Reported in New York Official Reports at A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co. (2007 NY Slip Op 03636)
| A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co. |
| 2007 NY Slip Op 03636 [39 AD3d 779] |
| April 24, 2007 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| A.B. Medical Services, PLLC, Respondent, et al., Plaintiffs, v Liberty Mutual Insurance Company, Appellant. |
—[*1] Bee Ready Fishbein Hatter & Donovan LLP, Mineola, N.Y. (Joshua M. Jemal, Robert E. Fekete, and Peter A. Bee of counsel), for appellant.
Marylou A. Paolucci, Smithtown, N.Y., for respondent.
In an action to recover no-fault benefits under an insurance contract, the defendant appeals, by permission, as limited by its brief, from so much of an order of the Appellate Term of the Supreme Court for the Second and Eleventh Judicial Districts, dated November 21, 2005, as reversed so much of an order of the Civil Court of the City of New York, Kings County (E. Spodek, J.), dated June 30, 2004, as denied that branch of the motion of the plaintiff A.B. Medical Services, PLLC, which was for summary judgment on the cause of action to recover the sum of $1,999.12, and granted that branch of the motion.
Ordered that the order dated November 21, 2005, is reversed insofar as appealed from, on the law, with costs, and the order of the Civil Court of the City of New York, Kings County, dated June 30, 2004, is affirmed insofar as it was appealed from.
To the extent the Appellate Term’s order may be understood to require an insurer denying a claim for first-party no-fault benefits on the ground of lack of medical justification to include a medical rationale in its denial of claim form, we agree with the defendant that the court erred. The applicable regulations provide that if a no-fault claim is denied in whole or in part based on a medical examination or peer review report requested by the insurer, then the insurer shall release a copy of that report to, among others, the applicant or its attorney, upon written request (see 11 NYCRR 65-3.8 [b] [4]). Had it been the intent of the Department of Insurance to require the [*2]carrier to set forth a medical rationale in the prescribed denial of claim form (see NYS Form N-F 10; 11 NYCRR 65-3.4 [c] [11]), it would have so provided (see A.B. Med. Servs. v GEICO Cas. Ins. Co., 39 AD3d 778 [2007] [decided herewith]; New York Univ. Hosp. Rusk Inst. v Government Empls. Ins. Co., 39 AD3d 832 [2007] [decided herewith]).
While the plaintiff A.B. Medical Services, PLLC (hereinafter A.B. Medical), made a prima facie showing of entitlement to judgment as a matter of law by submitting evidentiary proof that the prescribed statutory billing forms were mailed and received, and that payment of no-fault benefits was overdue (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.8 [c]; Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co., 16 AD3d 564 [2005]; Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742, 742-743 [2004]), in response, the defendant raised a triable issue of fact with respect to its argument that the claimed benefits were properly denied on the ground of lack of medical justification (see Alvarez v Prospect Hosp., 68 NY2d 320 [1986]). Accordingly, the Civil Court of the City of New York correctly denied that branch of A.B. Medical’s motion which was for summary judgment on the cause of action to recover the sum of $1,999.12. Miller, J.P., Santucci, Florio and Lifson, JJ., concur.
Reported in New York Official Reports at A.B. Med. Servs., PLLC v GEICO Cas. Ins. Co. (2007 NY Slip Op 03635)
| A.B. Med. Servs., PLLC v GEICO Cas. Ins. Co. |
| 2007 NY Slip Op 03635 [39 AD3d 778] |
| April 24, 2007 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| A.B. Medical Services, PLLC, Respondent, v GEICO Casualty Insurance Co., Appellant. |
—[*1] Short & Billy, New York, N.Y. (Skip Short of counsel), for appellant.
Amos Weinberg, Great Neck, N.Y., for respondent.
In an action to recover no-fault benefits under an insurance contract, the defendant appeals, by permission, from an order of the Appellate Term of the Supreme Court for the Second and Eleventh Judicial Districts, dated April 6, 2006, which modified an order of the Civil Court of the City of New York, Kings County (R. Garson, J.), dated May 17, 2004, granting the plaintiff’s motion for summary judgment awarding the sum of $4,061.96, plus interest and an attorney’s fee, to provide that the plaintiff’s motion for summary judgment was granted only to the extent of awarding the plaintiff the sum of $3,971.20, and remitting the matter for the calculation of interest and an assessment of an attorney’s fee.
Ordered that the order of the Appellate Term is reversed, on the law, with costs, the order of the Civil Court of the City of New York, Kings County, is reversed, and the plaintiff’s motion for summary judgment is denied.
Under the circumstances presented, the plaintiff failed to make a prima facie showing of entitlement to judgment as a matter of law (see Alvarez v Prospect Hosp., 68 NY2d 320 [1986]; cf. Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 34 AD3d 532 [2006]). Accordingly, the plaintiff’s motion for summary judgment should have been denied regardless of the sufficiency of the opposing papers (see Ayotte v Gervasio, 81 NY2d 1062, 1063 [1993]).
Even assuming the plaintiff had made a prima facie showing of entitlement to summary judgment, we conclude that the defendant succeeded in raising a triable issue of fact in [*2]response (see Alvarez v Prospect Hosp., supra). For the reasons set forth in A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co. (39 AD3d 779 [2007] [decided herewith]), and New York Univ. Hosp. Rusk Inst. v Government Empls. Ins. Co. (39 AD3d 832 [2007] [decided herewith]), we disagree with the Appellate Term’s conclusion that the defendant’s denial of claim forms were insufficient because they failed to set forth with sufficient particularity the factual basis and medical rationale upon which they were based. The applicable regulations provide that if a no-fault claim is denied in whole or in part based on a medical examination or peer review report requested by the insurer, then the insurer shall release a copy of that report to, among others, the applicant or its attorney, upon written request (see 11 NYCRR 65-3.8 [b] [4]). Had it been the intent of the Department of Insurance to require the carrier to set forth a medical rationale in the prescribed denial of claim form (see NYS Form N-F 10; 11 NYCRR 65-3.4 [c] [11]), it would have so provided.
In light of the foregoing determination, we need not address the defendant’s remaining contentions. Miller, J.P., Santucci, Florio and Lifson, JJ., concur.
Reported in New York Official Reports at Maple Med. Acupuncture, P.C. v Motor Veh. Acc. Indem. Corp. (2007 NY Slip Op 50827(U))
[*1]| Maple Med. Acupuncture, P.C. v Motor Veh. Acc. Indem. Corp. |
| 2007 NY Slip Op 50827(U) [15 Misc 3d 1124(A)] |
| Decided on April 20, 2007 |
| Nassau Dist Ct |
| Engel, 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. |
Maple Medical Acupuncture, P.C., as assignee of Gale Glasgow, Plaintiff,
against Motor Vehicle Accident Indemnification Corporation, Defendant. |
1739/06
Attorneys for Plaintiff: LaSorsa & Beneventano, Esqs
Attorneys for Defendant: Morris, Duffy, Alonso & Faley, Esqs
Andrew M. Engel, J.
Plaintiff commenced this action seeking to recover no-fault first party benefits in the sum of $600.00, plus interest and attorney’s fees, on or about January 17, 2006, allegedly necessitated by a motor vehicle accident which occurred on September 22, 2002. The Plaintiff’s Endorsed Complaint sets forth, in sum and substance, that the Plaintiff timely submitted bills for the payment of no-fault benefits for services provided on September 24, 26, 27, 28, 2002 and October 1, 2002 and that these bills were neither paid nor properly denied in accordance with the no-fault regulations.
