BNE Clinton Med., P.C. v MVAIC (2022 NY Slip Op 50058(U))

Reported in New York Official Reports at BNE Clinton Med., P.C. v MVAIC (2022 NY Slip Op 50058(U))

[*1]
BNE Clinton Med., P.C. v MVAIC
2022 NY Slip Op 50058(U) [74 Misc 3d 128(A)]
Decided on January 28, 2022
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This opinion is uncorrected and will not be published in the printed Official Reports.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 January 28, 2022
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2020-466 K C

BNE Clinton Medical, P.C., as Assignee of Gregory Diaz, Respondent,

against

MVAIC, Appellant.


Bruno, Gerbino, Soriano & Aitken, LLP (Susan B. Eisner of counsel), for appellant. Kopelevich & Feldsherova, P.C. (David Landfair of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Sandra E. Roper, J.), entered January 21, 2020. The order denied defendant’s motion for summary judgment dismissing the complaint.

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

In this action by a provider to recover assigned first-party no-fault benefits, defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) appeals from an order of the Civil Court denying defendant’s motion which had sought summary judgment dismissing the complaint on the ground that plaintiff’s assignor was not a “qualified” person.

Upon a review of the record, we find that the motion papers establish that plaintiff’s assignor was not a “qualified” person entitled to benefits from MVAIC, as he resided in the same household as his stepfather who had an automobile insurance policy which provided that relatives who reside in the same household were also insureds under the insurance policy (see Insurance Law § 5202 [b]; Smith v Pennsylvania Gen. Ins. Co., 32 AD2d 854 [1969], affd 27 NY2d 830 [1970]). To the extent plaintiff argued, and the Civil Court held, that plaintiff’s assignor was not an insured because he was [*2]over 18 years of age, neither the insurance policy nor the mandatory personal injury protection endorsement (11 NYCRR 65-1.1) limits coverage based upon the age of relatives. In light of the


foregoing, MVAIC’s motion for summary judgment dismissing the complaint should have been granted (see Longevity Med. Supply, Inc. v MVAIC, 64 Misc 3d 143[A], 2019 NY Slip Op 51276[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]; Island Life Chiropractic Pain Care, PLLC v MVAIC, 62 Misc 3d 148[A], 2019 NY Slip Op 50226[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]; T & S Med. Supply Corp. v MVAIC, 58 Misc 3d 131[A], 2017 NY Slip Op 51755[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]).

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

ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.



ENTER:

Paul Kenny


Chief Clerk
Decision Date: January 28, 2022Castro v Omni Ins. Co. (2022 NY Slip Op 50057(U))

Reported in New York Official Reports at Castro v Omni Ins. Co. (2022 NY Slip Op 50057(U))

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

Michael R. Castro, as Assignee of Karim Abad, Respondent,

against

Omni Ins. Co., Appellant.

Freiberg, Peck & Kang, LLP (Yilo J. Kang of counsel), for appellant. Gary Tsirelman, P.C. (Darya Klein of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Sandra E. Roper, J.), dated September 11, 2019. The order denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, it is undisputed that the vehicle in question was insured by defendant under a Pennsylvania automobile insurance policy and that defendant received notice of plaintiff’s claim more than 30 days after the accident. Defendant moved for summary judgment dismissing the complaint, asserting that Pennsylvania substantive law applied, and arguing that, under Pennsylvania law, it was entitled to dismissal of the complaint because it had not received timely notice of either the accident or the claim for insurance benefits, and plaintiff had failed to demonstrate good cause for the lateness of the notice it had provided. In support of its motion, defendant submitted, among other things, a portion of its insured’s automobile insurance policy, which provided, in part: “We must be notified within 30 days, or as soon as practicable, of how, when and where the accident or loss happened.”

Plaintiff opposed the motion in part on the ground that it was untimely because it had been made more than 120 days after a notice of trial had been served. With respect to the substantive portion of the motion, plaintiff agreed that Pennsylvania law controlled, but argued that questions of fact as to whether plaintiff had given notice of the accident or loss as soon as practicable precluded summary judgment, and, in addition, that the governing policy did not require plaintiff or plaintiff’s assignor to provide a reasonable justification for its late notice. The Civil Court deemed the motion to have been timely made, but denied it on the ground that there existed a triable issue of fact as to whether defendant had been notified of the claim as soon as practicable.

We note that the record is devoid of any showing that a notice of trial, the Civil Court equivalent to a note of issue, was filed with the clerk of the Civil Court more than 120 days prior to the time when defendant made its summary judgment motion. Consequently, the motion was not shown to be untimely (see CPLR 3212 [a]).

