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December 23, 2014

Allstate Ins. Co. v Pierre (2014 NY Slip Op 08921)

https://www.beynensonlaw.com/case-law/allstate-ins-co-v-pierre-2014-ny-slip-op-08921/

Court
Appellate Division, First Department
Decided
December 23, 2014
Citation
2014 NY Slip Op 08921 · 123 AD3d 618
Posture
Summary judgment
Outcome
Insurer prevailed
Later treatment
Declined to follow in 1, contrasted (cf., but see) in 1 and followed in 9 later decisions (see Cited by)
Issues
EUO no-show Timeliness and preclusion Discovery and procedure
Legal questions
No-show: coverage defense or precludable? · No-show defense: insurer's proof · Proof of mailing (see the maps)
Cite as
Allstate Ins. Co. v Pierre, 123 AD3d 618 (1st Dept 2014)

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.

Failure to attend requested EUOs breaches a no-fault coverage condition, regardless of denial timeliness or willfulness. The insurer established that each assignor missed two EUOs: the first nonappearances were undisputed, and admissible business-record evidence proved the second. Applying Unitrin to EUOs, the Appellate Division, First Department, modified the summary judgment order solely to declare that the appealing providers were not entitled to benefits and otherwise affirmed. The providers' challenges concerning correct-address mailing and waiver through failure to deny were unpreserved and unavailing; their verified answer alleged denials. The insurer did not have to prove willful nonappearance. The providers also failed to show that outstanding discovery made summary judgment premature.

Reported in New York Official Reports at Allstate Ins. Co. v Pierre (2014 NY Slip Op 08921)

Allstate Ins. Co. v Pierre
2014 NY Slip Op 08921 [123 AD3d 618]
December 23, 2014
Appellate Division, First Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, January 28, 2015

[*1]

 Allstate Insurance Company, Respondent,
v
Jean Eddy Pierre et al., Defendants, and Adelaida Laga PT et al., Appellants.

The Rybak Firm, PLLC, Brooklyn (Damin J. Toell of counsel), for appellants.

Freiberg, Peck & Kang, LLP, Armonk (Yilo J. Kang of counsel), for respondent.

Order, Supreme Court, Bronx County (Alison Y. Tuitt, J.), entered July 18, 2013, which granted plaintiff insurer’s motion for summary judgment declaring that defendants-appellants are not entitled to no-fault benefits, unanimously modified, on the law, solely to declare that defendants-appellants are not entitled to no-fault benefits, and otherwise affirmed, without costs.

Plaintiff established that defendants are not entitled to no-fault benefits because their assignors failed to appear at scheduled examinations under oath (EUOs). This Court in Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC (82 AD3d 559 [1st Dept 2011], lv denied 17 NY3d 705 [2011]) held that the failure to submit to requested independent medical examinations (IMEs) constitutes a breach of a condition precedent to coverage under a no-fault policy and voids coverage regardless of the timeliness of the denial of coverage (id. at 560). Although the instant case involves the failure to appear at EUOs, and not IMEs, this Court’s holding in Unitrin applies to EUOs (see e.g. Interboro Ins. Co. v Perez, 112 AD3d 483, 483 [1st Dept 2013]; Seacoast Med., P.C. v Praetorian Ins. Co., 38 Misc 3d 127[A], 2012 NY Slip Op 52354[U] [App Term, 1st Dept 2012]; Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 [2d Dept 2014]). Defendants do not dispute that their assignors failed to appear at their first EUOs, and plaintiff established, through admissible evidence, that the assignors failed to appear at their second EUOs (see Arco Med. NY, P.C. v Metropolitan Cas. Ins. Co., 41 Misc 3d 140[A], 2013 NY Slip Op 52001[U], *2 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]; Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co., 36 Misc 3d 146[A], 2012 NY Slip Op 51628[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]). Plaintiff also established that the statements on the record were business records (see e.g. People v Cratsley, 86 NY2d 81, 90-91 [1995]; One Step Up, Ltd. v Webster Bus. Credit Corp., 87 AD3d 1, 11-12 [1st Dept 2011]). Although plaintiff was required to show (and did show) that the assignors each failed to appeared at two EUOs (see DVS Chiropractic, P.C. v Interboro Ins. Co., 36 Misc 3d 138[A], 2012 NY Slip Op 51443[U], *2 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]), plaintiff was not required to demonstrate that the assignors’ nonappearances were willful (see Unitrin, 82 AD3d at 561).

