Reported in New York Official Reports at Childs Play of New City Patricia Riley-Tesi, OTR/L v Global Liberty Ins. (2020 NY Slip Op 50989(U))
| Childs Play of New City Patricia Riley-Tesi, OTR/Lv Global Liberty Ins. |
| 2020 NY Slip Op 50989(U) [68 Misc 3d 130(A)] |
| Decided on August 28, 2020 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 August 28, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, WAVNY TOUSSAINT, JJ
2018-1286 K C
against
Global Liberty Insurance, Appellant.
Law Office of Jason Tenenbaum, P.C. (Jason Tenenbaum of counsel), for appellant. Law Offices of Ilona Finkelshteyn, P.C., 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 April 17, 2018. The order, insofar as appealed from and as limited by the brief, denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, 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 moved for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations. By order entered April 17, 2018, the Civil Court, insofar as is relevant to this appeal, denied the motion, but found, in effect pursuant to CPLR 3212 (g), that defendant had established timely mailing of the denial of claim forms.
For the reasons stated in Colin, as Assignee of Tyrell Sloan v Global Liberty Ins. Co. of NY (___ Misc 3d ___, 2020 NY Slip Op ______ [appeal No. 2018-2315 K C], decided herewith), the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
ALIOTTA, P.J., ELLIOT and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 28, 2020
Reported in New York Official Reports at Solution Bridge, Inc. v Nationwide Ins. (2020 NY Slip Op 50988(U))
| Solution Bridge, Inc. v Nationwide Ins. |
| 2020 NY Slip Op 50988(U) [68 Misc 3d 130(A)] |
| Decided on August 28, 2020 |
| 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 August 28, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, WAVNY TOUSSAINT, JJ
2018-837 K C
against
Nationwide Ins., Respondent.
The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Harris J. Zakarin, P.C. (Harris J. Zakarin 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 January 23, 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 modified by providing that defendant’s motion for summary judgment dismissing the complaint is denied; as so modified, the order 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, arguing that plaintiff had failed to appear for examinations under oath (EUOs) and that the action was premature because plaintiff had failed to provide requested verification. Plaintiff cross-moved for summary judgment. By order entered January 23, 2018, the Civil Court granted defendant’s motion for summary judgment dismissing the complaint on the ground that the action was premature due to plaintiff’s failure to provide requested verification and denied plaintiff’s cross motion.
Defendant demonstrated, prima facie, that it had timely mailed initial and follow-up requests for verification (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and had not received the requested verification. However, as plaintiff argues, the affidavit submitted by plaintiff in opposition to defendant’s motion was sufficient to give rise to a presumption that the requested verification had been mailed to, and received by, defendant (see id.). In light of the foregoing, there is a triable issue of fact as to whether the action is premature (see Compas Med., P.C. v Praetorian Ins. Co., 49 Misc 3d 152[A], 2015 NY Slip Op 51776[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). Plaintiff’s remaining contention lacks merit (see Frankel v Stavsky, 40 AD3d 918 [2007]).
Accordingly, the order is modified by providing that defendant’s motion for summary judgment dismissing the complaint is denied.
ALIOTTA, P.J., ELLIOT and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 28, 2020
Reported in New York Official Reports at Maiga Prods. Corp. v MVAIC (2020 NY Slip Op 50993(U))
[*1]| Maiga Prods. Corp. v MVAIC |
| 2020 NY Slip Op 50993(U) [68 Misc 3d 131(A)] |
| Decided on August 28, 2020 |
| 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 August 28, 2020
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, WAVNY TOUSSAINT, JJ
2018-1641 K C
against
MVAIC, Appellant.
Marshall & Marshall, PLLC (Barbara Carabell of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.
Appeal from a judgment of the Civil Court of the City of New York, Kings County (Michael Gerstein, J.), entered May 3, 2018. The judgment, entered pursuant to a decision of that court dated March 8, 2018, after a nonjury trial, awarded plaintiff the principal sum of $1,610.19.
ORDERED that, on the court’s own motion, the notice of appeal from the decision dated March 8, 2018 is deemed a premature notice of appeal from the judgment entered May 3, 2018 (see CPLR 5520 [c]); and it is further,
ORDERED that the judgment is reversed, with $30 costs, and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the complaint.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from a judgment, after a nonjury trial, awarding plaintiff the principal sum of $1,610.19.