It is undisputed that Pennsylvania law controls with respect to the substance of this controversy (see T & S Med. Supply Corp. v Ocean Harbor Cas. Ins. Co., 59 Misc 3d 142[A], 2018 NY Slip Op 50665[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018]; see also Jimenez v Monadnock Constr., Inc., 109 AD3d 514, 516 [2013]). Pennsylvania insurance policies, such as the one at issue in this matter, pursuant to which an insured is required to provide the insurer with notice “as soon as practicable,” are governed by a “notice-prejudice” rule (see Lozado v Workers’ Compensation Appeal Board [Dependable Concrete Work and Uninsured Employers Guaranty Fund], 123 A3d 365, 378 [Pa Commw 2015]). Under the notice-prejudice rule, “unless the insurer establishes prejudice resulting from the insured’s failure to give notice as required under the policy, the insurer cannot avoid its contractual obligation” (Ario v Underwriting Members of Lloyd’s of London Syndicates, 996 A2d 588, 598 [Pa Commw 2010]; see Brakeman v Potomac Ins. Co., 472 Pa 66, 76-77, 371 A2d 193, 198 [1977]). The Civil Court correctly concluded that there was an unresolved issue of fact as to whether defendant had been given notice of the accident or loss as soon as practicable. In any event, as defendant’s motion papers failed to establish that it had been prejudiced by reason of the lateness of the notice it received, the Civil Court properly denied defendant’s motion.

Accordingly, the order is affirmed.

ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: January 21, 2022
JFL Med. Care, P.C. v Lancer Ins. Co. (2022 NY Slip Op 50056(U))

Reported in New York Official Reports at JFL Med. Care, P.C. v Lancer Ins. Co. (2022 NY Slip Op 50056(U))

[*1]
JFL Med. Care, P.C. v Lancer Ins. Co.
2022 NY Slip Op 50056(U) [74 Misc 3d 127(A)]
Decided on January 21, 2022
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 January 21, 2022

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


PRESENT: : THOMAS P. ALIOTTA, P.J., WAVNY TOUSSAINT, DONNA-MARIE E. GOLIA, JJ
2020-742 K C
JFL Medical Care, P.C., as Assignee of Durham, Sarah, Appellant,

against

Lancer Insurance Co., Respondent.

The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Hollander Legal Group, P.C. (Allan S. Hollander of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Jill R. Epstein, J.), entered November 7, 2019. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.

ORDERED that the order is affirmed, with $25 costs.

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

Contrary to plaintiff’s only contention with respect to defendant’s motion for summary judgment, defendant established that the independent medical examination scheduling letters had been mailed to plaintiff’s assignor (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Madison Prods. of USA, Inc. v 21st Century Ins. Co., 71 Misc 3d 138[A], 2021 NY Slip Op 50446[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists [2021]).

In view of the foregoing, plaintiff’s cross motion for summary judgment was properly denied.

Accordingly, the order is affirmed.

ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.



ENTER:

Paul Kenny


Chief Clerk
Decision Date: January 21, 2022
North Val. Med., P.C. v Permanent Gen. Assur. Corp. (2022 NY Slip Op 50048(U))

Reported in New York Official Reports at North Val. Med., P.C. v Permanent Gen. Assur. Corp. (2022 NY Slip Op 50048(U))

[*1]
North Val. Med., P.C. v Permanent Gen. Assur. Corp.
2022 NY Slip Op 50048(U) [74 Misc 3d 127(A)]
Decided on January 21, 2022
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 January 21, 2022
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2019-499 K C

North Valley Medical, P.C., as Assignee of Ernest Frazier, Respondent,

against

Permanent General Assurance Corp., Appellant.


Freiberg, Peck & Kang, LLP (Yilo J. Kang of counsel), for appellant. Petre and Associates, P.C. (Damin Toell of counsel), for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Consuelo Mallafre-Melendez, J.), entered March 1, 2019. The order denied defendant’s motion for, in effect, summary judgment dismissing the complaint.

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

Plaintiff North Valley Medical, P.C. (North Valley) commenced this action against Permanent General Assurance Corp. (Permanent General) to recover assigned first-party no-fault benefits for services that North Valley had provided to its assignor, Ernest Frazier, who had allegedly sustained injuries in a motor vehicle accident on November 3, 2013. After issue was joined, Permanent General commenced a declaratory judgment action in the Supreme Court, New York County, against, insofar as relevant here, North Valley and Ernest Frazier, which parties failed to appear or answer in the Supreme Court action. By order entered December 3, 2015, the Supreme Court granted, on default, Permanent General’s motion for a default judgment against, among others, North Valley and Ernest Frazier.