The Defendant has not served an Answer, but has brought this motion to dismiss the Plaintiff’s Complaint. The Defendant’s Notice of Motion indicates that the motion is brought “for an Order Pursuant to CPLR § 3211(a)(7) dismissing the complaint, pursuant to Articles 51 & 52 of the Insurance Laws on the grounds that the pleadings fail to state a cause of action against the Defendant, Motor Vehicle Accident Indemnification Corporation, (“MVAIC”) and for such other and further relief as this Court deems just and proper.” In addition thereto, the Affirmation in Support accompanying the Notice of Motion states, “This Affirmation is submitted in support of defendant’s Motion to dismiss, which seeks an Order pursuant to CPLR §§ 3211, 214(2) and Articles 51 & 52 of the Insurance Law and 11 NYCRR Section 65.12, dismissing the plaintiff’s complaint against MVAIC and for such other and further relief as this Court may deem just and proper.”(emphasis in original) (Massaro Affirmation 9/25/06, ¶ 2)
Given the fact that neither party addressed the statute of limitations issue in their papers, they were given the opportunity to do so; and, by order dated March 12, 2007, [*2](Engel, J.) the parties were directed to appear on March 27, 2007 at 9:30 a.m., before Civil Part 3, to orally argue that issue. In accordance with that order, counsel for both parties appeared and were heard on the statute of limitations issue. Based thereon, and after full consideration of the papers submitted, the court renders the following decision.
The Defendant argues that the Plaintiff’s Complaint must be dismissed “because coverage is nonexistent with MVAIC as plaintiff’s assignor (1) failed to prove that an accident or [sic] occurred, or alternatively, failed to prove that the alleged accident was reported to the police within 24 hours as required by statute, by submitting a police accident report.” (Massaro Affirmation 9/25/06, ¶ 4) The Defendant further urges that, based thereon, the Plaintiff’s assignor never qualified to receive MVAIC benefits and that the assignor is not a “covered person” within the ambit of Insurance Law Article 51 or Article 52.
According to the Defendant, “When a person is qualified, it is at that time, only, that MVAIC can be held responsible to pay or deny a claim for no-fault benefits to that applicant. MVAIC can only be considered a proper defendant when it is legally responsible for providing coverage to an injured party. The plaintiff fails to recognize that it is seeking redress from MVAIC when MVAIC lacks an obligation to provide coverage- the injured party is not qualified.” (Massaro Affirmation 9/25/06, ¶ 12) The court notes that the Defendant’s arguments, whether valid or not, do not address the sufficiency of the Plaintiff’s Complaint, but attack the viability of the Plaintiff’s action. “The question presented for review [however] is not whether plaintiff[] should ultimately prevail in this litigation, but rather, more narrowly, whether [its] complaint[] state[s] cognizable causes of action.” Becker v. Schwartz, 46 NY2d 401, 413 NYS2d 895 (1978); see also: Benerofe v. Avnet, Inc., 236 AD2d 496, 654 NYS2d 619 (2nd Dept. 1997); Reliance Insurance Company v. Morris Associates, P.C., 200 AD2d 728, 607 NYS2d 106 (2nd Dept. 1994)
In determining the motion that is before the court, the pleadings must be liberally construed, Leon v. Martinez, 84 NY2d 83, 614 NYS2d 972 (1994); Natural Organics, Inc. v. Smith, __ AD2d, __ NYS2d __, 2007 WL 765955 (2nd Dept. 2007), accepting the facts as alleged in the complaint as true, Kempf v. Magida, 37 AD3d 763, __ NYS2d __ (2nd Dept. 2007); Williams v. Williams, 36 AD3d 693, 828 NYS2d 189 (2nd Dept. 2007), and according the Plaintiff the benefit of every possible favorable inference. Rovello v. Orofino Realty Co., Inc., 40 NY2d 633, 389 NYS2d 314 (1976); Fasano v. Colon, 27 AD3d 691, 812 NYS2d 610 (2nd Dept. 2006) “Initially, the sole criterion is whether the pleading states a cause of action, and if from the four corners factual allegations are discerned which taken together manifest any cause of action cognizable at law a motion for dismissal will fail (citations omitted).” Guggenheimer v. Ginzburg, 43 NY2d 268, 401 NYS2d 182 (1997)
Unlike a motion for summary judgment, where the parties must lay bare their proof in evidentiary form, Friends of Animals, Inc. v. Associate Fur Manufacturers, Inc., 46 [*3]NY2d 1065, 416 NYS2d 790 (1979); Zuckerman v. City of New York, 49 NY2d 557, 427 NYS2d 595 (1980), there is no such obligation upon a motion to dismiss pursuant to CPLR § 3211(a)(7). Kempf v. Magida, supra .; Rovello v. Orofino Realty Co., Inc., supra . The parties may, nevertheless, “submit any evidence that could properly be considered on a motion for summary judgment.” CPLR § 3211(c); Rovello v. Orofino Realty Co., Inc., supra . In such an event, when the court considers such evidentiary material, “unless it has been shown that a material fact as claimed by the pleader to be one is not a fact at all and unless it can be said that no significant dispute exists regarding it, again dismissal should not eventuate (citations omitted).” Guggenheimer v. Ginzburg, supra .; see also: Quesada v. Global Land, Inc., 35 AD3d 575, 826 NYS2d 667 (2nd Dept. 2006). More pointedly, “affidavits submitted by the defendant will seldom if ever warrant the relief he seeks unless … the affidavits establish conclusively that plaintiff has no cause of action.” Rovello v. Orofino Realty Co., Inc., supra .; see also: Simmons v. Edelstein, 32 AD3d 464, 820 NYS2d 614 (2nd Dept. 2006)
Turning to the Complaint sub judice, there is no question that it states a cause of action for the recovery of no-fault first party benefits, on its face. To make out a prima facie case, the Plaintiff would be obligated to establish the proper submission of the bills in question and the Defendant’s failure to either pay or properly deny same within thirty (30) days of receipt thereof. See: 11 N.Y.C.R.R. § 65-3.8(c); Presbyterian Hospital in the City of New York v. Maryland Casualty Company, 90 NY2d 274, 660 NYS2d 536 (1997); Nyack Hospital v. State Farm Mutual Automobile Insurance Company, 11 AD3d 664, 784 NYS2d 136 (2nd Dept. 2004); Westchester Medical Center v. AIG, Inc., 36 AD3d 900, 829 NYS2d 180, (2nd Dept. 2007); New York Craniofacial Care, P.C. v. Allstate Insurance Company, 11 Misc 3d 1071(A), 816 NYS2d 698 (Civ. Ct. Kings Co., 2006). The Complaint herein sets forth each of these elements; and, the Defendant does not argue otherwise.
The Defendant, instead, hopes to rely upon the affidavit of one of its Claims Examiners and a report of an “independent contractor” (Fuentes Affidavit 9/22/06, ¶ 6) hired by the Defendant to investigate whether or not the Plaintiff’s assignor reported the alleged accident to the police within twenty-four (24) hours of its occurrence, as required by Insurance Law § 5208(2)(A), to demonstrate that no cause of action actually exists against MVAIC. As will be discussed, the Defendant’s reliance upon these documents is misplaced.