At the outset of the trial, the parties noted that, by a prior order, the issues for trial would be limited (see CPLR 3212 [g]) to whether there was coverage for plaintiff’s claims by defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) and whether plaintiff’s assignor owned the allegedly uninsured vehicle. The only witness at trial was an employee of MVAIC, who testified that plaintiff’s assignor had appeared for an examination under oath and that the assignor was the de facto owner of the vehicle he was operating at the time of the accident (see generally Vehicle and Traffic Law § 128).
Proof that a claimant is a resident of the State of New York who is not the owner of the uninsured motor vehicle is a condition precedent to the claimant being a “qualified person” (Insurance Law § 5202 [b]) and, thus, potentially eligible to be deemed to be a “covered person” (Insurance Law § 5221 [b] [2]) who would be entitled to recover no-fault benefits from MVAIC. Plaintiff did not establish that its assignor was not the owner of the uninsured vehicle he was driving when the accident occurred. In view of the foregoing, plaintiff failed to establish its prima facie case (see Insurance Law §§ 5202 [b]; 5208, 5221 [b] [2]; Advanced Chiropractic of NY, P.C. v MVAIC, 56 Misc 3d 134[A], 2017 NY Slip Op 50955[U] [App Term, 2d Dept, 2d, [*2]11th & 13th Jud Dists 2017]; see also Barillas v Rivera, 32 AD3d 872 [2006]), and we reach no other issue.
Accordingly, the judgment is reversed and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the complaint.
ALIOTTA, P.J., ELLIOT and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 28, 2020Quality Health Supply Corp. v Hertz Co. (2020 NY Slip Op 50996(U))
Reported in New York Official Reports at Quality Health Supply Corp. v Hertz Co. (2020 NY Slip Op 50996(U))
[*1]| Quality Health Supply Corp. v Hertz Co. |
| 2020 NY Slip Op 50996(U) [68 Misc 3d 131(A)] |
| Decided on August 28, 2020 |
| 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 August 28, 2020
PRESENT: : MICHELLE WESTON, J.P., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-1968 K C
against
Hertz Co., Respondent.
The Rybak Firm, PLLC (Damin Toell and Karina Barska of counsel), for appellant. Rubin, Fiorella, Friedman & Mercante, LLP (Deena Khalifa Sarah Cohenson of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Joy F. Campanelli, J.), entered February 6, 2018. The order granted defendant’s motion to amend the pleadings and to dismiss the complaint on the ground of res judicata, and denied plaintiff’s cross motion for summary judgment.
ORDERED that the order is modified by providing that defendant’s motion seeking to amend the pleadings and to dismiss the complaint on the ground of res judicata is denied; as so modified, the order is affirmed, without costs.
Plaintiff Quality Health Supply Corp. (Quality Health) commenced this action against “Hertz Co.” to recover assigned first-party no-fault benefits for services provided to plaintiff’s assignor, who had allegedly been injured in an accident on July 7, 2015. Prior to the commencement of this action, “Hertz Vehicles, LLC” had brought a declaratory judgment action in the Supreme Court, New York County, against Quality Health and its assignor herein, among other parties, pertaining to the July 7, 2015 accident, and had moved in the Supreme Court for a default judgment against Quality Health and its assignor. In an order entered August 4, 2016, the Supreme Court, upon granting an unopposed motion by Hertz Vehicles, LLC, declared that Hertz Vehicles, LLC was not obligated to pay claims for reimbursement submitted by Quality Health and its assignor. Hertz Co. thereafter moved in the Civil Court for an order pursuant to CPLR 3025 (c), “amending the named defendant in this action to the proper party, ‘Hertz Vehicles, LLC.’ ” Relying upon the Supreme Court’s order, Hertz Co. sought the further relief in the Civil Court of dismissing the complaint on the ground that the present action is barred by the doctrine of res judicata. Plaintiff cross-moved for summary judgment and opposed defendant’s motion. Plaintiff appeals from an order of the Civil Court entered February 6, 2018 which granted defendant’s motion and denied plaintiff’s cross motion.