Thereafter, Permanent General moved in the Civil Court for, in effect, summary judgment [*2]dismissing the complaint on the ground that the present Civil Court action is barred under the doctrine of res judicata, as the instant claims had been fully litigated in the Supreme Court. North Valley opposed the motion. Permanent General appeals from an order of the Civil Court entered March 1, 2019 denying Permanent General’s motion.

“Under the doctrine of res judicata, a final adjudication of a claim on the merits precludes relitigation of that claim and all claims arising out of the same transaction or series of transactions by a party or those in privity with a party” (Ciraldo v JP Morgan Chase Bank, N.A., 140 AD3d 912, 913-914 [2016]; see Matter of Hunter, 4 NY3d 260, 269 [2005]; Schuylkill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 [1929]). ” ‘A judgment by default that has not been vacated is conclusive for res judicata purposes and encompasses the issues that were raised or could have been raised in the prior action’ ” (Tracey v Deutsche Bank National Trust, 187 AD3d 815, 817 [2020], quoting Eaddy v US Bank N.A., 180 AD3d 756, 758 [2020]).

In light of the Supreme Court’s order in the declaratory judgment action, the Civil Court should have granted Permanent General’s motion for, in effect, summary judgment dismissing the Civil Court complaint (see Pavlova v Metlife Auto & Home,68 Misc 3d 133[A], 2020 NY Slip Op 51007[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]; EBM Med. Health Care, P.C. v Republic W. Ins.,38 Misc 3d 1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]), as any judgment in favor of North Valley in this action would destroy or impair rights or interests established by the order in the declaratory judgment action (see Schuylkill Fuel Corp., 250 NY at 306-307; Flushing Traditional Acupuncture, P.C. v Kemper Ins. Co., 42 Misc 3d 133[A], 2014 NY Slip Op 50052[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]; EBM Med. Health Care, P.C., 38 Misc 3d at 2). Moreover, the Supreme Court’s order is a conclusive final determination, notwithstanding that it was entered on default (see Lazides v P & G Enters., 58 AD3d 607 [2009]; Matter of Allstate Ins. Co. v Williams, 29 AD3d 688, 690 [2006]; Matter of Eagle Ins. Co. v Facey, 272 AD2d 399 [2000]; Vital Meridian Acupuncture, P.C. v Republic W. Ins. Co., 46 Misc 3d 147[A], 2015 NY Slip Op 50222[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; EBM Med. Health Care, P.C., 38 Misc 3d 1; Ava Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co., 34 Misc 3d 149[A], 2012 NY Slip Op 50233[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]).

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

ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: January 21, 2022Loyalty Physical Therapy, P.T., P.C. v Permanent Gen. Assur. Corp. (2022 NY Slip Op 50049(U))

Reported in New York Official Reports at Loyalty Physical Therapy, P.T., P.C. v Permanent Gen. Assur. Corp. (2022 NY Slip Op 50049(U))

[*1]
Loyalty Physical Therapy, P.T., P.C. v Permanent Gen. Assur. Corp.
2022 NY Slip Op 50049(U) [74 Misc 3d 127(A)]
Decided on January 21, 2022
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 January 21, 2022
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2019-524 K C

Loyalty Physical Therapy, P.T., P.C., as Assignee of Ernest Frazier, Respondent,

against

Permanent General Assurance Corp., Appellant.


Freiberg, Peck & Kang, LLP (Yilo J. Kang of counsel), for appellant. Petre and Associates, P.C. (Damin Toell of counsel), for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Consuelo Mallafre-Melendez, J.), entered March 1, 2019. The order denied defendant’s motion for, in effect, summary judgment dismissing the complaint.

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

Plaintiff Loyalty Physical Therapy, P.T., P.C. (Loyalty) commenced this action against Permanent General Assurance Corp. (Permanent General) to recover assigned first-party no-fault benefits for services that Loyalty had provided to its assignor, Ernest Frazier, who had allegedly sustained injuries in a motor vehicle accident on November 3, 2013. After issue was joined, Permanent General commenced a declaratory judgment action in the Supreme Court, New York County, against, insofar as relevant here, Loyalty and Ernest Frazier, which parties failed to appear or answer in the Supreme Court action. By order entered December 3, 2015, the Supreme Court granted, on default, Permanent General’s motion for a default judgment against, among others, Loyalty and Ernest Frazier.