[*2] Defendants’ argument that plaintiff failed to establish that it had mailed the EUO notices to the assignors’ correct addresses is unpreserved (see e.g. Ta-Chotani v Doubleclick, Inc., 276 AD2d 313, 313 [1st Dept 2000]) and unavailing (see American Tr. Ins. Co. v Leon, 112 AD3d 441, 442 [1st Dept 2013]). Similarly, their argument that plaintiff waived the defense of the assignors’ nonappearance because plaintiff did not establish that it ever denied defendants’ claims is unpreserved (see 276 AD2d at 313). In any event, the argument is unavailing, as defendants’ own verified answer alleged that plaintiff had denied their claims.

Defendants failed to show that summary judgment is premature due to outstanding discovery (see Interboro, 113 AD3d at 597).

We modify the court’s order solely to make a declaration in plaintiff’s favor (see Maurizzio v Lumbermens Mut. Cas. Co., 73 NY2d 951, 954 [1989]; see also QBE Ins. Corp. v Jinx-Proof Inc., 102 AD3d 508, 510 [1st Dept 2013]).

We have considered defendants’ remaining arguments and find them unavailing. Concur—Tom, J.P., Friedman, Renwick, Manzanet-Daniels and Kapnick, JJ.

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.

No-show: coverage defense or precludable?

Open the full map

Is an IME/EUO no-show defense precluded if the insurer did not timely deny the claim on that ground?

This decision: No-show voids coverage; insurer need not show a timely denial

Held that the rule that an exam no-show voids coverage regardless of the denial's timeliness applies to EUOs, and rejected as unpreserved and unavailing the argument that the insurer waived the defense by not proving a denial.

  • Appellate DivisionApp Div 12
  • Appellate TermApp Term 13
  • Trial courtsTrial 11
2021, Appellate Division: 1 decision (1 Coverage defense)2020, Appellate Division: 1 decision (1 Coverage defense)2018, Appellate Division: 2 decisions (1 Coverage defense, 1 Precludable: denial lacking)2016, Appellate Division: 2 decisions (2 Coverage defense)2014, Appellate Division: 1 decision (1 Coverage defense)2013, Appellate Division: 2 decisions (2 Coverage defense)2011, Appellate Division: 1 decision (1 Coverage defense)2024, Appellate Division: 1 decision (1 Coverage defense)2025, Appellate Division: 1 decision (1 Coverage defense)2016, Appellate Term: 2 decisions (2 Coverage defense)2015, Appellate Term: 6 decisions (6 Coverage defense)2014, Appellate Term: 3 decisions (3 Coverage defense)2013, Appellate Term: 1 decision (1 Coverage defense)2005, Appellate Term: 1 decision (1 Precludable: denial lacking)2021, Trial courts: 2 decisions (2 Coverage defense)2019, Trial courts: 1 decision (1 Coverage defense)2015, Trial courts: 1 decision (1 Precludable: denial lacking)2014, Trial courts: 3 decisions (1 Coverage defense, 2 Precludable: denial timely)2013, Trial courts: 1 decision (1 Coverage defense)2024, Trial courts: 1 decision (1 Precludable: denial timely)2005, Trial courts: 1 decision (1 Precludable: denial timely)2023, Trial courts: 1 decision (1 Coverage defense)This decision
20052010201520202025
Coverage defensePrecludable: denial lackingPrecludable: denial timelyThis decisionCites it or cited by itCited or followed

Of the 36 decisions on this question in the First Department courts and the Court of Appeals, 29 (this one included) are in the same category. 4 decisions in other departments that cite or are cited by this one are on the full map.

No-show defense: insurer's proof

Open the full map

Did the insurer prove its IME/EUO no-show defense: mailed, compliant scheduling requests and the claimant’s nonappearance?

This decision: Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected

Held the insurer proved by admissible business-record evidence that each assignor failed to appear at two EUOs, needed not show willfulness, and the address challenge to the notices was unpreserved and unavailing.