CPLR 3025 (c) provides that “the court may permit pleadings to be amended before or [*2]after judgment to conform them to the evidence.” Upon a review of the record, we find that the Civil Court improperly exercised its discretion in granting the branch of defendant’s motion seeking to amend the pleadings, as defendant failed to proffer any evidence to support the conclusory statement by its claim representative that Hertz Vehicles, LLC is “the proper party.” Defendant also sought an order dismissing the complaint on the ground of res judicata. “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” (Ciraldo v JP Morgan Chase Bank, N.A., 140 AD3d 912, 913 [2016]; see Matter of Hunter, 4 NY3d 260, 269 [2005]; Schuylkill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 [1929]). In the case at bar, as defendant failed to establish that plaintiff had sued the wrong party, there is no demonstration that there had been “a final adjudication of [the present claims] on the merits” (Ciraldo, 140 AD3d at 913; Matter of Hunter, 4 NY3d 260; Schuylkill Fuel Corp., 50 NY 304) in the Supreme Court, and, thus, there is no basis for preclusion, under the doctrine of res judicata, of the Civil Court action against Hertz Co. Consequently, Hertz Co.’s motion should have been denied.
With respect to plaintiff’s cross motion for summary judgment, contrary to plaintiff’s contention, plaintiff failed to demonstrate its prima facie entitlement to summary judgment, as the proof submitted in support of its motion failed to establish either that the claims at issue had not been timely denied or that defendant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law (see Insurance Law § 5106 [a]; Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).
Accordingly, the order is modified by providing that Hertz Co.’s motion to amend the pleadings and to dismiss the complaint on the ground of res judicata is denied.
WESTON, J.P., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 28, 2020Matter of Advanced Orthopaedics PLLC v Unitrin Advantage Ins. Co. (2020 NY Slip Op 51017(U))
Reported in New York Official Reports at Matter of Advanced Orthopaedics PLLC v Unitrin Advantage Ins. Co. (2020 NY Slip Op 51017(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS
against
Unitrin Advantage Insurance Company, Respondent.
Law Offices of Jonathan B. Seplowe, Esq. (Alan M. Elis of counsel), for appellant. Goldberg, Miller & Rubin, P.C. (Timothy R. Bishop of counsel), for respondent.
Appeal from an order of the District Court of Nassau County, First District (Ignatius L. Muscarella, J.), dated April 11, 2019. The order denied a petition to vacate a master arbitrator’s award, dated September 12, 2018, in a CPLR 7511 proceeding. The appeal was taken to the Appellate Term, Second, Eleventh and Thirteenth Judicial Districts and was transferred to this court by a decision and order on motion of that court dated January 23, 2020 (2020 NY Slip Op 61944[U]).
ORDERED that the order is modified by adding thereto a provision confirming the master arbitrator’s award; as so modified, the order is affirmed, without costs.
Petitioner commenced this proceeding pursuant to CPLR article 75 to vacate a master arbitrator’s award dated September 12, 2018, which upheld the award of an arbitrator, rendered pursuant to Insurance Law § 5106 (b), denying petitioner’s claim to recover assigned first-party no-fault benefits. The District Court denied the petition.
We initially note that, contrary to respondent’s contention, it is well settled that arbitration under the no-fault law is compulsory (see Matter of Bay Needle Care Acupuncture, P.C. v Country Wide Ins. Co., 176 AD3d 695 [2019]; Barry Rubin, M.D., P.C. v Met Life Auto & Home Ins. Co., 26 Misc 3d 138[A], 2010 NY Slip Op 50223[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2010]). “A court reviewing the award of a master arbitrator is limited to the grounds set forth in CPLR article 75, which include, in this compulsory arbitration, the question of whether the determination had evidentiary support, was rational, or had a plausible basis (see Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d 207, 212 [1981])” (Matter of Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co., 176 AD3d 800, 802 [2019]). Applying this standard, we find a rational basis for the determination of the master arbitrator upholding the arbitrator’s award (see Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d 214 [1996]; Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d 207). Consequently, the Civil Court properly denied the petition to vacate the master arbitrator’s award.However, upon [*2]denying the petition, the court was required, pursuant to CPLR 7511 (e), to confirm the award (see Matter of Exclusive Med. & Diagnostic v Government Empls. Ins. Co., 306 AD2d 476 [2003]).
Accordingly, the order is modified by adding thereto a provision confirming the master arbitrator’s award.
We note that a proceeding to vacate or to confirm an arbitrator’s award is a special proceeding brought pursuant to CPLR article 4 and should, therefore, terminate in a judgment rather than an order (see CPLR 411).
