March 23, 2016

Actual Chiropractic, P.C. v A. Cent. Ins. Co. (2016 NY Slip Op 50397(U))

Headnote

The insurer failed to establish timely mailing of the IME scheduling letters underlying its nonappearance defense. It sought summary judgment dismissing the provider's assigned no-fault complaint, asserting that it had timely and properly denied the claim for the assignor's failure to attend scheduled IMEs. Its motion papers did not show timely mailing under St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co. It therefore failed to establish proper scheduling or breach of a condition precedent to liability under Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co. The Appellate Term, Second Department, affirmed denial of the insurer's motion.

Reported in New York Official Reports at Actual Chiropractic, P.C. v A. Cent. Ins. Co. (2016 NY Slip Op 50397(U))

[*1]
Actual Chiropractic, P.C. v A. Cent. Ins. Co.
2016 NY Slip Op 50397(U) [51 Misc 3d 130(A)]
Decided on March 23, 2016
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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 23, 2016

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


PRESENT: : PESCE, P.J., ALIOTTA and ELLIOT, JJ.
2013-1096 K C
Actual Chiropractic, P.C. as Assignee of OLIVER HAMILTON, Respondent,

against

A. Central Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered February 15, 2013. 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, defendant moved to dismiss the complaint on the ground that it had timely and properly denied the claim at issue based upon plaintiff’s assignor’s failure to appear for duly scheduled independent medical examinations (IMEs). The Civil Court denied defendant’s motion.

Defendant’s motion papers failed to establish as a matter of law that the letters scheduling the IMEs of plaintiff’s assignor had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Consequently, defendant failed to demonstrate that the IMEs had been properly scheduled and, thus, that it is entitled to summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to comply with a condition precedent to an insurer’s liability on a policy (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]).

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 23, 2016