While, as indicated above, the parties may “submit any evidence that could properly be considered on a motion for summary judgment” CPLR § 3211(c); Rovello v. Orofino Realty Co., Inc., supra ., neither the affidavit of Mr. Fuentes nor the unsworn report of the Defendant’s hired investigator qualify as such evidence. Mr. Fuentes acknowledges that he has no personal knowledge of this matter, and, in fact, attests that his knowledge of this case is based solely upon the review of the file for a claimant named “Giselle Abreu.” There is, however, no such applicant for benefits involved in this [*4]action. Moreover, overlooking what appears to be a draftsperson’s “cut and paste” error in the preparation of Mr. Fuentes’ affidavit, Mr. Fuentes presents nothing other than inadmissible hearsay testimony. His opinion, that the Plaintiff’s assignor did not report her accident to the police within twenty-four (24) hours, is based upon his review of MVAIC’s file in this matter, which allegedly does not contain a police report. Mr. Fuentes, however, neither provides a proper business record foundation for the submission of such records nor even attempts to submit same. Moreover, Insurance Law § 5208(2)(A) does not mandate that the claimant provide MVAIC with a copy of a police report. Similarly, the report of the Defendant’s “independent contractor” is unsworn and is not properly submitted as the Defendant’s business record. Standard Textile Company, Inc. v. National Equipment Rental, Ltd., 80 AD2d 911, 437 NYS2d 398 (2nd Dept. 1981) [papers received from another entity, even if retained in ordinary course of business insufficient to qualify as a business record]; Johnson v. Lutz, 253 NY 124, 170 N.E. 517 (1930) [the investigation report contains hearsay statements of others]; Vozdik v. Frederick, 146 AD2d 898, 536 N.Y.lS.2d 599 (3rd Dept. 1989) [unsworn investigation report not in admissible form for summary judgment motion]
The above notwithstanding, even if the court were to overlook these defects, the papers submitted by the Defendant simply do not “demonstrate[], without significant dispute, that a material fact alleged by the complaint is not a fact at all,” Quesada v. Global Land, Inc., supra ., and certainly do not “conclusively establish that no cause of action exists (citation omitted).” Annunziato v. City of New York, 33 AD3d 950, 824 NYS2d 115 (2nd Dept. 2006)
The Defendant’s argument that the Plaintiff’s assignor is not a “qualified person”, pursuant to Insurance Law Article 52, by virtue of allegedly failing to report her accident to the police within twenty-four (24) hours, thereby rendering MVAIC immune to suit herein, confuses a “qualified person” and a “covered person” under Insurance Law Article 52 and is not as factually clear as the Defendant represents.
As here relevant, the purpose of Insurance Law Article 52, known as the Motor Vehicle Accident Indemnification Act, is set forth in Insurance Law § 5201(b) as follows:
The legislature finds and declares that the motor vehicle financial security act in the vehicle and traffic law, … fails to accomplish its full purpose of securing to innocent victims of motor vehicle accidents recompense for the injury and financial loss inflicted upon them in that the act makes no provision for the payment of loss on account of injury to or death of persons who, through no fault of their own, were involved in motor vehicle accidents caused by:
(2) unidentified motor vehicles which leave the scene of the accident.
In addition, this article is intended 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 [*5]motor vehicle, as provided herein and in the comprehensive motor vehicle insurance reparations act. The legislature determines that it is a matter of grave concern that those persons are not recompensed for their injury and financial loss inflicted upon them and that the public interest can best be served by closing such gaps in the motor vehicle financial security act and the comprehensive motor vehicle insurance reparations act through the continued operation of the motor vehicle accident indemnification corporation.
Canty v. Motor Vehicle Accident Indemnification Corporation, 95 AD2d 509, 467 NYS2d 50 (2nd Dept. 1983); A.B. Medical Services PLLC v. Motor Vehicle Accident Indemnification Corp., 10 Misc 3d 145(A), 814 NYS2d 889 (App. Term 2nd and 11th Jud. Dists. 2006); Ocean Diagnostic Imaging v. Motor Vehicle Accident Indemnification Corp., 8 Misc 3d 137(A), 803 NYS2d 19 (App. Term 2nd and 11th Jud. Dists. 2005)
Contrary to the Defendant’s argument, a “qualified person” entitled to coverage under Article 52 is defined by Insurance Law § 5202(b) as nothing more or less than:
(i) a resident of this state, other than an insured or the owner of an uninsured motor vehicle and his spouse when a passenger in such vehicle, or his legal representative, or (ii) a resident of another state, territory or federal district of the United States or province of the Dominion of Canada, or foreign country, in which recourse is afforded, to residents of this state, of substantially similar character to that provided for by this article, or his legal representative. It does not include any operator of or passenger on a snowmobile. In this subsection, “operator” means every person who operates or is in actual physical control of a snowmobile, whether or not it is under way.
Canty v. Motor Vehicle Accident Indemnification Corporation, supra .; McNair v. Motor Vehicle Accident Indemnification Corporation, 11 NY2d 701, 225 NYS2d 767 (1962); Saunderson v. The Motor Vehicle Accident Indemnification Corporation, 54 AD2d 936, 388 NYS2d 318 (2nd Dept. 1976).
The Plaintiff’s assignor, being a resident of the State of New York who was not an insured or the owner of an uninsured motor vehicle, struck by a vehicle that left the scene after striking the assignor, a pedestrian, is a “qualified person” pursuant to Insurance Law § 5202(b). “[This] threshold determination that an individual is a qualified person’ does not, however, end the inquiry.” Canty v. Motor Vehicle Accident Indemnification Corporation, supra . Before MVAIC becomes obligated to pay no-fault first party benefits pursuant to the Comprehensive Motor Vehicle Reparations Act, Insurance Law Article 51, to a “qualified person” that individual must also be a “covered person” by complying with the requirements of Insurance Law Article 52. A.B. Medical Services PLLC v. Motor Vehicle Accident Indemnification Corp., supra .; Ocean Diagnostic Imaging v. Motor Vehicle Accident Indemnification Corp., supra .; Insurance Law § 5221(b)(2) [“A qualified person who has complied with all the applicable requirements of [*6]this article shall be deemed to be a covered person and shall have only such rights as a covered person may have under article fifty-one of this chapter.”]
Insurance Law § 5208 specifically provides, in pertinent part:
(a) The protection provided by the corporation on account of motor vehicle accidents caused by financially irresponsible motorists shall be available to:
(2)(A) Any qualified person having a cause of action because of death or bodily injury, arising out of a motor vehicle accident occurring within this state and reported within twenty-four hours after the occurrence to a police, peace or judicial officer in the vicinity or to the commissioner, and who files with the corporation within ninety days of the accrual of the cause of action, as a condition precedent to the right to apply for payment from the corporation, an affidavit stating that:
(i) the person has the cause of action for damages arising out of the accident and setting forth the supporting facts,
(ii) the cause of action is against a person whose identity is unascertainable, and
(iii) the person is making a claim for those damages.
Hempstead General Hospital v. MVAIC, 97 AD2d 544, 468 NYS2d 48 (2nd Dept. 1983)
The Plaintiff, however, need not plead or prove its assignor’s compliance with these requirements as part of its prima facie case.
Insurance Law § 5221futher provides, in pertinent part:
(b)(1) Notwithstanding the provisions of this article, the corporation [MVAIC] shall also provide for the payment of first party benefits to a qualified person for basic economic loss arising out of the use or operation in this state of an uninsured motor vehicle.