ADAMS, P.J., GARGUILO and EMERSON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 27, 2020
Reported in New York Official Reports at Excel Surgery Ctr., LLC v MVAIC (2020 NY Slip Op 51016(U))
[*1]| Excel Surgery Ctr., LLC v MVAIC |
| 2020 NY Slip Op 51016(U) [68 Misc 3d 134(A)] |
| Decided on August 27, 2020 |
| 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 August 27, 2020
PRESENT: : THOMAS A. ADAMS, P.J., JERRY GARGUILO, ELIZABETH H. EMERSON, JJ
2019-706 S C
against
MVAIC, Appellant.
Marshall & Marshall, PLLC (Tracy Bader Pollack and Jeffrey Kadushin of counsel), for Appellant. Gabriel & Shapiro, LLC (Justin Rosenbaum of counsel), for respondent.
Appeal from an order of the District Court of Suffolk County, Third District (C. Stephen Hackeling, J.), dated March 18, 2019. 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, without 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 Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) appeals from an order of the District Court which denied defendant’s motion which had sought summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs) and granted plaintiff’s cross motion for summary judgment.
Defendant’s moving papers demonstrated, prima facie, that plaintiff’s assignor had failed to appear for either of two duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]) and that upon receipt of the claim at issue, defendant timely mailed the denial of claim form (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), which denied the claim on that ground. Plaintiff failed to raise a triable issue of fact in opposition. Defendant’s motion for summary judgment dismissing the complaint should therefore have been granted and plaintiff’s cross motion should have been denied.
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.
ADAMS, P.J., GARGUILO and EMERSON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 27, 2020
American Tr. Ins. Co. v Martinez (2020 NY Slip Op 50930(U))Reported in New York Official Reports at American Tr. Ins. Co. v Martinez (2020 NY Slip Op 50930(U))
American Transit
Insurance Company, Plaintiff,
against Jeremy Martinez, EMPRESS AMBULANCE SERVICE, FOREST PARK ACUPUNCTURE PC, NEIGHBORHOOD MEDICAL HEALTH CARE PC, NEW YORK HEIGHTS MEDICAL PC, PAIN PHYSICIANS NY PLLC, WELLMART RX INC, Defendants. |
651486/2019
Larkin Farrell LLC, New York, NY (William Larkin of counsel), for plaintiff.
Law Offices of Gary Tsirelman P.C., Brooklyn, NY (Jung Pryjma of counsel), for defendant Wellmart RX Inc.
Gerald Lebovits, J.
This motion concerns the potential obligation to pay no-fault insurance benefits of plaintiff American Transit Insurance Company. Defendant Jeremy Martinez was in a vehicle that was involved in a collision. The vehicle was covered by a no-fault insurance policy issued by American Transit. Martinez assigned the right to collect no-fault benefits under that policy to various treating medical providers, including defendant Wellmart RX Inc. Wellmart applied for no-fault benefits, which American Transit denied.
American Transit brought this action for a declaratory judgment that it is not required to pay no-fault benefits to Martinez or to the other defendants (all medical-provider assignees of Martinez). Wellmart was the only defendant that appeared in the action. American Transit moved for default judgment under CPLR 3215 against Martinez and several of the other non-appearing defendants.
This court granted the default-judgment motion without opposition. The court issued a declaration that Martinez and the non-appearing providers “are not entitled to no-fault benefits as a result of a motor vehicle accident involving Jeremy Martinez . . . due to Jeremy Martinez’s failure to appear for duly scheduled independent medical examinations.” (NYSCEF No. 34 at 1-2 [capitalization omitted].) The court also severed and continued the action as against the remaining defendants, including Wellmart. (See id. at 2.)
American Transit now moves for summary judgment under CPLR 3212 against Wellmart. The motion is denied.
DISCUSSION
The Effect of This Court’s Prior Default-Judgment OrderAmerican Transit argues that because Wellmart is Martinez’s assignee, Wellmart’s claim for benefits is derivative of Martinez’s rights under the no-fault policy—and thus that the default judgment against Martinez ousted Wellmart’s right to claim benefits. This court disagrees. Decades ago, the Appellate Division held that when an assignment of no-fault benefits is made prior to the institution of legal action, a decision on default against the assignor does not bar the assignee from asserting a claim to no-fault benefits. (See Lakeside Hosp. v Government Empls. Ins. Co., 70 AD2d 658, 658 [2d Dept 1979], citing Gramatan Home Inv. Corp. v Lopez, 46 NY2d 481, 486-487 [1979].)
