its brief on appeal, and defendant does not deny, that the TRO has subsequently been lifted.

Accordingly, the judgment is reversed, the order entered July 27, 2010 is vacated, and defendant’s motion to dismiss the complaint is denied.

Pesce, P.J., Rios and Solomon, JJ., concur.
Decision Date: August 06, 2012

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

Appeal from an order of the Civil Court of the City of New York, Queens County (Genine D. Edwards, J.), entered September 28, 2010. The order denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, without costs.

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

The affidavit submitted by defendant in support of its motion for summary judgment failed to establish that defendant 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]). Thus, the Civil Court properly denied defendant’s motion for summary judgment dismissing the complaint, as defendant failed to establish that it is not precluded from raising as a defense the failure of plaintiff’s assignor to appear for an independent medical examination (see Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90 NY2d 274, 282 [1997]).

Accordingly, the order is affirmed.
[*2]Pesce, P.J., Weston and Aliotta, JJ., concur.
Decision Date: August 06, 2012

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

Appeal from an order of the Civil Court of the City of New York, Kings County (Ingrid Joseph, J.), entered August 3, 2010. The order, insofar as appealed from as limited by the brief, granted the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services rendered between July 17, 2007 and October 3, 2007, and denied plaintiff’s cross motion for summary judgment with respect to those claims.

ORDERED that the order, insofar as appealed from, is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint and plaintiff cross- moved for summary judgment. Insofar as is relevant to this appeal, the Civil Court granted the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover on claims for services rendered between July 17, 2007 and October 3, 2007, which claims had been denied on the ground that plaintiff had failed to appear for examinations under oath (EUOs), and denied plaintiff’s cross motion for summary judgment with respect to those claims.

Contrary to plaintiff’s contentions, the affidavits submitted by defendant were sufficient to establish that the EUO scheduling letters and denial of claim forms had been timely and [*2]properly 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]). Plaintiff’s remaining contentions are similarly without merit. Accordingly, the order, insofar as appealed from, is affirmed.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: August 06, 2012