(3) The corporation shall have only those rights and obligation which are applicable to an insurer subject to article fifty-one of this chapter.
(c) The corporation shall continue to comply with the plan of operation approved by the superintendent, which provides for the economical, prompt and fair payment of first party benefits to qualified persons in substantially the same manner as is required of insurers and self-insurers by article fifty-one of this chapter and regulations of the superintendent.
As with any other claimant for no-fault first party benefits, pursuant to Article 51 and the Insurance Department Regulations implementing the Comprehensive Motor Vehicle Reparations Act, 22 N.Y.C.R.R. Ch. III, Subch. B, Pt. 65, to establish a prima facie case the Plaintiff need only demonstrate “that [it] submitted claims, setting forth the fact and the amount of the loss sustained, and the payment of no -fault benefits was overdue (citations omitted).” A.B. Medical Serivces PLLC v. Motor Vehicle Accident [*7]Indemnification Corp., 6 Misc 3d 131(A), 800 NYS2d 341 (App. Term 2nd and 11th Jud. Dists. 2005)
Payments will be overdue when the carrier has failed to either pay a claim or issue a timely valid denial. 11 N.Y.C.R.R. § 65-3.8(c); New York Craniofacial Care, P.C. v. Allstate Insurance Company, supra .; Nyack Hospital v. State Farm Mutual Automobile Insurance Company, 11 AD3d 664, 784 NYS2d 136 (2nd Dept. 2004); Presbyterian Hospital in the City of New York v. Maryland Casualty Company, supra . Contrary to the Defendant’s argument herein, MVAIC’s time to pay or deny a claim begins to run upon receipt of the claim and not after MVAIC has “qualified” the claimant. New York Hospital Medical Center of Queens v. Motor Vehicle Accident Indemnification Corporation;, supra .; A.B. Medical Serivces PLLC v. Motor Vehicle Accident Indemnification Corp., supra .
There is no dispute herein that the Defendant did not pay. The only “denial” tendered was a letter from the Defendant erroneously indicating that the assignor is not a “qualified person” and that the accident in question was not reported to the police within twenty-four (24) hours. This “denial” was not issued on the “prescribed claim forms that must be used by all insurers, [which] shall not be altered unless approved by the superintendent” 11 N.Y.C.R.R. § 65-3.(c), rendering it incomplete and invalid on its face. Nyack Hospital v. Metropolitan Casualty & Liability Insurance Company, 16 AD3d 564, 791 NYS2d 658 (2nd Dept. 2005) lv. den. 5 NY3d 713, 806 NYS2d 163 (2005); Nyack Hospital v. v. State Farm Mutual Automobile Insurance Company, supra .; Spineamaricare Medical, P.C. v. United States Fidelity & Guarantee Company, 12 Misc 3d 138(A), 824 NYS2d 766 (App. Term 9th and 10th Jud. Dists. 2006).
Nevertheless, the Defendant’s argument remains concerning the Plaintiff’s assignor’s compliance with Insurance Law § 5208(a)(2)(A), establishing her as a “covered person” entitled to recover no-fault first party benefits from the Defendant. The Defendant’s “lack of coverage” defense is not waived by its failure to issue a proper denial. Central General Hospital v. Chubb Group of Insurance Companies, 90 NY2d 195, 659 NYS2d 246 (1997); Hospital for Joint Diseases v. Allstate Insurance Company, 21 AD2d 348, 800 NYS2d 190 (2nd Dept. 2005) It should be emphasized however, that this lack of coverage defense is just that, a defense, to be raised by the Defendant; it is not a pleading requirement for the Plaintiff; and it is the Defendant’s burden, not the Plaintiff’s, to “establish that the [Plaintiff] failed to comply with the notification provision” of Insurance Law § 5208(a)(2)(A). Matter of Country Wide Insurance Co., 201 AD2d 368, 607 NYS2d 648 (1st Dept. 1994) This the Defendant has not done.
The Defendant acknowledges that the Plaintiff filed a Notice of Intention to Make A Claim within ninety (90) days of the date of the accident, which indicates that the accident was reported to the 102nd Precinct of the New York City Police Department on the date of the accident. As previously indicated, in an effort to rebut this representation, the Defendant submits the report of its hired investigator which is based upon nothing [*8]more than a conversation this investigator had with a Cadet at the 102nd Precinct. The court notes that this report indicates that it is a “Supplemental” report; but, the original report is not submitted to the court. The investigator’s report further indicates that the Cadet with whom he spoke was confused, completing two (2) separate reports, because more than one individual was apparently involved, when only one report was required. The investigator further indicates that based upon his conversation with the Cadet and a printout of a complaint report, which was provided to MVAIC [FN1] but not to this court, the Plaintiff’s assignor reported the accident at the station house some time on the second day following the accident. The investigator’s report is silent as to whether or not the accident was reported at the scene, in addition to the report made at the station house.
This “proof” tendered by the Defendant raises more questions than it answers. Even if the court were to overlook that the investigator’s report is not in evidentiary form and replete with double and triple hearsay entries, it does not conclusively demonstrate that “the accident was not reported within twenty-four hours after the occurrence … or that it was made as soon as was reasonably possible.” Insurance Law § 5208(a)(2)(B) The Defendant’s papers alone having raised significant questions regarding the reporting of this accident to the police, which cannot be resolved without a determination of credibility, a hearing on this issue will ultimately be necessary. Matter of Country Wide Insurance Co., supra .; Canty v. Motor Vehicle Accident Indemnification Corporation, supra .; Francis v. Motor Vehicle Accident Indemnification Corporation, 41 AD2d 556, 340 NYS2d 2 (2nd Dept. 1973); Caceres v. Motor Vehicle Accident Indemnification Corporation, 37 AD3d 215, 829 NYS2d 487 (1st Dept. 2007); Chick v. Motor Vehicle Accident Indemnification Corporation, 74 AD2d 558, 424 NYS2d 280 (2nd Dept. 1980)
Mindful that this court has not chosen to treat the Defendant’s motion as one for summary judgment under CPLR §§ 3211(c) and 3212, the Plaintiff has not been forced to come forth with proof regarding the reporting of this accident, which proof may well exist.
“Although absent further evidence, the dispute may be finally resolved on the more embracive and exploratory motion for summary judgment, disposition by summary dismissal under CPLR 3211 (subd. (a), par. 7) [which is what the Defendant requests] is premature.” Rovello v. Orofino Realty Co., Inc., supra . Accordingly, that branch of the Defendant’s motion which seeks to dismiss the complaint for failure to state a cause of action, pursuant to CPLR § 3211(a)(7), is denied.