To be sure, in Lakeland Hospital the court noted that the assignee was not a party to the prior arbitration. Here, as American Transit points out, Wellmart is a party defendant. But although Wellmart is a party to this action, it was not a party to the prior motion. To the contrary, American Transit’s motion papers expressly stated that “[n]o relief is sought at this time with respect to” Wellmart. (NYSCEF No. 20 at 1.) This court’s prior order in this action, although it “awarded a default judgment to [American Transit] against [Wellmart’s] assignor . . . did not declare the rights of [American Transit] as against [Wellmart].” The default-judgment order thus does not have preclusive effect on the current summary-judgment motion. (Jamaica Wellness Medical, P.C. v Mercury Casualty Co., 2018 NY Slip Op 51128[U], at *2 (App Term 2d Dept 2018]; accord Ultimate Health Prods., Inc. v Ameriprise Auto & Home, 57 Misc 3d 9, 11 [App Term 2d Dept 2017].)
American Transit argues that the grant of default judgment against Martinez had the effect of declaring that the no-fault policy was void, leaving Martinez without any claim to benefits that he could [*2]have assigned to Wellmart in the first place. But the judgment that American Transit requested from this court, and which this court entered, did not reach so far. As noted above, the default judgment merely declared that Wellmart (and the other non-appearing defendants) are not entitled to benefits, without going on to declare that the no-fault policy itself was void. (See NYSCEF No. 34 at 1-2.) In any event, in Lakeland Hospital, the arbitration decision entered on the assignor’s default sustained the insurer’s argument that the assignor had no claim to benefits as a result of her no-fault policy having been canceled outright prior to the occurrence—and thus prior to any assignment—for nonpayment of premiums. (See 70 AD2d at 658.) The Second Department nonetheless held that this prior arbitration decision did not preclude the assignee from claiming a right to benefits. (See id.)
American Transit thus is not entitled to summary judgment against Wellmart based merely on this court’s prior default-judgment order against Martinez.
Whether American Transit is Entitled to Summary Judgment on the Merits
Alternatively, American Transit argues that Martinez’s failure to appear for scheduled independent medical examinations (IMEs) defeats coverage under the no-fault policy, and thus forecloses Wellmart’s claim to benefits. This court is not persuaded.
A no-fault insurer seeking a declaration of no coverage due to asserted violations of the terms of the policy must first demonstrate that it complied with each of the procedural and timeliness requirements of 11 NYCRR § 65-3.5, governing the handling of no-fault claims. (See American Transit Ins. Co. v Longevity Med. Supply, Inc., 131 AD3d 841, 841 [1st Dept 2015].) One such requirement is that if the insurer requests additional verification of a no-fault claim in the form of an IME, the IME must be scheduled to occur “within 30 calendar days from the date of receipt of the prescribed verification forms.” (11 NYCRR § 65-3.5 [d].) American Transit has not shown that it satisfied this 30-calendar-day timeframe. The documents submitted by American Transit show at most that the first IME was scheduled to be held 26 days after the date of the scheduling notice. (See NYSCEF No. 41 at 17.) Those documents do not reflect when American Transit received the prescribed verification form, as required to determine whether the IME’s scheduled date satisfied the 30-day requirement.[FN1] Given this failure of proof, American Transit has not satisfied its initial prima facie burden at summary judgment. (See Longevity Medical Supply, 131 AD3d at 841.)[FN2]
American Transit argues that these deadlines apply only to “medical examinations that are necessary to determine if [a] particular claim should be paid,” as opposed to “being scheduled for a more broad reason, ie to determine, generally, if the claimant needs future treatment.” (NYSCEF No. 47 at 12-13.) Even assuming for the sake of argument that this interpretive argument is correct, it does not avail American Transit here.
The record evidence on this motion reflects only that American Transit received Martinez’s NF-2 benefits application on October 2, 2017 (see NYSCEF No. 41 at 11-14 [mailroom stamp and date/time footer]), and prepared an IME scheduling notice 10 days later, on October 12, 2017 (see id. at 17). That short time period itself suggests a connection between Martinez’s initial benefits claim and the scheduling of an IME. More fundamentally, there is no record evidence indicating any other purpose for holding the [*3]IME that could even potentially take that IME out of the scheduling framework of 11 NYCRR § 65-3.5 (b) through (d).
