April 6, 2018
Active Care Med. Supply Corp. v Amica Mut. Ins. Co. (2018 NY Slip Op 50500(U))
https://www.beynensonlaw.com/case-law/active-care-med-supply-corp-v-amica-mut-ins-co-2018-ny-slip-op50500u/
- Decided
- April 6, 2018
- Citation
- 2018 NY Slip Op 50500(U) · 59 Misc 3d 135(A)
- Posture
- Summary judgment
- Outcome
- Split result
- Later treatment
- Followed in 1 later decision (see Cited by)
Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.
Summary
Editorial summary by Beynenson Law, not part of the court’s decision.
Reported in New York Official Reports at Active Care Med. Supply Corp. v Amica Mut. Ins. Co. (2018 NY Slip Op 50500(U))
| Active Care Med. Supply Corp. v Amica Mut. Ins. Co. |
| 2018 NY Slip Op 50500(U) [59 Misc 3d 135(A)] |
| Decided on April 6, 2018 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., MICHELLE WESTON, THOMAS P. ALIOTTA, JJ
2016-955 K C
Active Care Medical Supply Corp., as Assignee of Tyrone, David, Respondent,
against
Amica Mutual Ins. Co., Appellant.
Lawrence N. Rogak, LLC (Lawrence N. Rogak of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell and Karina Barska of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Theresa M. Ciccotto, J.), entered August 12, 2015, deemed from a judgment of that court entered January 13, 2016 (see CPLR 5512 [a]). The judgment, entered pursuant to the August 12, 2015 order denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment, awarded plaintiff the principal sum of $1,819.12.
ORDERED that the judgment is reversed, with $30 costs, so much of the order entered August 12, 2015 as granted plaintiff’s cross motion for summary judgment is vacated, and plaintiff’s cross motion is denied.
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 action is barred by the doctrine of res judicata, and plaintiff cross-moved for summary judgment. By order entered August 12, 2015, the Civil Court denied defendant’s motion and granted plaintiff’s cross motion. Defendant’s appeal from the order entered August 12, 2015 is deemed to be from the judgment entered pursuant thereto on January 13, 2016 (see CPLR 5512 [a]).
While defendant failed to include res judicata as an affirmative defense in its answer or [*2]move to dismiss the complaint on that ground pursuant to CPLR 3211 (a) (5) prior to serving its answer, defendant moved for summary judgment dismissing the complaint on the ground of res judicata based upon orders in a declaratory judgment action in the Supreme Court, Kings County. We note that “an unpleaded defense may serve as the basis for granting summary judgment in the absence of surprise or prejudice to the opposing party” (Sullivan v American Airlines, Inc., 80 AD3d 600, 602 [2011]). Plaintiff’s papers in the Civil Court failed to allege any prejudice (see Barrett v Kasco Constr. Co., 84 AD2d 555, 556 [1981], affd 56 NY2d 830 [1982]; J.K.M. Med. Care, P.C. v Liberty Mut. Fire Ins. Co., 52 Misc 3d 137[A], 2016 NY Slip Op 51071[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016])or surprise (see CPLR 3018 [b]; Rogoff v San Juan Racing Assn., 54 NY2d 883, 885 [1981]; J.K.M. Med. Care, P.C., 52 Misc 3d 137[A], 2016 NY Slip Op 51071[U]; Renelique v State-Wide Ins. Co., 50 Misc 3d 137[A], 2016 NY Slip Op 50096[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]).
“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]). However, plaintiff herein was neither named nor served in the Supreme Court declaratory judgment action. Moreover, plaintiff was not in privity with the injured party, as the assignment of benefits had been executed before defendant commenced the declaratory judgment action. Thus, plaintiff had no full and fair opportunity to defend its interests in that action (see J.K.M. Med. Care, P.C. v Ameriprise Ins. Co., 54 Misc 3d 54 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]; Magic Recovery Med. & Surgical Supply Inc. v State Farm Mut. Auto. Ins. Co., 27 Misc 3d 67 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2010]). Consequently, defendant failed to demonstrate its entitlement to summary judgment dismissing the complaint based on res judicata.