The parties do not dispute that the Defendant’s obligation to pay no-fault first party benefits was “created or imposed by statute, but for which [it] would not exist. Hence the [*9]three-year Statute of Limitations (CPLR 214[2]) applies.” Motor Vehicle Accident Indemnification Corporation v. Aetna Casualty & Surety Company, 89 NY2d 214, 652 NYS2d 584 (1996); See also: Stracar Medical Services, P.C. v. Motor Vehicle Accident Indemnification Corporation, 10 Misc 3d 1056(A), 809 NYS2d 484 (Civ. Ct. Kings Co. 2005)
As previously indicated, MVIAC’s obligation to pay or deny begins upon its receipt of the claims in question; and, payments are overdue if not paid or properly denied within thirty (30) days of their receipt. CPLR § 5106(a); 11 N.Y.C.R.R. § 65-3.8(c); Presbyterian Hospital in the City of New York v. Maryland Casualty Company, supra .; Nyack Hospital v. State Farm Mutual Automobile Insurance Company, supra .; Westchester Medical Center v. AIG, Inc., supra . This is the accrual date for the Plaintiff’s cause of action. Micha v. Merchants Mutual Insurance Company, 94 AD2d 835, 463 NYS2d 110 (3 Dept. 1983); Benson v. Boston Old Colony Insurance Company, 134 AD2d 214, 521 NYS2d 14 (1st Dept.1987); Alleviation Supplies Inc. v. Enterprise Rent A Car, 12 Misc 3d 787, 819 NYS2d 404 (Civ.Ct. Richmond Co. 2006)
While the Plaintiff alleges that it sent two (2) bills dated October 29, 2002 to the Defendant, which comprise the claim herein, neither party knows when, if at all, these bills were received by the Defendant. Although not required to do so at this time, the Plaintiff has not demonstrated “proof of actual mailing or proof of a standard office practice or procedure designed to ensure that items are properly addressed and mailed”, Amaze Medical Supply Inc. v. Allstate Insurance Company, 3 Misc 3d 133(A), 787 NYS2d 675 (App. Term 2nd and 11th Jud. Dists. 2004); Residential Holding Corp. v. Scottsdale Insurance Company, 286 AD2d 679, 729 NYS2d 776 (2nd Dept. 2001), which would have raised a presumption of their receipt. Similarly, there is no proper denial, or any other indication from the Defendant, indicating when these bills were received, which would have substituted for proof of mailing. Prestige Medical & Surgical Supply Inc. v. Clarendon National Insurance Company, 13 Misc 3d 127(A), 824 NYS2d 758 (App. Term 2nd and 11th Jud. Dists. 2006); Magnezit Medical Care, P.C. v. New York Central Mutual Fire Ins. Co., 12 Misc 3d 144(A), 824 NYS2d 763 (App. Term 2nd and 11th Jud. Dists. 2006).
Although the issue of the statute of limitations was raised and the parties were given the opportunity to appear before the court and address this specific issue, neither party has provided the court with the necessary information to determine when, if at all, the Plaintiff’s cause of action accrued. It is possible that the Plaintiff mailed the subject bills on or about October 29, 2002 and that they were received by the Defendant shortly thereafter; it is also possible that the bills were mailed on or about October 29, 2002 but never received by the Defendant; and, it is possible that these bills were actually never mailed at all. The Defendant, who made this motion seeking dismissal, has not provided the court with any information which would permit the court to divine which of these scenarios occurred, when the cause of action accrued and whether or not the Plaintiff’s action was timely commenced. Accordingly, that branch of the Defendant’s motion to dismiss this action based upon the [*10]running of the statute of limitations is denied; and, it is hereby
ORDERED, that the Defendant shall serve an Answer upon the Plaintiff within thirty (30) days of service of a copy of this order with Notice of Entry.
This constitutes the decision and order of this court.
Dated: Hempstead, New York
April 20, 2007
___________________________
ANDREW M. ENGEL
J.D.C.
Footnote 1: This is direct contravention to Mr. Fuentes’ representation that he searched MVIAC’s files and that there was not complaint report contained therein.A.M. Med. Servs., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50860(U))
Reported in New York Official Reports at A.M. Med. Servs., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50860(U))
| A.M. Med. Servs., P.C. v Allstate Ins. Co. |
| 2007 NY Slip Op 50860(U) [15 Misc 3d 136(A)] |
| Decided on April 19, 2007 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected in part through May 16, 2007; it will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS
PRESENT: : RUDOLPH, P.J., LIPPMAN and MOLIA, JJ
2006-972 N C.
against
Allstate Insurance Co., Respondent.
Appeal from an order of the District Court of Nassau County, Third District (Bonnie P. Chaikin, J.), entered March 15, 2006. The order, insofar as appealed from as limited by the brief, denied plaintiff’s motion for renewal of its prior motion for summary judgment.
Order, insofar as appealed from, is affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. The motion was supported by an affirmation of counsel, an affidavit of an officer of plaintiff, and various documents annexed thereto.
In opposition to plaintiff’s motion, defendant argued, inter alia, that the affirmation of counsel was of no probative value and that the affidavit of plaintiff’s officer was insufficient to establish personal knowledge of the facts set forth therein. The court below denied plaintiff’s motion on this basis and plaintiff moved to renew the motion, annexing a more detailed affidavit of its officer. The court below denied the motion to renew on the ground that plaintiff failed to set forth any facts not previously known to plaintiff at the time of submission of the original motion. The instant appeal ensued.
CPLR 2221 (e) (2) provides that a motion for leave to renew a prior motion must be based upon “new facts not offered on the prior motion that would change the prior [*2]determination” or must show “that there has been a change in the law that would change the prior determination.” Furthermore, the motion papers must contain a “reasonable justification for the failure to present such facts on the prior motion” (CPLR 2221 [e] [3]). In the instant case, plaintiff did not proffer a reasonable justification for its failure to present the facts upon which its renewal motion was based to the motion court on its prior motion for summary judgment (see T&B Port Washington, Inc. v McDonough, 32 AD3d 785 [2006]; Renna v Gullo, 19 AD3d 472 [2005]). Moreover, to the extent that plaintiff based its motion upon changes in the law, the cases proffered by plaintiff which purportedly represented such changes were neither dispositive of the
issue of the sufficiency of plaintiff’s officer’s affidavit nor did they actually represent changes in the decisional law. Accordingly, the motion was properly denied.
Rudolph, P.J., Lippman and Molia, JJ., concur.
Decision Date: April 19, 2007
Reported in New York Official Reports at First Help Acupuncture, P.C. v General Assur. Co. (2007 NY Slip Op 50859(U))
[*1]| First Help Acupuncture, P.C. v General Assur. Co. |
| 2007 NY Slip Op 50859(U) [15 Misc 3d 136(A)] |
| Decided on April 19, 2007 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
PRESENT: : PESCE, P.J., WESTON PATTERSON and RIOS, JJ
2006-356 K C.
against
General Assurance Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Kathy J. King, J.), dated December 12, 2005. The order denied plaintiff’s motion for summary judgment.
Order affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff’s motion for summary judgment was supported by an affirmation from plaintiff’s counsel, an affidavit by an employee of plaintiff and various documents annexed thereto. The affidavit executed by plaintiff’s employee stated in a conclusory manner that the documents attached to plaintiff’s motion papers were plaintiff’s business records. In opposition, defendant argued, inter alia, that the affidavit by plaintiff’s employee failed to lay a proper foundation for the documents annexed to plaintiff’s moving papers and that, as a result, plaintiff failed to establish a prima facie case. Plaintiff appeals from the denial of its motion for summary judgment.
Inasmuch as the affidavit submitted by plaintiff’s employee was insufficient to establish that said employee possessed personal knowledge of plaintiff’s practices and procedures so as to lay a foundation for the admission, as business records, of the documents annexed to plaintiff’s moving papers, plaintiff failed to make a prima facie showing of its entitlement to summary [*2]judgment (see Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Consequently, plaintiff’s motion for summary judgment was properly denied.
Pesce, P.J., Weston Patterson and Rios, JJ., concur.