Accordingly, for the foregoing reasons it is hereby
ORDERED that American Transit’s motion under CPLR 3212 for summary judgment in its favor as to defendant Wellmart is denied.
8/21/2020
Footnotes
Footnote 1:American Transit has provided the NF-2 claim form provided by Martinez, which contains markings indicating that American Transit received the form on October 2, 2017, 36 days before the IME date. (See NYSCEF No. 41 at 11-14 [mailroom stamp and date/time footer].) But it has not provided the NF-3 verification form.
Footnote 2:In arguing that it could deny no-fault coverage due to Martinez’s failure to appear for IMEs even if those IMEs were not timely scheduled (see NYSCEF No. 54 at 5-10), American Transit does not mention the First Department’s decision in Longevity Medical Supply.
Reported in New York Official Reports at American Tr. Ins. Co. v Wildex (2020 NY Slip Op 50929(U))
American Transit
Insurance Company, Plaintiff,
against Marsillant Wildex, ATLANTIC DIAGNOSTICS LLC, BL HEALTHY LIFE ACUPUNCTURE PC, CITY WIDE HEALTH FACILITY INC, CP MEDICAL DIAGNOSTIC SERVICES PC, CURE CARE PHARMACY INC, DANIMARK PHYSICAL THERAPY PC, DV CHIROPRACTIC CARE PC, FIVE PALMS ACUPUNCTURE PC, FRANK SAUCHELLI, MARINA GADABORSHEV, METROPOLITAN SPECIALTY LABS INC, OUTREACH MANUAL PHYSICAL THERAPY PC, PRO BALANCE CHIROPRACTIC PC, PSYCHOLOGY AFTER ACCIDENT PC, ROBERT LUCA, SUFFICIENT CHIROPRACTIC CARE PLLC, SUPER SCRIPT PHARMACY, and WEI DAO ACUPUNCTURE PC, Defendants. |
650105/2019
Larkin Farrell LLC, New York, NY (William Larkin of counsel), for plaintiff.
Law Offices of Gary Tsirelman P.C., Brooklyn, NY (Jung Pryjma of counsel), for defendant City Wide Health Facility Inc.
Gerald Lebovits, J.
The following e-filed documents, listed by NYSCEF document number (Motion 002) 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 were read on this motion to/for SUMMARY JUDGMENT.
This motion concerns the potential obligation to pay no-fault insurance benefits of plaintiff American Transit Insurance Company. Defendant Marsillant Wildex was in a vehicle that was involved in a collision. The vehicle was covered by a no-fault insurance policy issued by American Transit. Wildex assigned the right to collect no-fault benefits under that policy to various treating medical providers, including defendant City Wide Health Facility Inc. City Wide applied for no-fault benefits, which American Transit denied.
American Transit brought this action for a declaratory judgment that it is not required to pay no-fault benefits to Wildex or to the other defendants (all medical-provider assignees of Wildex). City Wide was the only defendant that appeared in the action. American Transit moved for default judgment under CPLR 3215 against Wildex and the other non-appearing defendants.
This court granted the default-judgment motion without opposition. The court issued a declaration that Wildex and the non-appearing providers “are not entitled to no-fault benefits as a result of a motor vehicle accident involving Marsillant Wildex . . . due to Marsillant Wildex’s failure to appear for duly scheduled independent medical examinations.” (NYSCEF No. 39 at 2-3 [capitalization omitted].) The court also severed and continued the action as against City Wide. (See id. at 3.)
American Transit now moves for summary judgment under CPLR 3212 against City Wide. The motion is denied.
DISCUSSION
The Effect of This Court’s Prior Default-Judgment OrderAmerican Transit argues that because City Wide is Wildex’s assignee, City Wide’s claim for benefits is derivative of Wildex’s rights under the no-fault policy—and thus that the default judgment against Wildex ousted City Wide’s right to claim benefits. This court disagrees. Decades ago, the Appellate Division held that when an assignment of no-fault benefits is made prior to the institution of legal action, a decision on default against the assignor does not bar the [*2]assignee from asserting a claim to no-fault benefits. (See Lakeside Hosp. v Government Empls. Ins. Co., 70 AD2d 658, 658 [2d Dept 1979], citing Gramatan Home Inv. Corp. v Lopez, 46 NY2d 481, 486-487 [1979].)