  • Appellate DivisionApp Div 53
  • Appellate TermApp Term 71
  • Trial courtsTrial 40
2023, Appellate Division: 4 decisions (3 Defense proved, 1 Requests not compliant)2022, Appellate Division: 8 decisions (3 Defense proved, 5 Requests not compliant)2021, Appellate Division: 2 decisions (2 Defense proved)2020, Appellate Division: 4 decisions (3 Defense proved, 1 Requests not compliant)2019, Appellate Division: 3 decisions (1 Defense proved, 1 Mailing not proved, 1 Requests not compliant)2018, Appellate Division: 5 decisions (2 Defense proved, 1 Mailing not proved, 2 Requests not compliant)2017, Appellate Division: 3 decisions (2 Defense proved, 1 Requests not compliant)2016, Appellate Division: 5 decisions (3 Defense proved, 1 Nonappearance not proved, 1 Requests not compliant)2015, Appellate Division: 7 decisions (2 Defense proved, 5 Requests not compliant)2014, Appellate Division: 2 decisions (2 Defense proved)2013, Appellate Division: 4 decisions (3 Defense proved, 1 Mailing not proved)2011, Appellate Division: 1 decision (1 Defense proved)2024, Appellate Division: 2 decisions (2 Defense proved)2025, Appellate Division: 3 decisions (2 Defense proved, 1 Requests not compliant)2019, Appellate Term: 3 decisions (1 Mailing not proved, 1 Nonappearance not proved, 1 Triable issue)2018, Appellate Term: 1 decision (1 Defense proved)2017, Appellate Term: 1 decision (1 Nonappearance not proved)2016, Appellate Term: 14 decisions (5 Defense proved, 6 Nonappearance not proved, 1 Requests not compliant, 2 Triable issue)2015, Appellate Term: 12 decisions (11 Defense proved, 1 Requests not compliant)2014, Appellate Term: 6 decisions (6 Defense proved)2013, Appellate Term: 5 decisions (4 Defense proved, 1 Mailing not proved)2012, Appellate Term: 8 decisions (6 Defense proved, 2 Mailing not proved)2011, Appellate Term: 7 decisions (6 Defense proved, 1 Mailing not proved)2010, Appellate Term: 2 decisions (2 Defense proved)2007, Appellate Term: 1 decision (1 Requests not compliant)2006, Appellate Term: 2 decisions (1 Requests not compliant, 1 Triable issue)2005, Appellate Term: 3 decisions (1 Defense proved, 2 Requests not compliant)2025, Appellate Term: 3 decisions (3 Defense proved)2026, Appellate Term: 2 decisions (2 Defense proved)2020, Appellate Term: 1 decision (1 Mailing not proved)2022, Trial courts: 8 decisions (2 Defense proved, 1 Mailing not proved, 1 Nonappearance not proved, 4 Requests not compliant)2021, Trial courts: 6 decisions (3 Defense proved, 2 Requests not compliant, 1 No-show excused)2020, Trial courts: 7 decisions (1 Mailing not proved, 6 Requests not compliant)2019, Trial courts: 1 decision (1 Defense proved)2018, Trial courts: 2 decisions (1 Defense proved, 1 Requests not compliant)2015, Trial courts: 1 decision (1 Defense proved)2014, Trial courts: 3 decisions (2 Defense proved, 1 Nonappearance not proved)2013, Trial courts: 4 decisions (2 Defense proved, 2 Nonappearance not proved)2009, Trial courts: 1 decision (1 Defense proved)2007, Trial courts: 1 decision (1 Requests not compliant)2024, Trial courts: 1 decision (1 Requests not compliant)2025, Trial courts: 2 decisions (1 Mailing not proved, 1 Nonappearance not proved)2026, Trial courts: 1 decision (1 Mailing not proved)2005, Trial courts: 1 decision (1 Defense proved)2023, Trial courts: 1 decision (1 Defense proved)This decision
20052010201520202025
Defense provedMailing not provedNonappearance not provedRequests not compliantTriable issueNo-show excusedThis decisionCites it or cited by itCited or followedDistinguished or limited

Of the 164 decisions on this question in the First Department courts and the Court of Appeals, 93 (this one included) are in the same category. 4 decisions in other departments that cite or are cited by this one are on the full map.

Proof of mailing

Open the full map

Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?

This decision: The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice (rules on the question, but another ground decided the case)

Rejected, as unpreserved and in any event unavailing, the providers' argument that the insurer failed to show the EUO notices were mailed to the assignors' correct addresses.