Decision Date: April 19, 2007Jones v AIG Ins. Co. (2007 NY Slip Op 50816(U))
Reported in New York Official Reports at Jones v AIG Ins. Co. (2007 NY Slip Op 50816(U))
| Jones v AIG Ins. Co. |
| 2007 NY Slip Op 50816(U) [15 Misc 3d 1123(A)] |
| Decided on April 11, 2007 |
| Supreme Court, Queens County |
| Hart, 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. |
Supreme Court, Queens County
Barbara Jones, Plaintiff,
against AIG Insurance Company, Defendant. |
13956 2006
Duane A. Hart, J.
Plaintiff allegedly was injured in a motor vehicle accident in New York on March 17, 2006, while a passenger in a vehicle owned and operated by Silvanous Parchment. Defendant issued an insurance policy in Florida to Parchment, who purportedly was a resident of Florida, for that vehicle, which was registered in Florida. [*2]
On April 13, 2006, plaintiff submitted a claim for no-fault benefits to defendant insurer. On June 15, 2006, defendant insurer denied said claim on the ground that the policy was revoked for material misrepresentation.
In this action by plaintiff, among other things, for judgment declaring her rights under the policy, plaintiff moves for summary judgment determining that she is eligible for no-fault benefits and that defendant’s denial of such benefits was untimely. Defendant cross-moves for summary judgment on the ground that plaintiff’s injuries did not arise from a covered accident.
Defendant cancelled the policy on June 7, 2006, after it discovered Parchment made a material misrepresentation on the insurance application. The material misrepresentation was that Parchment resided and garaged his vehicle in Florida. An investigation by defendant after the subject accident revealed that Parchment resided and garaged his vehicle in New York.
Florida law allows for the retroactive cancellation of an insurance policy, where, as in this case, a material misrepresentation is contained within the insurance application. (See Penaranda v Progressive American Insurance Co., 747 So.2d 953 [Fla. 1999].) New York law does not allow retroactive cancellation. (See Vehicle and Traffic Law § 313; see also Matter of Insurance Co. of North America v Kaplun, 274 AD2d 293 [2000]; Olivio v Government Employees Insurance Co. of Washington, D.C., 46 AD2d 437 [1975].) There is no dispute that there is a conflict between the law of New York and the law of Florida. This conflict of law relating to an insurance policy must be resolved by application of the conflict of law rules relevant to contracts. (See Matter of Integon Insurance Co. v Garcia, 281 AD2d 480 [2001].) The courts apply the “center of gravity” or “grouping of contacts” inquiry to determine which State has the most significant contacts to the dispute. (See Matter of Eagle Insurance Co. v Singletary, 279 AD2d 56 [2000].) Significant contacts in a case involving a contract, in addition to the place of contracting, are the place of negotiation and performance, the location of the subject matter of the contract and the domicile or place of business of the contracting parties. (See Zurich Insurance Co. v Shearson Lehman Hutton, Inc., 84 NY2d 309 [1994]; see also Matter of Integon Insurance Co. v Garcia, supra; Matter of Eagle Insurance Co. v Singletary, supra.)
Applying the grouping of contacts inquiry to the facts here, the State of Florida has the most significant contacts with the parties and the contract. Defendant issued its insurance policy to Parchment in Florida, who purportedly was a resident of Florida, [*3]for a vehicle registered in Florida, which terms incorporated Florida law. The only connection between the policy and New York is that Parchment was driving the vehicle in New York at the time of the accident. Thus, Florida law is controlling under New York’s conflict of law rules. Moreover, Florida’s significant contacts with the subject contract and legitimate governmental interest in protecting its honest policyholders from bearing the burden of paying claims incurred by dishonest policyholders outweighs New York’s governmental interest in protecting innocent third parties from being deprived of insurance coverage, especially since New York statutes provide the means to ensure compensation to persons injured due to the fault of uninsured motorists within the state by requiring New York policyholders to purchase uninsured motorist coverage (see Insurance Law § 3420[f]) and establishing and providing insurance through the Motor Vehicle Accident Indemnification Corp. (See Insurance Law § 5201 et seq.)
Applying Florida law, defendant’s retroactive cancellation of the insurance policy due to Parchment’s material misrepresentation in his application for insurance was valid. Since the subject policy was void ab initio, defendant’s denial of plaintiff’s no-fault claim was proper. In addition, the timeliness of defendant’s denial of plaintiff’s no-fault claim is irrelevant as the denial was based upon lack of coverage. (See Central General Hospital v Chubb Group of Insurance Cos., 90 NY2d 195 [1997].)
Accordingly, it is ORDERED AND ADJUDGED that plaintiff’s motion for summary judgment and attorney’s fees is denied and defendant’s cross motion for summary judgment dismissing plaintiff’s complaint is granted; and it is further
ADJUDGED AND DECLARED that defendant is not obligated to provide “no-fault” coverage to plaintiff.
Dated: April 11, 2007J.S.C.
Reported in New York Official Reports at Matter of New York Cent. Mut. Ins. Co. v Davalos (2007 NY Slip Op 03146)
| Matter of New York Cent. Mut. Ins. Co. v Davalos |
| 2007 NY Slip Op 03146 [39 AD3d 654] |
| April 10, 2007 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| In the Matter of New York Central Mutual Insurance Co., Appellant, v Daniel Davalos et al., Respondents. Allstate Insurance et al., Proposed Additional Respondents. |
—[*1] Russo, Keane & Toner, LLP, New York, N.Y. (David S. Gould of counsel), for appellant.
In a proceeding pursuant to CPLR article 75, inter alia, to permanently stay arbitration of a claim for uninsured motorist benefits, the petitioner appeals from an order of the Supreme Court, Kings County (Kramer, J.), dated January 5, 2006, which granted that branch of the motion of the respondent Daniel Davalos which was for reargument of the petition, which had been granted in an order of the same court dated August 15, 2005, and upon reargument, denied that branch of the petition which was to permanently stay arbitration, and, in effect, denied that branch of the petition which was, in effect, to add Allstate Insurance, Sebastian Gutierrez Meza, and Daniel Ashley as additional respondents.
Ordered that the order is modified, on the law, by deleting the provisions thereof which, upon reargument, denied that branch of the petition which was to permanently stay arbitration, and, in effect, denied that branch of the petition which was, in effect, to add Allstate Insurance, Sebastian Gutierrez Meza, and Daniel Ashley as additional respondents, and substituting therefor a provision granting that branch of the petition which was, in effect, to add Allstate Insurance, Sebastian Gutierrez Meza, and Daniel Ashley as additional respondents; as so modified, the order is affirmed, without costs or disbursements, and the matter is remitted to the Supreme [*2]Court, Kings County, for an evidentiary hearing on the issue of whether Allstate Insurance validly disclaimed coverage of the offending vehicle for the subject accident and for a new determination thereafter of that branch of the petition which was to permanently stay arbitration.
“Motions for reargument are addressed to the sound discretion of the court which decided the prior motion and may be granted upon a showing that the court overlooked or misapprehended the facts or law or for some other reason mistakenly arrived at its earlier decision” (E.W. Howell Co., Inc. v S.A.F. La Sala Corp., 36 AD3d 653, 654 [2007] [internal quotation marks omitted]; see Marini v Lombardo, 17 AD3d 545 [2005]; Carrillo v PM Realty Group, 16 AD3d 611 [2005]; Viola v City of New York, 13 AD3d 439 [2004]). Contrary to the petitioner’s contention, the Supreme Court providently exercised its discretion in granting reargument to consider whether its original determination to permanently stay arbitration was proper in light of a recent Court of Appeals decision that had been overlooked.