To be sure, in Lakeland Hospital the court noted that the assignee was not a party to the prior arbitration. Here, as American Transit points out, City Wide is a party defendant. But although City Wide is a party to this action, it was not a party to the prior motion. To the contrary, American Transit’s motion papers expressly stated that “[n]o relief is sought at this time with respect to” City Wide. (NYSCEF No. 27 at 2.) This court’s prior order in this action, although it “awarded a default judgment to [American Transit] against [City Wide’s] assignor . . . did not declare the rights of [American Transit] as against [City Wide].” The default-judgment order thus does not have preclusive effect on the current summary-judgment motion. (Jamaica Wellness Medical, P.C. v Mercury Casualty Co., 2018 NY Slip Op 51128[U], at *2 (App Term 2d Dept 2018]; accord Ultimate Health Prods., Inc. v Ameriprise Auto & Home, 57 Misc 3d 9, 11 [App Term 2d Dept 2017].)
American Transit argues that the grant of default judgment against Wildex had the effect of declaring that the no-fault policy was void, leaving Wildex without any claim to benefits that he could have assigned to City Wide in the first place. But the judgment that American Transit requested from this court, and which this court entered, did not reach so far. As noted above, the default judgment merely declared that Wildex (and the other non-appearing defendants) are not entitled to benefits, without going on to declare that the no-fault policy itself was void. (See NYSCEF No. 39 at 2-3.) In any event, in Lakeland Hospital, the arbitration decision entered on the assignor’s default sustained the insurer’s argument that the assignor had no claim to benefits as a result of her no-fault policy having been canceled outright prior to the occurrence—and thus prior to any assignment—for nonpayment of premiums. (See 70 AD2d at 658.) The Second Department nonetheless held that this prior arbitration decision did not preclude the assignee from claiming a right to benefits. (See id.)
American Transit thus is not entitled to summary judgment against City Wide based merely on this court’s prior default-judgment order against Wildex.
Whether American Transit is Entitled to Summary Judgment on the Merits
Alternatively, American Transit argues that Wildex’s failure to appear for scheduled independent medical examinations (IMEs) defeats coverage under the no-fault policy, and thus forecloses City Wide’s claim to benefits. This court is not persuaded.
A no-fault insurer seeking a declaration of no coverage due to asserted violations of the terms of the policy must first demonstrate that it complied with each of the procedural and timeliness requirements of 11 NYCRR § 65-3.5, governing the handling of no-fault claims. (See American Transit Ins. Co. v Longevity Med. Supply, Inc., 131 AD3d 841, 841 [1st Dept 2015].) One such requirement is that if the insurer requests additional verification of a no-fault claim in the form of an IME, the IME must be scheduled to occur “within 30 calendar days from the date [*3]of receipt of the prescribed verification forms.” (11 NYCRR § 65-3.5 [d].) American Transit has not shown that it satisfied this 30-calendar-day timeframe. To the contrary, the documents submitted by American Transit indicate that the first IME was scheduled to be held 43 days after the date of the scheduling notice itself. (See NYSCEF No. 48 at 20.) Given this failure of proof, American Transit has not satisfied its initial prima facie burden at summary judgment. (See Longevity Medical Supply, 131 AD3d at 841.)[FN1]
American Transit argues that these deadlines apply only to “medical examinations that are necessary to determine if [a] particular claim should be paid,” as opposed to “being scheduled for a more broad reason, ie to determine, generally, if the claimant needs future treatment.” (NYSCEF No. 54 at 12-13.) Even assuming for the sake of argument that this interpretive argument is correct, it does not avail American Transit here.
The record evidence on this motion reflects only that American Transit received Wildex’s NF-2 benefits application on July 31, 2017 (see NYSCEF No. 48 at 11-14 [mailroom stamp and date/time footer]), and prepared an IME scheduling notice 16 days later, on August 16, 2017 (see id. at 20). That short time period itself suggests a connection between Wildex’s initial benefits claim and the scheduling of an IME. More fundamentally, there is no record evidence indicating any other purpose for holding the IME that could even potentially take that IME out of the scheduling framework of 11 NYCRR § 65-3.5 (b) through (d).
