Matter of Fishkin (Allstate Ins. Co.) (2019 NY Slip Op 08060)

Reported in New York Official Reports at Matter of Fishkin (Allstate Ins. Co.) (2019 NY Slip Op 08060)

Matter of Fishkin (Allstate Ins. Co.) (2019 NY Slip Op 08060)
Matter of Fishkin (Allstate Ins. Co.)
2019 NY Slip Op 08060 [177 AD3d 1322]
November 8, 2019
Appellate Division, Fourth Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, January 1, 2020

[*1]

 In the Matter of the Arbitration between Zair Fishkin, M.D., as Assignee of Troy Hodge, Respondent, and Allstate Insurance Company, Appellant.

Law Office of Peter C. Merani, P.C., New York City (Karen McCloskey of counsel), for respondent-appellant.

The Wright Law Firm, LLC, Rochester (Ron F. Wright of counsel), for petitioner-respondent.

Appeal from an order of the Supreme Court, Monroe County (Ann Marie Taddeo, J.), entered November 27, 2018, in a proceeding pursuant to CPLR article 75. The order, inter alia, granted the petition to vacate the award of the master arbitrator.

It is hereby ordered that the order so appealed from is unanimously affirmed without costs.

Memorandum: This case arises from injuries that Troy Hodge sustained when a motor vehicle struck him while he rode a bicycle. Petitioner thereafter performed surgery on Hodge, who assigned his no-fault insurance claims to petitioner. Respondent, Hodge’s no-fault insurance carrier, denied petitioner’s claims for the cost of the surgery on the ground that the surgery was not medically necessary. Petitioner subsequently submitted the matter for arbitration. An initial arbitrator rendered an award in favor of petitioner, but respondent sought review from a master arbitrator, who vacated the award of the initial arbitrator and issued an award in favor of respondent. In this CPLR article 75 proceeding to review the determination of the master arbitrator, respondent appeals from an order that granted the petition, vacated the award of the master arbitrator, confirmed the award of the initial arbitrator, and denied the cross petition to confirm the master arbitrator’s award. We affirm.

It is well settled that “[t]he ‘role of the master arbitrator is to review the determination of the arbitrator to assure that the arbitrator reached his [or her] decision in a rational manner, that the decision was not arbitrary and capricious . . . , incorrect as a matter of law . . . , in excess of the policy limits . . . or in conflict with other designated no-fault arbitration proceedings’ (Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d 207, 212 [1981]). This power ‘does not include the power to review, de novo, the matter originally presented to the arbitrator’ ” (Matter of Progressive Cas. Ins. Co. [Elite Med. Supply of N.Y., LLC], 162 AD3d 1471, 1472 [4th Dept 2018]). Here, we agree with petitioner that the master arbitrator impermissibly performed a de novo review of the medical evidence, and thus clearly exceeded his powers. The initial arbitrator concluded that respondent failed to meet its burden of submitting a peer review report setting forth a medical rationale for denying the claim, inasmuch as the peer review report submitted by respondent was conclusory, failed to set forth appropriate medical standards and failed to address the specifics of the case. Contrary to respondent’s contention, the master arbitrator did not conclude that the arbitrator’s determination was incorrect as a matter of law. To the contrary, the master arbitrator reviewed the evidence de novo and concluded that the peer review report submitted by respondent “appears rational.” Thus, contrary to respondent’s contention, Supreme Court properly determined that the master arbitrator exceeded his authority (see generally Matter of Allstate Ins. Co. v Keegan, 201 AD2d 724, 725 [2d Dept 1994]). Present—Whalen, P.J., Smith, DeJoseph, Curran and Winslow, JJ.

BQE Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51803(U))

Reported in New York Official Reports at BQE Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51803(U))

BQE Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51803(U)) [*1]
BQE Acupuncture, P.C. v GEICO Ins. Co.
2019 NY Slip Op 51803(U) [65 Misc 3d 147(A)]
Decided on November 1, 2019
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 1, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, BERNICE D. SIEGAL, JJ
2018-1631 K C
BQE Acupuncture, P.C., as Assignee of Hart Peter, Respondent,

against

GEICO Ins. Co., Appellant.