Thereafter, Permanent General moved in the Civil Court for, in effect, summary judgment [*2]dismissing the complaint on the ground that the present Civil Court action is barred under the doctrine of res judicata, as the instant claims had been fully litigated in the Supreme Court. Loyalty opposed the motion. Permanent General appeals from an order of the Civil Court entered March 1, 2019 denying Permanent General’s motion.

For the reasons stated in North Valley Med., P.C., as Assignee of Ernest Frazier v Permanent Gen. Assur. Corp. (___ Misc 3d ___, 2022 NY Slip Op _____ [appeal No. 2019-499 K C], decided herewith), the order is reversed and defendant’s motion for, in effect, summary judgment dismissing the complaint is granted.

ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: January 21, 2022American Tr. Ins. Co. v Reyes (2022 NY Slip Op 50013(U))

Reported in New York Official Reports at American Tr. Ins. Co. v Reyes (2022 NY Slip Op 50013(U))

[*1]
American Tr. Ins. Co. v Reyes
2022 NY Slip Op 50013(U) [73 Misc 3d 1237(A)]
Decided on January 10, 2022
Supreme Court, New York County
Lebovits, J.
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on January 10, 2022

Supreme Court, New York County



American Transit Insurance Company, Plaintiff,

against

Samuel Reyes, CAREPOINT ACUPUNCTURE, P.C., COMMUNITY MEDICAL IMAGING P.C., DIAGNOSTIC ACCUTOX M., EXCELL CLINICAL LAB, INC., ILANA’S PHARMACY, LEV AMINOV, INTERNAL MEDICINE, P.C., MLJ CHIROPRACTIC P.C., PHOENIX MEDICAL SERVICES, P.C., RICHARD M. SELDES, M.D., P.C., TIM CANTY M.D. PLLC, UNION SCRIPTS, and WESTCHESTER MEDICAL CARE P.C., Defendants.

Index No. 160996/2020

Law Office of Daniel J. Tucker, Brooklyn, NY (Jaimie L. Boyd of counsel), for plaintiff.

No appearance for defendants.


Gerald Lebovits, J.

Plaintiff moves for a default judgment against the no-fault claimant and some of his treating medical providers; and moves for summary judgment against appearing defendants [*2]Community Medical Imaging P.C. and Lev Aminov Internal Medicine, P.C. The motion is denied in its entirety.

Plaintiff has not established that it complied with the regulatory timeliness requirements for the processing of no-fault insurance claims. (See American Transit Ins. Co. v Longevity Med. Supply, Inc., 131 AD3d 841, 841 [1st Dept 2015].) When the additional verification that the insurer seeks from an applicant for no-fault benefits takes the form of an independent medical examination (IME), the IME must be scheduled to be held within 30 calendar days from receipt of the verification forms. (See 11 NYCRR 65-3.5 [d].) Here, the IME was scheduled to be held 33 calendar days after the IME request, and thus necessarily more than the 30-day limit set by § 65-3.5 (d). (See NYSCEF No. 15 at 1.)

Thus, if plaintiff were required to satisfy § 65-3.5’s timeliness requirements, the record demonstrates that it failed to do so—and thus that it was not entitled to deny the claims of the no-fault claimant and his assignees on the ground that the claimant failed to appear for the requested IME. (See Longevity Medical Supply, 131 AD3d at 841.) That said, when an insurer requests additional verification before receiving any claims for benefits, § 65-3.5’s scheduling deadlines do not apply. (See Hereford Ins. Co. v Lida’s Med. Supply, Inc., 161 AD3d 442, 443 [1st Dept 2018].) Neither plaintiff’s attorney affirmation on this motion nor the affirmation’s supporting exhibits disclose when plaintiff received benefits claims or verification forms from the no-fault claimant’s provider assignees. (See NYSCEF No. 11 at ¶ 12; NYSCEF No. 14.) Thus, it is at least possible that plaintiff’s IME request was timely; and that plaintiff could still be entitled to the default and declaratory judgments that it seeks (assuming plaintiff also satisfies the other elements of its claim).

Accordingly, it is hereby

ORDERED that plaintiff’s motion under CPLR 3215 for default judgment against the defaulting defendants is denied; and it is further

ORDERED that if plaintiff does not bring a renewed default-judgment motion within 30 days of entry of this order, the action will be dismissed as to the defaulting defendants; and it is further

ORDERED that plaintiff’s motion under CPLR 3212 for summary judgment against the appearing defendants is denied.