Furthermore, upon granting reargument, the court properly concluded that the petitioner was not entitled to a stay of arbitration based upon the failure of the respondent Daniel Davalos to provide notice of his claim for uninsured motorist benefits “as soon as practicable” as required by the supplementary uninsured/underinsured motorist (hereinafter SUM) endorsement of the subject insurance policy. Where, as here, timely notice of an accident has been given and the injured claimant has applied for no-fault benefits, an insurer cannot disclaim coverage under a SUM endorsement unless it establishes that it has been prejudiced by late notice of the SUM claim (see Rekemeyer v State Farm Mut. Auto. Ins. Co., 4 NY3d 468 [2005]; Matter of Nationwide Mut. Ins. Co. v Perlmutter, 32 AD3d 947 [2006]; Matter of State Farm Mut. Auto. Ins. Co. v Rinaldi, 27 AD3d 476 [2006]). Timely notice of the accident is “sufficient to promote the valid policy objective of curbing fraud or collusion” underlying notice requirements (see Rekemeyer v State Farm Mut. Auto. Ins. Co., supra at 475). Although the petitioner argues that the rationale of the Court of Appeals in Rekemyer v State Farm Mut. Auto. Ins. Co. (supra), should be limited to claims for underinsured motorist benefits, we find it equally applicable to claims for uninsured motorist benefits made pursuant to a SUM endorsement. Since the petitioner has not claimed any prejudice arising from the late notice of the SUM claim, the court correctly determined that it is not entitled to a stay of arbitration on this ground.
However, the court should have added Allstate Insurance (hereinafter Allstate) and the owner and operator of the offending vehicle as additional respondents. In support of its petition, inter alia, to permanently stay arbitration of Davalos’s claim for uninsured motorist benefits, the petitioner submitted the police accident report which contained the offending vehicle’s insurance code designation, and Allstate’s letter disclaiming coverage to the owner of the offending vehicle based upon his alleged noncooperation. This proof raised a question of fact as to whether Allstate validly disclaimed coverage of the offending vehicle (see Matter of New York Cent. Mut. Fire Ins. Co. v Hall, 7 AD3d 629 [2004]; Matter of Eagle Ins. Co. [Villegas—State Farm Mut. Auto. Ins. Co.], 307 AD2d 879 [2003]; Matter of Allstate Ins. Co. v Anderson, 303 AD2d 496 [2003]; Matter of Lumbermens Mut. Cas. Co. v Beliard, 256 AD2d 579 [1998]). Accordingly, we remit the matter to the Supreme Court, Kings County, for an evidentiary hearing on the issue of whether Allstate validly disclaimed coverage of the offending vehicle for the subject acccident (see Matter of New York Cent. Mut. Fire Ins. Co. v Hall, supra; Matter of Lumbermens Mut. Cas. Co. v Beliard, supra). Santucci, J.P., Krausman, Lifson and Dillon, JJ., concur.
Reported in New York Official Reports at Friendly Physician, P.C. v Country-Wide Ins. Co. (2007 NY Slip Op 50747(U))
| Friendly Physician, P.C. v Country-Wide Ins. Co. |
| 2007 NY Slip Op 50747(U) [15 Misc 3d 1117(A)] |
| Decided on April 6, 2007 |
| Civil Court Of The City Of New York, Kings County |
| Rubin, J. |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
Civil Court of the City of New York, Kings County
Friendly Physician, P.C., a/a/o Richard Proctor, Plaintiff,
against Country-Wide Insurance Company, Defendant. |
047582/06
Attorney for Plaintiff:
Ilona Finkelshteytn, Esq.
2503 65th Street
Brooklyn, New York 111204
Attorney for Defendant:
Jaffe & Nohavicka
40 Wall Street – 12th Floor
New York, NY 10005
Alice Fisher Rubin, J.
Plaintiff commenced this action against the defendant to recover first party no-fault benefits pursuant to CPLR 5106(a) of the Insurance Law and Regulation of the New York State Insurance Department (11 NYCRR Sect. 65-1.1 et. seq.), for medical services rendered.
Plaintiff moves for summary judgment as a matter of law on the grounds that the claimants assigned their “no fault” benefits to plaintiff pursuant to the terms of the insurance policies sold by defendant, and the timely submission of invoices and/or bills to defendant in accordance with the New York State Insurance Law, were not denied or paid within 30 days, pursuant to the New York State Insurance Law. Defendant cross-moves for summary judgment and opposes plaintiff’s motion on the grounds that the denial was timely and based upon the
revocation of the assignment by the assignor, Richard Proctor.
The rule governing summary judgment requires the proponent of a summary judgment motion to make a prima facie showing of entitlement to summary judgment as a matter of law, offering sufficient evidence to eliminate any material issues of fact from the case” (Winegrad v. New York University Medical Center, 64 NY2d 851 [1985]; Tortello v. Carlin, 260 AD2d 201 [1st Dept., 1999]). The burden of proof, as well as persuasion rests with the proponent of the summary judgment motion. Once the burden is satisfied, the opponent of the motion must produce sufficient evidence, in admissible form, establishing the existence of a triable issue of fact. [*2]
Pursuant to both the Insurance Law and the regulations promulgated by the Superintendent of Insurance, an insurer is required to either pay or deny a claim for no-fault automobile insurance benefits within 30 days from the date an applicant supplies proof of claim. (See, Insurance Law 5106[a]; 11 NYCRR 65.15[h]). Failure to pay benefits within the 30-day requirement renders the benefits “overdue,” and all overdue payments bear interest at a rate of 2% per month. In addition, the claimant is entitled to recover attorney’s fees where a “valid claim or portion” was denied or overdue. See, Presbyterian Hospital in the City of New York v. Maryland Casualty Company, 90 NY2d 274, 660 N.Y.S.2d 536 (1997).
A plaintiff ordinarily establishes the submission of the claim forms by demonstrating that proof of proper mailing, which gives rise to the presumption that the claim forms were received by the addressee. The presumption may be created either by proof of actual mailing or by proof of a standard office practice or procedure designed to ensure that items are properly addressed and mailed. See, Residential Holding Corp., v. Scottsdale Ins. Co., 286 AD2d 679 [2001].
The plaintiff has annexed the affidavit of Kristina Meledina, billing manager, of the assignee, which makes reference to the plaintiff’s standard office mailing practices and/or procedures. The affidavit is sufficient to establish plaintiff’s mailing of its claim forms.
In addition, the court finds that the plaintiff has established its prima facie case, inasmuch as the defendant’s denial of claim forms which are annexed to defendant’s opposition papers as Exhibit “A,” as well as plaintiff’s moving papers, establish the dates of defendant’s receipt of the claim forms. See, PDG Psychological, P.C., (Jones) v. Utica Mut. Ins. Co., 11 Misc 3d 128[A], 2006 NY Slip Op. 50246[U][AT 2nd & 11th Jud. Dists.].
Defendant opposes plaintiff’s motion and cross-moves for summary judgment on the grounds that the denial was timely, as well as the fact that the assignment was revoked by the assignor, Richard Proctor. In support of its cross-motion, the defendant annexes a copy of the letter it received from Richard Proctor, which indicates that he was in fact involved in a car accident on 6/4/05, that he was requesting to drop all claims and that he would be willing to be held responsible for all medical bills.