Law Office of Goldstein & Flecker (Lawrence J. Chanice of counsel), for appellant. The Rybak Firm, PLLC (Oleg Rybak of counsel), for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Lorna J. McAllister, J.), entered June 11, 2018. The order, insofar as appealed from and as limited by the brief, denied defendant’s cross motion for summary judgment dismissing the complaint.

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

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

For the reasons stated in Acupuncture Now, P.C., as Assignee of Lozano, Cleotilde v Global Liberty Ins. (___ Misc 3d ___, 2019 NY Slip Op _____ [appeal No. 2018-962 K C], decided herewith), the order, insofar as appealed from, is reversed and defendant’s cross motion for summary judgment dismissing the complaint is granted.

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019
Sovera Med. Supply Corp. v 21st Century Ins. Co. (2019 NY Slip Op 51802(U))

Reported in New York Official Reports at Sovera Med. Supply Corp. v 21st Century Ins. Co. (2019 NY Slip Op 51802(U))

Sovera Med. Supply Corp. v 21st Century Ins. Co. (2019 NY Slip Op 51802(U)) [*1]
Sovera Med. Supply Corp. v 21st Century Ins. Co.
2019 NY Slip Op 51802(U) [65 Misc 3d 147(A)]
Decided on November 1, 2019
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 1, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, BERNICE D. SIEGAL, JJ
2018-1317 K C
Sovera Medical Supply Corp., as Assignee of Zunilda Garcia, Appellant,

against

21st Century Insurance Company, Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Law Offices of Buratti, Rothenberg & Burns (Rachel L. Hollander of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Richard J. Montelione, J.), entered March 27, 2018. 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, defendant moved for summary judgment dismissing the complaint on the ground, among others, that there was a lack of medical necessity for the supplies in question, and plaintiff cross-moved for summary judgment. The Civil Court granted defendant’s motion and denied plaintiff’s cross motion.

Contrary to plaintiff’s contention, the peer review report submitted by defendant sufficiently set forth a factual basis and medical rationale for the peer reviewer’s determination that there was a lack of medical necessity for the supplies at issue. In opposition to defendant’s motion, plaintiff submitted an affidavit from a doctor which failed to meaningfully refer to, let alone sufficiently rebut, the conclusions set forth in the peer review report (see Pan Chiropractic, [*2]P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]).

In light of the foregoing, we reach no other issue.

Accordingly, the order is affirmed.

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019
Y.A.M. Med. Supply, Inc. v Global Liberty Ins. Co. of NY (2019 NY Slip Op 51801(U))

Reported in New York Official Reports at Y.A.M. Med. Supply, Inc. v Global Liberty Ins. Co. of NY (2019 NY Slip Op 51801(U))

Y.A.M. Med. Supply, Inc. v Global Liberty Ins. Co. of NY (2019 NY Slip Op 51801(U)) [*1]
Y.A.M. Med. Supply, Inc. v Global Liberty Ins. Co. of NY
2019 NY Slip Op 51801(U) [65 Misc 3d 147(A)]
Decided on November 1, 2019
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 1, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, BERNICE D. SIEGAL, JJ
2018-1176 K C
Y.A.M. Medical Supply, Inc., as Assignee of Kallamni Hicham, Respondent,

against

Global Liberty Ins. Co. of NY, Appellant.

Law Office of Jason Tenenbaum, P.C. (Jason Tenenbaum of counsel), for appellant. Gary Tsirelman, P.C. (Douglas Mace of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), entered May 17, 2018. The order, insofar as appealed from as limited by the brief, denied defendant’s cross motion seeking to hold the action in abeyance pending a determination by the Workers’ Compensation Board of the parties’ rights under the Workers’ Compensation Law.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant cross-moved to hold the action in abeyance pending an application to the Workers’ Compensation Board to determine the parties’ rights under the Workers’ Compensation Law based upon plaintiff’s assignor’s alleged eligibility for workers’ compensation benefits. By order entered May 17, 2018, insofar as is relevant, the Civil Court denied defendant’s cross motion. Defendant appeals.