DATE 1/10/2022

Optimum Health Acupuncture, P.C. v Integon Natl. Ins. Co. (2022 NY Slip Op 50068(U))

Reported in New York Official Reports at Optimum Health Acupuncture, P.C. v Integon Natl. Ins. Co. (2022 NY Slip Op 50068(U))



Optimum Health Acupuncture, P.C., a/a/o CLYDE BOWAL, Plaintiff,

against

Integon National Ins. Co., Defendant.

Index No. CV-1526-20/SM
James F. Matthews, J.

Upon the following papers numbered 1 to 65 read on this motion by defendant for an order seeking Summary Judgment of dismissal ; by Notice of Motion/Order to Show Cause and supporting papers 1-4,61 ; Notice of Cross Motion and supporting papers ; Answering Affidavits and supporting papers 62,63 ; Replying Affidavits and supporting papers 64,65 ; Filed papers; Other exhibits: 5-60, (and after hearing counsel in support of and opposed to the motion), it is

ORDERED that the motion by defendant for summary judgment dismissing plaintiff’s complaint pursuant to CPLR 3212(b), is granted.

Plaintiff medical provider seeks reimbursement from defendant insurer for assigned first party no-fault benefits for medical dates of service (“DOS”) rendered to plaintiff’s assignor from 02/06/2019 through 03/19/2020, for injuries sustained from a car accident of 01/28/2019, in the outstanding sum of $7,399.77, under New York’s No-Fault Law.

Defendant now moves for summary judgment dismissing the complaint pursuant to CPLR 3212(b), supported by the affidavit of its Claims Supervisor, Danuta Fudali, which asserts, inter alia, that defendant timely mailed its NF-10 Denial Of Claim forms (“denials”) and Explanation of Benefits (“EOB’s”) to plaintiff, pursuant to the practices and procedures it established to ensure timely deliver of its mailings to the intended recipient, thereby creating a presumption of receipt. The denials were based upon defendant’s payment in full for plaintiff’s submissions of excessive billing not compiled in accordance with the Workers’ Compensation [*2]Fee Schedule (“Fee Schedule”), pursuant to the findings in the affidavit of Carolyn Mallory, C.P.C. (“Certified Professional Coder”)[FN1] , and the lack of medical necessity for certain chiropractic and acupuncture billing, as supported by the Independent Medical Examination (“IME”) and report of Dr. John Iozzio, D.C., L.Ac., dated 03/26/2019, the IME report of Dr. John Iozzio dated 05/02/2019, and the peer review report of Dr. Daniel Sposta, D.C., L.Ac., dated 05/15/2019, which cut off any further chiropractic and acupuncture treatments as of 04/22/2019 and 05/23/2019, respectively.

In opposition to the motion for summary judgment, plaintiff asserts it attached to its papers as an exhibit, the affidavit of Dr. Vadim Dolsky, L.Ac., to rebut the claims of Dr. Iozzio and Dr. Sposta, by demonstrating plaintiff’s assignor was symptomatic and required the treatments provided by the treating providers; that Dr. Iozzio’s IME reports concede that the evaluations and treatments prior to the IME dates were medically necessary; that defendant’s IME reports failed to demonstrate the disputed services were inconsistent with generally accepted medical or professional practices; and Dr. Dolsky’s professional opinion differs from that stated by defendant’s experts, thereby raising a question of fact requiring a trial.

In addition, plaintiff asserts it attached to its papers as an exhibit, the affidavit of Priti Kumar, C.P.C., to rebut the facts and opinions on the proper use of the fee schedule, in opposition to the opinion expressed by Carolyn Mallory, C.P.C. on behalf of defendant. Plaintiff contends the difference of opinion of each party’s expert raises a question of fact, which requires a trial.

In reply to plaintiff’s opposition papers, defendant urges the Court to ignore the purported findings of both Dr. Vadim Dolsky, L.Ac., and that of Priti Kumar, C.P.C., as there are no affidavits or exhibits attached to plaintiff’s papers as an exhibit. Indeed, a search by the Court for the existence of any exhibits or affidavits from plaintiff proved useless, as there is none to be found.

A proponent of a motion for summary judgment must make a prima facie showing of entitlement to judgment as a matter of law with proof in admissible form sufficient to establish the lack of any material issues of fact (see Alvarez v Prospect Hospital, 68 NY2d 320, 324 [1986]; Winegrad v New York Univ. Med. Ctr., 64 NY2d 851, 853 [1985]; Zuckerman v City of New York, 49 NY2d 557,562 [1980]; see also Manhattan Medical v State Farm Mut. Ins. Co., 20 Misc 3d 1144[A][Civ. Ct. Richmond Cty. 2008]).