With respect to plaintiff’s cross motion for summary judgment, although the affidavit of plaintiff’s employee, who stated that he had personally mailed the claim form to defendant, was sufficient to give rise to a presumption that the claim had been received by defendant (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]), defendant rebutted the presumption of receipt with an affidavit by its claims representative, who described defendant’s procedures for receiving mail and stated that defendant had not received the bill at issue. Consequently, as defendant raised a triable issue of fact in opposition to plaintiff’s cross motion, the Civil Court should have denied plaintiff’s cross motion.
Accordingly, the judgment is reversed, so much of the order as granted plaintiff’s cross motion for summary judgment is vacated, and plaintiff’s cross motion for summary judgment is denied.
PESCE, P.J., WESTON and ALIOTTA, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: April 06, 2018
Legal questions (3)
Questions of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.
Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?
This decision: The mailing proof (of either party) left only a triable issue of fact on whether or when the item was mailed or received
Held the employee's affidavit of personal mailing created a presumption of receipt, which the insurer rebutted with a claims representative's description of its mail-receiving procedures and statement of non-receipt, raising a triable issue.
Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 103 (this one included) are in the same category.
Does an insurer’s no-coverage declaratory judgment, or pending declaratory action, bar or stay a no-fault claimant’s action?
This decision: No preclusion because the claimant (or insurer) was not a party or privy to the DJ
Held the declaratory judgment was not res judicata because the provider was neither named nor served and its assignment predated the action, so it lacked privity and a full and fair opportunity to defend.
Of the 164 decisions on this question in the Second Department courts and the Court of Appeals, 20 (this one included) are in the same category.
On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?
This decision: Claimant's proof held to make out its prima facie case (rules on the question, but another ground decided the case)
Held the provider's employee's affidavit that he personally mailed the claim raised a presumption of receipt, but the insurer's non-receipt affidavit raised a triable issue defeating summary judgment.
Of the 1,065 decisions on this question in the Second Department courts and the Court of Appeals, 513 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- J.K.M. Med. Care, P.C. v Liberty Mut. Fire Ins. Co. (2016 NY Slip Op 51071(U)) FollowedThe insurer's answer was deemed amended to assert res judicata because the provider alleged no surprise or prejudice from that defense.
- Renelique v State-Wide Ins. Co. (2016 NY Slip Op 50096(U)) FollowedAn unpleaded res judicata defense may support summary judgment absent surprise or prejudice to the opposing party.
- J.K.M. Med. Care, P.C. v Ameriprise Ins. Co. (2016 NY Slip Op 26424) FollowedThe provider was not bound by a coverage declaration against its assignor because the assignment preceded the proceeding and the provider was absent.
- Magic Recovery Med. & Surgical Supply Inc. v State Farm Mut. Auto. Ins. Co. (2010 NY Slip Op 20130) FollowedThe provider was not collaterally estopped by default declaratory judgments in actions where it was neither a party nor in privity.
Cited by
A label shows how the later decision treated this one.
- NR Acupuncture, P.C. v Ocean Harbor Cas. Ins. Co. (2019 NY Slip Op 51892(U)) FollowedThe insurer failed to establish valid Florida policy rescission or that a Florida declaratory judgment bound the provider.
Similar decisions
- Active Chiropractic, P.C. v Allstate Ins. (2018 NY Slip Op 50201(U))An unpleaded res judicata defense may support summary judgment absent surprise or prejudice to the opposing party.
- Active Care Med. Supply Corp. v Farmington Cas. Co. (2019 NY Slip Op 50987(U))The provider's second and third causes of action were premature because requested wholesale invoices remained outstanding.
- Active Care Med. Supply Corp. v American Commerce Ins. Co. (2016 NY Slip Op 51813(U))An unvacated default declaratory judgment order can bar a provider's no-fault action under res judicata without a notice of entry.
- Compas Med., P.C. v Praetorian Ins. Co. (2013 NY Slip Op 50249(U))Seven provider claims were dismissed for IME nonappearance or unanswered verification; neither side established summary judgment on two others.
- Active Care Med. Supply Corp. v Tri State Consumers Ins. Co. (2017 NY Slip Op 51721(U))The provider raised a verification receipt issue on its first claim, but its second claim was submitted late and timely denied.