The defense that the assignor is eligible for workers’ compensation benefits is subject to preclusion (see Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 [2009]). As defendant failed to demonstrate that it had timely denied plaintiff’s claims on the ground that the [*2]assignor was injured in the course of his employment (see 11 NYCRR 65-3.5 [a]; Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90 NY2d 274, 282 [1997]), defendant’s cross motion was properly denied.

Accordingly, the order, insofar as appealed from, is affirmed.

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019
GC Chiropractic, P.C. v Integon Natl. Ins. Co. (2019 NY Slip Op 51800(U))

Reported in New York Official Reports at GC Chiropractic, P.C. v Integon Natl. Ins. Co. (2019 NY Slip Op 51800(U))

GC Chiropractic, P.C. v Integon Natl. Ins. Co. (2019 NY Slip Op 51800(U)) [*1]
GC Chiropractic, P.C. v Integon Natl. Ins. Co.
2019 NY Slip Op 51800(U) [65 Misc 3d 146(A)]
Decided on November 1, 2019
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 1, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, BERNICE D. SIEGAL, JJ
2018-1173 K C
GC Chiropractic, P.C., as Assignee of Edith Carver, Appellant,

against

Integon National Ins. Co., Respondent.

Gary Tsirelman, P.C. (Devon Riley Christian of counsel), for appellant. Law Offices of Moira Doherty, P.C., for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Rosemarie Montalbano, J.), entered May 7, 2018. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion to compel discovery.

ORDERED that the order is reversed, with $30 costs, defendant’s motion for summary judgment dismissing the complaint is denied and plaintiff’s cross motion to compel discovery is granted.

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 of lack of medical necessity. Plaintiff opposed the motion on the ground that defendant had failed to respond to discovery demands and that defendant’s responses were necessary to oppose defendant’s motion (see CPLR 3212 [f]). Plaintiff also cross-moved to compel defendant to provide the requested discovery (see CPLR 3124). The Civil Court granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion seeking to compel discovery.

In opposition to defendant’s motion, and in support of its cross motion to compel [*2]discovery, plaintiff demonstrated that it had requested from defendant, but had not received in time to oppose defendant’s motion (see CPLR 3212 [f]), the medical records relied upon by defendant’s peer reviewer. In light of the foregoing, defendant is not entitled to summary judgment dismissing the complaint (see IDF Diagnostic Med., P.C. v New York Cent. Mut. Fire Ins. Co., 48 Misc 3d 138[A], 2015 NY Slip Op 51213[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; see also Alrof, Inc. v Progressive Ins. Co., 34 Misc 3d 29 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).

Accordingly, the order is reversed, defendant’s motion for summary judgment dismissing the complaint is denied and plaintiff’s cross motion to compel discovery is granted.

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019
Psychology YME, P.C. v Travelers Ins. (2019 NY Slip Op 51798(U))

Reported in New York Official Reports at Psychology YME, P.C. v Travelers Ins. (2019 NY Slip Op 51798(U))

Psychology YME, P.C. v Travelers Ins. (2019 NY Slip Op 51798(U)) [*1]
Psychology YME, P.C. v Travelers Ins.
2019 NY Slip Op 51798(U) [65 Misc 3d 146(A)]
Decided on November 1, 2019
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 1, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, BERNICE D. SIEGAL, JJ
2018-1073 K C
Psychology YME, P.C., as Assignee of Josie Gonzalez, Respondent,

against

Travelers Insurance, Appellant.

Law Office of Aloy O. Ibuzor (Gregory W. Broido of counsel), for appellant. Zara Javakov, P.C. (Zara Javakov of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered March 27, 2018. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.

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

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court denying defendant’s motion which had sought summary judgment dismissing the complaint based on plaintiff’s failure to provide requested verification within 120 days of the initial verification request (see 11 NYCRR 65-3.5 [o]), and granting plaintiff’s cross motion for summary judgment.

Defendant’s proof was sufficient to demonstrate prima facie that it had timely mailed initial and follow-up verification requests (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]); that it had not received the requested verification; and that it had timely denied the claim on that ground. In opposition, plaintiff failed to raised a [*2]triable issue of fact.