Once a showing of entitlement to summary judgment has been made, the burden shifts to the party opposing the motion for summary judgment, to produce evidentiary proof in admissible form sufficient to establish the existence of material issues of fact which require a trial of the action (see CPLR 3212 [b]; Alvarez v Prospect Hospital, supra; Zuckerman v City of New York, supra).

An attorney’s affirmation which demonstrates no personal knowledge of the facts, is insufficient to defeat a motion for summary judgment, but may serve as a vehicle for the submission of acceptable attachments, which do provide evidentiary proof in admissible form (see Zuckerman v City of New York, supra).

Here, the Court determines defendant has satisfied its burden of demonstrating the existence and following of its standard office practices and procedures for the timely and proper mailing of its NF-10 denial of claim forms and EOR’s to plaintiff (see Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2nd Dept, 2007]). Defendant’s mailing methods were sufficient to create a rebuttable presumption of proper mailing (see St. Vincent’s Hosp. of Richmond v GEICO, 50 AD3d 1123, 1124 [2nd Dept 2008]; New York Presbyt. Hosp. v Allstate Ins. Co.,29 AD3d 547 [2nd Dept 2006]; Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co., 57 Misc 3d 150[A][App Term, 2d, 11th & 13th Jud Dists 2017]). “…Proof of proper mailing gives rise to a presumption that the item was received by the addressee” (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679, 680 [2nd Dept 2001]), which presumptions of receipt, were not refuted or denied by plaintiff in the instant matter. Plaintiff’s arguments in opposition are unavailing.

The Court further determines that defendant has made a prima facie showing of entitlement to summary judgment as a matter of law with proof in admissible form sufficient to establish the lack of any material issues of fact, which has not been refuted by plaintiff (see Alvarez v Prospect Hospital,supra]; Winegrad v New York Univ. Med. Center, supra; Zuckerman v City of New York, supra).

The failure to submit a rebuttal affidavit from plaintiff’s C.P.C. expert on the contested fee schedule issues, leaves only the opposition analysis of plaintiff’s attorney, with no personal knowledge of the facts, unsupported by expert witness testimony as to the use and interpretation of the fee schedules in the context of defendant’s components and calculations of the alleged maximum permissible fee (see Murali v Upton, 175 Misc 2d 186, 187-188 [Civ Ct, NY Cty, 1997]).

In addition, the failure to submit a rebuttal affidavit from plaintiff’s expert physician showing the medical necessity of its billing in a non-conclusory manner and meaningful way, rebutting the issues raised in the insurer’s IME and peer review reports, fails to demonstrate the existence of a triable issue of fact as to whether there was a lack of medical necessity for the medical services at issue (see Throgs Neck Multicare, P.C. v Mercury Ins. Co., 52 Misc 3d 138[a}[App Term, 2nd Dept, 9th & 10th Jud Dists 2016]), and leaves the conclusions of defendant’s medical experts un-refuted (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A][App Term, 2nd, 11th & 13th Jud Dists 2009]).

“The law is well settled that a party, in opposition to a motion for summary judgment, must assemble and lay bare affirmative proof to demonstrate that the matters alleged are real and capable of being established upon trial” (see Nelson v Lundy, 298 AD2d 689, 690 [3rd Dept 2002]; see also Wasson v Bond, 80 AD3d 1114 [3rd Dept 2011]). The plaintiff’s papers fail to meet this standard and accordingly, judgment is granted in favor of defendant and the complaint is dismissed (see Jamil M. Abraham, M.D., P.C. v Country Wide Ins. Co.,3 Misc 3d 130[A][App Term, 2nd & 11th Jud Dists 2004]; Murali v Upton, supra).

Accordingly, the motion for summary judgment by defendant pursuant to CPLR 3212(b), is granted. The foregoing constitutes the decision and order of this Court.

Dated: January 5, 2022
J.D.C.

Footnotes

Footnote 1:Defendant’s expert Coder states under oath that in the event medical necessity is found at a trial, the amounts to be allowed under the fee schedule would be $447.32 for Bills 1 through 6, and $3,798.60 for Bills 7 through 46 (see page 46 of Carolyn Mallory’s affidavit).

Arcadia Acupuncture, P.C. v Nationwide Ins. Co. (2021 NY Slip Op 51258(U))

Reported in New York Official Reports at Arcadia Acupuncture, P.C. v Nationwide Ins. Co. (2021 NY Slip Op 51258(U))

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

Arcadia Acupuncture, P.C., as Assignee of Juan Hernandez, Respondent,

against

Nationwide Ins. Co., Appellant.