Accordingly, for the foregoing reasons it is hereby
ORDERED that American Transit’s motion under CPLR 3212 for summary judgment in its favor as to defendant City Wide is denied.
Defendants.
8/21/2020
Footnotes
Footnote 1:In arguing that it could deny no-fault coverage due to Wildex’s failure to appear for IMEs even if those IMEs were not timely scheduled (see NYSCEF No. 54 at 5-10), American Transit does not mention the First Department’s decision in Longevity Medical Supply.
Reported in New York Official Reports at Omphil Care, Inc. v Pearl Holding Group Managing Gen. Agent for Ocean Harbor Cas. Ins. Co. (2020 NY Slip Op 50946(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Pearl Holding Group Managing General Agent for Ocean Harbor Casualty Insurance Company, Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Karina Barska of counsel), for appellant. Gallo, Vitucci & Klar, LLP (Richard E. Weber and Marissa Dunderdale of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), entered March 18, 2019. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint on the ground that the automobile insurance policy in question had been issued in Florida and that, pursuant to Florida law, there was a lack of coverage due to the valid rescission of the automobile insurance policy and the refund of the insured’s premiums. Plaintiff appeals from an order of the Civil Court entered March 18, 2019 which denied plaintiff’s motion and granted defendant’s cross motion.
It is undisputed that the vehicle in question was insured by defendant under a Florida automobile insurance policy. 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 policyholder had applied for automobile insurance, he did not reside at the Florida address listed on his insurance application, and that the insured vehicle was not being garaged in Florida [*2]for the period stated on the application. Subsequent to defendant’s investigation, it initiated a declaratory judgment action in Florida Circuit Court in Broward County in which a final judgment was entered declaring the subject policy null and void based on the applicant’s misrepresentations in procuring the policy. Defendant then rescinded the policy ab initio, pursuant to Florida Statutes Annotated, title 37, § 627.409, which permits the retroactive rescission of an insurance policy if there has been a material misrepresentation in the application for insurance.
It is undisputed by the parties that Florida law applies. Inasmuch as defendant’s cross motion papers demonstrated that a rescission notice was sent to the insured, and that defendant had returned, or tendered, all premiums paid to the insured 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 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 176, 179 [Fla Dist Ct App, 4th Dist 1996]).
Plaintiff’s remaining arguments are not properly before this court as they are being raised for the first time on appeal, and we decline to consider them (see Joe v Upper Room Ministries, Inc., 88 AD3d 963 [2011]; Mind & Body Acupuncture, P.C. v Elrac, Inc., 48 Misc 3d 139[A], 2015 NY Slip Op 51219[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]).
Accordingly, the order is affirmed.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 14, 2020
Reported in New York Official Reports at Psychmetrics Med., P.C. v State Farm Mut. Ins. Co. (2020 NY Slip Op 50944(U))
| Psychmetrics Med., P.C. v State Farm Mut. Ins. Co. |
| 2020 NY Slip Op 50944(U) [68 Misc 3d 129(A)] |
| Decided on August 14, 2020 |
| 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 August 14, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2018-2059 Q C
against
State Farm Mutual Insurance Co., Respondent.
Law Office of David O’Connor, LLC (David O’Connor of counsel), for appellant. Rivkin Radler, LLP (Stuart M. Bodoff of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Phillip Hom, J.), entered August 8, 2018. The order granted the branch of defendant’s motion seeking to dismiss the complaint on the ground of laches.
ORDERED that the order is reversed, without costs, the branch of defendant’s motion seeking to dismiss the complaint on the ground of laches is denied, and the matter is remitted to the Civil Court for a determination of the remaining branches of defendant’s motion.
Insofar as is relevant to the appeal in this action by a provider to recover assigned first-party no-fault benefits, defendant moved to, among other things, dismiss the complaint on the ground of laches, based on plaintiff’s delay in prosecuting the action. The Civil Court granted this branch of defendant’s motion and found that the remaining branches of the motion were moot.
For the reasons stated in Rockaway Med. & Diagnostic, P.C. v State Farm Mut. Ins. Co. (66 Misc 3d 147[A], 2020 NY Slip Op 50238[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]), the order is reversed, the branch of defendant’s motion seeking to dismiss the complaint on the ground of laches is denied, and the matter is remitted to the Civil Court for a determination of the remaining branches of defendant’s motion.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 14, 2020