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

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019
Acupuncture Now, P.C. v Global Liberty Ins. (2019 NY Slip Op 51797(U))

Reported in New York Official Reports at Acupuncture Now, P.C. v Global Liberty Ins. (2019 NY Slip Op 51797(U))

Acupuncture Now, P.C. v Global Liberty Ins. (2019 NY Slip Op 51797(U)) [*1]
Acupuncture Now, P.C. v Global Liberty Ins.
2019 NY Slip Op 51797(U) [65 Misc 3d 146(A)]
Decided on November 1, 2019
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 1, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, BERNICE D. SIEGAL, JJ
2018-964 K C
Acupuncture Now, P.C., as Assignee of Rosario, Johanna, Respondent,

against

Global Liberty Insurance, Appellant.

Law Office of Jason Tenenbaum, P.C. (Jason Tenenbaum of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered February 21, 2018. The order, insofar as appealed from and as limited by the brief, denied defendant’s cross motion for summary judgment dismissing the complaint.

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

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

For the reasons stated in Acupuncture Now, P.C., as Assignee of Lozano, Cleotilde v Global Liberty Ins. (___ Misc 3d ___, 2019 NY Slip Op _____ [appeal No. 2018-962 K C], decided herewith), the order, insofar as appealed from, is reversed and defendant’s cross motion for summary judgment dismissing the complaint is granted.

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019
Acupuncture Now, P.C. v Global Liberty Ins. (2019 NY Slip Op 51796(U))

Reported in New York Official Reports at Acupuncture Now, P.C. v Global Liberty Ins. (2019 NY Slip Op 51796(U))

Acupuncture Now, P.C. v Global Liberty Ins. (2019 NY Slip Op 51796(U)) [*1]
Acupuncture Now, P.C. v Global Liberty Ins.
2019 NY Slip Op 51796(U) [65 Misc 3d 146(A)]
Decided on November 1, 2019
Appellate Term, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 1, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, BERNICE D. SIEGAL, JJ
2018-962 K C
Acupuncture Now, P.C., as Assignee of Lozano, Cleotilde, Respondent,

against

Global Liberty Insurance, Appellant.

Law Office of Jason Tenenbaum, P.C. (Jason Tenenbaum of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered February 22, 2018. The order, insofar as appealed from and as limited by the brief, denied defendant’s cross motion for summary judgment dismissing the complaint

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

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

The proof submitted by defendant in support of its cross motion was sufficient to give rise to a presumption that the denial of claim forms at issue had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant also demonstrated that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Plaintiff failed to raise a triable issue of fact in opposition.

In view of the foregoing, we reach no other issue.

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

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019
Easy Care Acupuncture, P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 51794(U))

Reported in New York Official Reports at Easy Care Acupuncture, P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 51794(U))

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

Easy Care Acupuncture, P.C., as Assignee of Jackie Maulange, Appellant,

against

Ameriprise Ins. Co., Respondent.

Gary Tsirelman, P.C. (Douglas Mace of counsel), for appellant. Bruno, Gerbino & Soriano, LLP (Nathan M. Shapiro of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Richard J. Montelione, J.), entered November 2, 2017. The order, insofar as appealed from, granted the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover on claims for $2,079.15, $1,035.12, $980.12, $862.60, $542.56, and $255.04.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from so much of an order of the Civil Court as granted the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover on claims for $2,079.15, $1,035.12, $980.12, $862.60, $542.56, and $255.04 on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs).

Contrary to plaintiff’s contentions on appeal, defendant established that the EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; see also ARCO Med. NY, P.C. v Lancer Ins. Co., 34 Misc 3d 134[A], 2011 NY Slip Op 52382[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists [*2]2011]) and that plaintiff had failed to appear for the duly scheduled EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]).

Plaintiff’s remaining contentions lack merit.

Accordingly, the order, insofar as appealed from, is affirmed.

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019
Bronx Med. Diagnostic, P.C. v Hereford Ins. Co. (2019 NY Slip Op 51793(U))

Reported in New York Official Reports at Bronx Med. Diagnostic, P.C. v Hereford Ins. Co. (2019 NY Slip Op 51793(U))

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

Bronx Medical Diagnostic, P.C., as Assignee of Henly Gonzalez, Appellant,

against

Hereford Ins. Co., Respondent.