Hollander Legal Group, P.C. (Allan S. Hollander of counsel), for appellant. Zara Javakov, P.C. (Victoria Tarasova of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Matthew P. Blum, J.), entered February 18, 2020. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint and, in effect, granted plaintiff’s cross motion for summary judgment to the extent of (1) dismissing defendant’s affirmative defense that plaintiff had failed to appear for duly scheduled examinations under oath and (2) awarding plaintiff partial summary judgment on liability.

ORDERED that the order, insofar as appealed from, is modified by vacating so much of the order as granted the branches of plaintiff’s cross motion seeking (1) summary judgment dismissing defendant’s affirmative defense that plaintiff had failed to appear for duly scheduled examinations under oath with respect to the claims received between May 11, 2018 and June 22, 2018 and (2) partial summary judgment on liability with respect to the claims received between May 11, 2018 and June 22, 2018, and by providing that those branches of plaintiff’s cross motion are denied; as so modified, 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 on the ground that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). Plaintiff cross-moved for summary judgment. In an order entered February 18, 2020, the Civil Court denied defendant’s motion for summary judgment, stating that “Defendant [had] failed to issue the denials within 30 days of the second missed EUO,” and granted plaintiff’s cross motion to the extent of dismissing the affirmative defense that plaintiff failed to appear for duly scheduled EUOs and awarding plaintiff partial summary judgment on liability.

With respect to the claims received by defendant between May 11, 2018 through June 22, 2018, the record demonstrates, prima facie, that the EUO scheduling letters were timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) to plaintiff, that plaintiff failed to appear for those EUOs, and that defendant timely denied those claims on the ground that plaintiff had failed to appear. However, as we find that a triable issue of fact exists as to whether those EUOs were scheduled to be held at a place that was “reasonably convenient” to plaintiff (see 11 NYCRR 65-3.5 [e]; Parisien v Metlife Auto & Home, 68 Misc 3d 126[A], 2020 NY Slip Op 50845[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]), defendant failed to establish that it is entitled to summary judgment dismissing so much the complaint as sought to recover upon the claims received between May 11, 2018 through June 22, 2018. Consequently, neither party is entitled to summary judgment upon those claims.

While defendant further contends that the branch of its motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claims it received between March 22, 2018 and April 27, 2018 should have been granted and that the Civil Court erred in granting the branch of plaintiff’s cross motion seeking partial summary judgment on liability upon those claims, defendant’s argument lacks merit. The record establishes that defendant failed to timely deny those claims (see Island Life Chiropractic Pain Care, LLC v 21st Century Ins. Co., — Misc 3d &mdash, 2021 NY Slip Op 21340 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]; Quality Health Supply Corp. v Nationwide Ins., 69 Misc 3d 133[A], 2020 NY Slip Op 51226[A] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]). Furthermore, here there is no basis to disturb so much of the order as granted plaintiff partial summary judgment as to liability upon these claims.

Accordingly, the order, insofar as appealed from, is modified by vacating so much of the order as granted the branches of plaintiff’s cross motion seeking (1) summary judgment dismissing defendant’s affirmative defense that plaintiff had failed to appear for duly scheduled examinations under oath, with respect to the claims received between May 11, 2018 and June 22, 2018 and (2) partial summary judgment on liability with respect to the claims received between May 11, 2018 and June 22, 2018, and by providing that those branches of plaintiff’s cross motion are denied.

ALIOTTA, P.J., ELLIOT and GOLIA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 22, 2021
Blackman Pelham Med., P.C. v Ocean Harbor Cas. Ins. Co. (2021 NY Slip Op 51257(U))

Reported in New York Official Reports at Blackman Pelham Med., P.C. v Ocean Harbor Cas. Ins. Co. (2021 NY Slip Op 51257(U))

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

Blackman Pelham Medical, P.C., as Assignee of Sunil Bicano, Appellant,

against

Ocean Harbor Casualty Insurance Co., Respondent.

Kopelevich & Feldsherova, P.C. (David Landfair of counsel), for appellant. Gallo, Vitucci & Klar, LLP, for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Matthew P. Blum, J.), entered March 10, 2020. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that, pursuant to Florida law, there was a lack of coverage due to the valid rescission, ab initio, of the Florida automobile insurance policy in question. According to an affidavit submitted by an employee of defendant’s managing general agent, an investigation conducted after the accident revealed that, at the time the policy was renewed, about three weeks before the accident, the policyholder, who is also the assignor, did not reside, or garage the vehicle, in Florida. Plaintiff opposed the motion. By order entered March 10, 2020, the Civil Court granted the motion. On appeal, plaintiff contends that New York law, which does not permit retroactive rescission, controls and, in any event, that defendant failed to demonstrate that the insurance policy had been properly rescinded in accordance with Florida law.