After careful consideration of the moving papers, supporting documents and opposition thereto, the court finds that plaintiff is entitled to summary judgment as a matter of law.
In order for a provider to receive direct payment from an insurer under the no-fault regulation, the claims must have been assigned to the provider pursuant to an assignment containing language required by the regulation (See, 11 NYCRR 65-3.11[b][2].).
Plaintiff has annexed a copy of assignment of benefits form, which was signed by the assignor, Richard Proctor on June 4, 2005. [See, Exhibit “1” to plaintiff’s moving papers]. The defendant does not argue the validity of the assignment of benefits form, and there is no indication that same was an issue which verification was requested. The applicable rules and regulations are as follows: [*3]
§65.3-11 – Direct Payments
(a) An insurer shall pay benefits for any element of loss, other than death benefits, directly to the applicant or, when appropriate, to the applicants parent or legal guardian or to any person legally responsible for necessities, or, upon assignment by the applicant or any of the aforementioned persons, shall pay benefits directly to providers of health care services as covered under section five thousand one hundred two (a)(1) of this article….Emphasis added.
(2)(d) If an assignment has been furnished an insurer, the assignor or legal representative of the assignor shall not unilaterally revoke the assignment after the services for which the assignment was originally executed were rendered. If the assignment is revoked for services not yet rendered, the assignor or leal representative shall provide written notification to the insurer that the assignee has been notified of the revocation.
The services rendered by plaintiff-provider were rendered on 6/17/05 and 6/27/05, all of which total $304.79. The assignor’s revocation letter which is addressed to defendant is dated 6/25/05. Section 65.3-11 states that the assignor may not unilaterally revoke the assignment after services for which the assignment was originally executed were rendered. Therefore, the assignor could not revoke the assignment as to those services rendered on or before 6/25/07. The regulation also states that if the assignment is revoked for services not yet rendered, the assignor or legal representative shall provide written notification to the insurer that the assignee has been notified of the revocation.
The defendant has not submitted to this court, and the record is void as to a letter from the assignor that the assignee was notified of the revocation. The letter which is annexed to defendant’s cross-motion is a letter which merely states that the assignor is “requesting to drop all claims.” The defendant’s proof is insufficient to establish its prima facie entitlement to summary judgment.
Accordingly, summary judgment is hereby awarded in favor of plaintiff and against defendant in the amount of $304.79, with interest at 2% per month from 7/22/05, costs and attorney’s fees. Defendant’s cross-motion is hereby denied.
This constitutes the order of this Court.
Court Attorney to notify.
Dated: Brooklyn, New York
March ______, 2007
______________________________
Alice Fisher Rubin, J.C.C. [*4]
Reported in New York Official Reports at Preferred Med. Imaging, P.C. v Countrywide Ins. Co. (2007 NY Slip Op 50693(U))
| Preferred Med. Imaging, P.C. v Countrywide Ins. Co. |
| 2007 NY Slip Op 50693(U) [15 Misc 3d 133(A)] |
| Decided on April 3, 2007 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON PATTERSON and RIOS, JJ
2006-344 K C.
against
Countrywide Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Kathy J. King, J.), dated December 27, 2005. The order granted plaintiff’s motion for summary judgment.
Order reversed without costs and plaintiff’s motion for summary judgment denied.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff’s motion for summary judgment was supported by an affirmation from plaintiff’s counsel, an affidavit by an employee of plaintiff, and various documents annexed thereto. The affidavit executed by plaintiff’s employee stated in a conclusory manner that the documents attached to plaintiff’s motion papers were plaintiff’s business records. In opposition, defendant argued, inter alia, that the affidavit by plaintiff’s employee failed to lay a proper foundation for the documents annexed to plaintiff’s moving papers and that, as a result, plaintiff failed to establish a prima facie case. The court granted plaintiff’s motion for summary judgment and this appeal by defendant ensued.
On appeal, defendant reiterates its argument that plaintiff did not make a prima facie showing because plaintiff failed to establish the admissibility of the claim forms annexed to plaintiff’s moving papers. Inasmuch as the affidavit submitted by plaintiff’s employee was insufficient to establish that said employee possessed personal knowledge of plaintiff’s practices and procedures so as to lay a foundation for the admission, as business records, of the documents [*2]annexed to plaintiff’s moving papers, plaintiff failed to make a prima facie showing of its entitlement to summary judgment (see Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Accordingly, plaintiff’s motion for summary judgment should have been denied.
To the extent defendant asks this court to search the record and grant it summary judgment, defendant is not entitled to such relief since, among other things, the record does not contain any proof that defendant’s denials were timely issued.
Pesce, P.J., Weston Patterson and Rios, JJ., concur.
Reported in New York Official Reports at S.P. Med. Ctr. v Trumbull Ins. Co. (2007 NY Slip Op 50692(U))
| S.P. Med. Ctr. v Trumbull Ins. Co. |
| 2007 NY Slip Op 50692(U) [15 Misc 3d 133(A)] |
| Decided on April 3, 2007 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON PATTERSON and RIOS, JJ
2006-319 K C.
against
Trumbull Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Jack M. Battaglia, J.), entered November 18, 2005, deemed an appeal from a judgment entered on January 3, 2006 (see CPLR 5501 [c]). The judgment, entered pursuant to the November 18, 2005 order granting plaintiff’s motion for summary judgment and denying defendant’s cross motion to dismiss the complaint, awarded plaintiff the sum of $55,272.72.
Judgment reversed without costs, the branch of the November 18, 2005 order which granted plaintiff’s motion for summary judgment vacated and plaintiff’s motion for summary judgment denied.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved to dismiss the complaint for lack of subject matter jurisdiction. The court below granted plaintiff’s motion and denied defendant’s cross motion. The instant appeal by defendant ensued.
While plaintiff listed in its complaint under the heading “First Cause of Action” all three of its claims for no-fault benefits, the recovery of which was assigned to it by three different assignors, it is clear that all three claims were separate and distinct and each was within the Civil Court’s monetary jurisdictional limit of $25,000 (CCA 202, 211; see Karp v Manhattan Mtge. Co., Inc., 11 Misc 3d 142[A], 2006 NY Slip Op 50699[U] [App Term, 1st Dept]). Therefore, the court below properly denied defendant’s cross motion to dismiss the action for lack of subject [*2]matter jurisdiction.
On appeal, defendant contends that the affidavit by plaintiff’s corporate officer, submitted in support of the motion, failed to lay a proper foundation for the documents annexed to plaintiff’s moving papers and that, as a result, plaintiff failed to establish a prima facie case. The affidavit submitted by plaintiff’s corporate officer was insufficient to establish that said officer possessed personal knowledge of plaintiff’s practices and procedures so as to lay a foundation for the admission, as business records, of the documents annexed to plaintiff’s moving papers. Accordingly, plaintiff failed to make a prima facie showing of its entitlement to summary judgment (see Bath Med. Supply, Inc. v Deerbrook Ins. Co., 14 Misc 3d 135[A], 2007 NY Slip Op 50179[U] [App Term, 2d & 11th Jud Dists]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Consequently, the judgment is reversed, the branch of the order entered November 18, 2005 which granted plaintiff’s motion for summary judgment is vacated, and plaintiff’s motion for summary judgment denied.
Pesce, P.J., Weston Patterson and Rios, JJ., concur.
Decision Date: April 03, 2007