Zara Javakov, P.C. (Zara Javakov and Victoria Tarasova of counsel), for appellant. Goldberg Miller & Rubin (Melissa Brooks and Harlan Schreiber of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Andrew Borrok, J.), entered July 25, 2017. The order, insofar as appealed from as limited by the brief, granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendant’s cross motion for summary judgment dismissing the complaint is denied.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs). As limited by its brief, plaintiff appeals from so much of an order of the Civil Court as granted defendant’s cross motion.

While plaintiff may have made a specific assertion, that defendant failed to establish that it had timely sought verification in the form of an EUO, for the first time on appeal, we, nonetheless, reach this issue as it is a question of law apparent on the face of the record, which could not have been avoided if raised at the proper juncture (see 41 Clinton Ave. Realty Corp. v [*2]Silver, 150 AD3d 1053, 1054 [2017]; Goldman & Assoc., LLP v Golden, 115 AD3d 911, 912 [2014]; Muniz v Mount Sinai Hosp. of Queens, 91 AD3d 612, 617-618 [2012]; Delta Diagnostic Radiology, P.C. v Citiwide Auto Leasing, 56 Misc 3d 132[A], 2017 NY Slip Op 50924[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]).

Plaintiff correctly argues that defendant’s cross-moving papers failed to establish, as a matter of law, that the first EUO scheduling letter defendant sent to plaintiff had been timely, as defendant’s affiant stated that the letter had been mailed more than 30 days after defendant had received the claims at issue (see Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins., 48 Misc 3d 139[A], 2015 NY Slip Op 51220[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134[A], 2015 NY Slip Op 50476[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). In view of the foregoing, defendant failed to demonstrate its entitlement to summary judgment based upon plaintiff’s failure to comply with a condition precedent to coverage (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]).

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

PESCE, P.J., and ALIOTTA, J., concur.

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

Plaintiff, for the first time on appeal, challenges defendant’s EUO scheduling letter as untimely. Since plaintiff never raised this issue in the Civil Court, the issue is not preserved for appellate review, and I see no reason to review it in the interest of justice. Accordingly, I vote to affirm the order, insofar as appealed from.

With regard to the EUO scheduling letters, plaintiff challenged the sufficiency of the affidavit to establish the protocol for mailing scheduling letters. Plaintiff’s contention in the Civil Court was that the dates were not legible on the mailing receipts for the first letter, that the second letter contained a typographical error, and that a signed return receipt was not attached to the papers. Although these were the only arguments advanced by plaintiff concerning the letters, plaintiff now, on appeal, has adopted a completely different strategy by asserting, for the first time, that the request to schedule an EUO was untimely, since the scheduling letter was mailed 39 days after receipt of the initial bill and 38 days after receipt of the third bill. Nothing in plaintiff’s submissions before the Civil Court makes any mention of the timeliness of the EUO letters. To the contrary, the focus of plaintiff’s arguments was the manner and mechanism of defendant’s mailing procedures. To consider plaintiff’s newly asserted argument on appeal not only ignores well-established rules of preservation, but undermines considerations of fundamental fairness.

It is a longstanding appellate practice principle that an issue raised for the first time on appeal will not be addressed (see Opalinski v City of New York, 110 AD3d 694, 696 [2013]; Libeson v Copy Realty Corp., 167 AD2d 376 [1990]; Block v Magee, 146 AD2d 730 [1989]). Where, as here, a party had the opportunity to raise an issue in the motion court, but failed to do so, the court should refrain from giving that party another opportunity to prevail on an issue by advancing a new legal theory (see generally Matter of Matarrese v New York City Health & Hosps. Corp., 247 AD2d 475 [1998]). Here, plaintiff has raised the timeliness of the EUO in its brief for the first time on appeal without stating any explanation for the failure to raise it in the Civil Court. By addressing an unpreserved issue, we are reversing a judge who never had an opportunity to rule on the issue, encouraging litigants to raise issues for the first time on appeal and exhausting the limited resources available in our appellate courts, given their overloaded case load. We should limit the scope of our review to address issues properly before us. For these reasons, I urge my colleagues to refrain from this practice, and I vote to affirm the order, insofar as appealed from.



ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 01, 2019