Upon a review of the record, we find that the Civil Court properly applied Florida law to the substantive issue involved herein (see Matter of Allstate Ins. Co. [Stolarz-New Jersey Mfrs. Ins. Co.], 81 NY2d 219, 223 [1993]; Auten v Auten, 308 NY 155, 160-161 [1954]; Matter of Eagle Ins. Co. v Singletary, 279 AD2d 56, 60 [2000]). In order to demonstrate that an [*2]automobile insurance policy has been properly rescinded ab initio in accordance with Florida law, an insurer must demonstrate that it gave notice of the rescission to the policyholder and that it returned, or tendered, all paid premiums within a reasonable time after the discovery of the grounds for avoiding the policy (see Fla Stat Ann § 627.728 [5]; Leonardo v State Farm Fire and Cas. Co., 675 So 2d 176, 179 [Fla Dist Ct App, 4th Dist 1996]; see also United Auto. Ins. Co. v Salgado, 22 So 3d 594, 600-601 [Fla Dist Ct App, 3d Dist 2009]). Contrary to plaintiff’s arguments, in the case at bar, defendant was not required to demonstrate the basis for the retroactive rescission in support of its motion for summary judgment (see Craigg v Infinity Select Ins. Co., 38 Misc 3d 56, 58 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]).

As defendant’s motion papers demonstrated that a rescission notice was sent to the policyholder, and that defendant had returned all premiums paid to the policyholder within a reasonable period of time after defendant’s discovery of the grounds for rescinding the policy, defendant established, prima facie, that it had voided the policy ab initio pursuant to Florida law (see Omphil Care, Inc. v Pearl Holding Group Managing Gen. Agent for Ocean Harbor Cas. Ins. Co., 68 Misc 3d 129[A], 2020 NY Slip Op 50946[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]; W.H.O. Acupuncture, P.C. v Infinity Prop. & Cas. Co., 36 Misc 3d 4, 6-7 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012], citing Leonardo v State Farm Fire and Cas. Co., 675 So 2d at 179). Plaintiff failed to raise a triable issue of fact in opposition to the motion (see Zuckerman v City of New York, 49 NY2d 557 [1980]).

Accordingly, the order is affirmed.

ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 22, 2021
BSS Med., P.C. v Metropolitan Prop. & Cas. Ins. (2021 NY Slip Op 51255(U))

Reported in New York Official Reports at BSS Med., P.C. v Metropolitan Prop. & Cas. Ins. (2021 NY Slip Op 51255(U))

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

BSS Medical, P.C., as Assignee of Carlton Holder and Keldon Frederick, Respondent,

against

Metropolitan Property and Casualty Ins., Appellant.

Bruno, Gerbino, Soriano & Aitken, LLP (Susan B. Eisner of counsel), for appellant. Zara Javakov, P.C. (Zara Javakov of counsel), for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Ira R. Greenberg, J.), entered October 7, 2019. The order denied as untimely defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and the matter is remitted to the Civil Court for a determination of defendant’s motion on the merits.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff filed a notice of trial on June 14, 2018. On October 12, 2018, defendant moved for summary judgment dismissing the complaint. Plaintiff opposed the motion on the ground that defendant’s motion was untimely. By order entered October 7, 2019, the Civil Court denied defendant’s motion on the ground that it was untimely.

Contrary to plaintiff’s contention, defendant’s motion for summary judgment dismissing the complaint was not untimely under CPLR 3212 (a). CPLR 3212 (a) provides that a motion for summary judgment “shall be made no later than one hundred twenty days after the filing of the note of issue, except with leave of court on good cause shown” (see also Brill v City of New York, 2 NY3d 648, 651 [2004]). A motion is made when the notice of motion is served (see CPLR 2211; Russo v Eveco Dev. Corp., 256 AD2d 566, 566 [1998]; Chimbay v Palma, 14 Misc 3d 130[A], 2007 NY Slip Op 50019[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2007]), and when a motion is served upon a party’s attorney by mail, service is complete upon mailing (see CPLR 2103 [b] [2]; Pietrafesa v Canestro, 130 AD3d 602 [2015]). Here, it is uncontroverted that the notice of trial, the Civil Court equivalent of a note of issue, was filed on June 14, 2018 [*2]and, thus, contrary to the Civil Court’s determination, defendant’s motion was timely when it was served on October 12, 2018.

Accordingly, the order is reversed and the matter is remitted to the Civil Court for a determination of defendant’s motion on the merits.

ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 22, 2021