  • Court of AppealsCt App 1
  • Appellate DivisionApp Div 25
  • Appellate TermApp Term 98
  • Trial courtsTrial 36
2015, Court of Appeals: 1 decision (1 Provider proved mailing)2023, Appellate Division: 1 decision (1 Insurer proved mailing)2022, Appellate Division: 1 decision (1 Insurer proved mailing)2020, Appellate Division: 1 decision (1 Insurer proved mailing)2019, Appellate Division: 1 decision (1 Insurer failed to prove)2018, Appellate Division: 4 decisions (3 Insurer proved mailing, 1 Insurer failed to prove)2016, Appellate Division: 2 decisions (1 Insurer proved mailing, 1 Insurer failed to prove)2015, Appellate Division: 5 decisions (5 Insurer proved mailing)2014, Appellate Division: 1 decision (1 Insurer proved mailing)2013, Appellate Division: 4 decisions (3 Insurer proved mailing, 1 Insurer failed to prove)2024, Appellate Division: 2 decisions (2 Insurer proved mailing)2025, Appellate Division: 3 decisions (2 Insurer proved mailing, 1 Insurer failed to prove)2017, Appellate Term: 3 decisions (2 Insurer failed to prove, 1 Provider proved mailing)2016, Appellate Term: 12 decisions (12 Insurer proved mailing)2015, Appellate Term: 18 decisions (14 Insurer proved mailing, 2 Insurer failed to prove, 1 Provider proved mailing, 1 Provider failed to prove)2014, Appellate Term: 15 decisions (11 Insurer proved mailing, 2 Insurer failed to prove, 2 Triable issue on mailing)2013, Appellate Term: 7 decisions (5 Insurer proved mailing, 1 Insurer failed to prove, 1 Provider failed to prove)2012, Appellate Term: 16 decisions (11 Insurer proved mailing, 2 Insurer failed to prove, 2 Provider failed to prove, 1 Triable issue on mailing)2011, Appellate Term: 8 decisions (7 Insurer proved mailing, 1 Insurer failed to prove)2010, Appellate Term: 3 decisions (2 Insurer proved mailing, 1 Provider proved mailing)2008, Appellate Term: 3 decisions (1 Insurer proved mailing, 1 Insurer failed to prove, 1 Provider proved mailing)2007, Appellate Term: 1 decision (1 Provider failed to prove)2006, Appellate Term: 6 decisions (1 Insurer proved mailing, 1 Insurer failed to prove, 1 Provider proved mailing, 2 Provider failed to prove, 1 Triable issue on mailing)2004, Appellate Term: 1 decision (1 Provider proved mailing)2025, Appellate Term: 2 decisions (2 Insurer proved mailing)2026, Appellate Term: 1 decision (1 Insurer proved mailing)2005, Appellate Term: 1 decision (1 Insurer proved mailing)2020, Appellate Term: 1 decision (1 Insurer failed to prove)2022, Trial courts: 2 decisions (1 Insurer proved mailing, 1 Insurer failed to prove)2021, Trial courts: 6 decisions (5 Insurer proved mailing, 1 Provider proved mailing)2020, Trial courts: 3 decisions (1 Insurer failed to prove, 2 Provider failed to prove)2019, Trial courts: 2 decisions (2 Insurer proved mailing)2018, Trial courts: 3 decisions (2 Insurer proved mailing, 1 Triable issue on mailing)2013, Trial courts: 2 decisions (2 Insurer proved mailing)2009, Trial courts: 2 decisions (1 Insurer proved mailing, 1 Provider proved mailing)2008, Trial courts: 2 decisions (2 Insurer proved mailing)2007, Trial courts: 2 decisions (1 Insurer proved mailing, 1 Provider proved mailing)2024, Trial courts: 2 decisions (2 Insurer proved mailing)2025, Trial courts: 4 decisions (2 Insurer proved mailing, 1 Insurer failed to prove, 1 Provider proved mailing)2026, Trial courts: 2 decisions (2 Insurer failed to prove)2005, Trial courts: 1 decision (1 Mixed rulings)2006, Trial courts: 2 decisions (1 Provider proved mailing, 1 Triable issue on mailing)2023, Trial courts: 1 decision (1 Insurer proved mailing)This decision
20052010201520202025
Insurer proved mailingInsurer failed to proveProvider proved mailingProvider failed to proveTriable issue on mailingMixed rulingsThis decisionCites it or cited by itCited or followed

Of the 160 decisions on this question in the First Department courts and the Court of Appeals, 109 (this one included) are in the same category. 2 decisions in other departments that cite or are cited by this one are on the full map.

Cited in this decision

A label shows how this decision treated the case it cites.

  • Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC (2011 NY Slip Op 01948) FollowedAn assignor's failure to attend required IMEs permits retroactive denial of no-fault claims regardless of denial timeliness.
  • Interboro Ins. Co. v Perez (2013 NY Slip Op 08347)The insurer failed to establish mailing of EUO scheduling letters and was denied a default judgment declaring no coverage.
  • Seacoast Med., P.C. v Praetorian Ins. Co. (2012 NY Slip Op 52354(U))The insurer established timely and proper IME and EUO notices and the assignor's nonappearance, warranting dismissal.
  • Interboro Ins. Co. v Clennon (2014 NY Slip Op 00092) FollowedThe assignor's two EUO nonappearances supported a declaration that the providers were not entitled to no-fault benefits.
  • Arco Med. NY, P.C. v Metropolitan Cas. Ins. Co. (2013 NY Slip Op 52001(U))The insurer established its EUO nonappearance defense to four claims but left the provider's awards on two other claims unchallenged.
  • Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co. (2012 NY Slip Op 51628(U))The insurer's attorney affirmation established the assignor's EUO nonappearance through the law firm's appearance-recording procedures.
  • Dvs Chiropractic, P.C. v Interboro Ins. Co. (2012 NY Slip Op 51443(U)) FollowedMutually rescheduling an EUO before its scheduled date does not constitute a failure to appear.
  • American Tr. Ins. Co. v Leon (2013 NY Slip Op 08124) FollowedAn assignor's failure to attend an IME breaches a condition of coverage and does not require a timely denial.

Cited by (15)

A label shows how the later decision treated this one.

  • Nationwide Affinity Ins. Co. of Am. v Jamaica Wellness Med., P.C. (2018 NY Slip Op 07850) Declined to followAn EUO nonappearance defense is subject to preclusion when the insurer fails to issue a timely denial.
  • Country-Wide Ins. Co. v Delacruz (2022 NY Slip Op 03068) Contrasted (cf., but see)The insurer's EUO nonappearance motion was premature because it withheld the specific objective justification for requesting the EUO. The Appellate Division, First Department, affirmed denial of summary judgment against the providers under CPLR 3212 (f).
  • Mapfre Ins. Co. of N.Y. v Manoo (2016 NY Slip Op 04446) FollowedEUO requests made before receipt of a claim form are not subject to the verification notice requirements of 11 NYCRR 65-3.5 and 65-3.6.
  • Kemper Independence Ins. Co. v Adelaida Physical Therapy, P.C. (2017 NY Slip Op 00916) FollowedThe insurer failed to establish whether its EUO notices were subject to regulatory deadlines or complied with applicable deadlines.
  • Metro Psychological Servs., P.C. v Mercury Cas. Co. (2015 NY Slip Op 51644(U)) FollowedAn EUO request issued after an assignor misses a rescheduled EUO constitutes a follow-up request under 11 NYCRR 65-3.6 (b).
  • MDJ Med. PC v Delos Ins. Co. (2016 NY Slip Op 50604(U)) FollowedThe insurer established timely EUO requests, proper mailing and the assignor's nonappearance at two scheduled EUOs. Its EUO letters demonstrated compliance with the request periods in 11 NYCRR 65-3.5 (b) and 65-3.6 (b).
  • Omega Diagnostic Imaging, P.C. v Praetorian Ins. Co. (2016 NY Slip Op 50762(U)) FollowedThe insurer's own submissions raised triable issues about whether the assignor's EUO nonappearances were excusable because of incarceration.
  • Vladenn Med. Supply, Corp. v American Commerce Ins. Co. (2016 NY Slip Op 50775(U)) FollowedThe insurer failed to establish EUO nonappearances through evidence from anyone with personal knowledge.
  • Metro 8 Med. Equip., Inc. v Esurance Ins. Co. (2016 NY Slip Op 50904(U)) FollowedThe insurer established the assignor's repeated EUO nonappearance through an attorney's affirmation and a scheduling employee's affidavit.
  • Village Med. Supply, Inc. v Hereford Ins. Co. (2018 NY Slip Op 51014(U)) FollowedThe insurer established the assignor's EUO nonappearances through an employee affidavit demonstrating personal knowledge.
Show all 15 citing decisions
  • Alsaad Med., P.C. v State Farm Mut. Auto. Ins. Co. (2021 NY Slip Op50532(U)) Followed
  • National Liab. & Fire Ins. Co. v Tam Med. Supply Corp. (2015 NY Slip Op 06763)
  • Harmonic Physical Therapy v Encompass Home & Auto Ins. Co. (2015 NY Slip Op 50733(U))
  • Liberty Mut. Ins. Co. v Brutus (2022 NY Slip Op 50799(U))
  • Park Ave. Chiropractic & Health Care PC v Maya Assur. Co. (2021 NY Slip Op 50804(U))

Similar decisions

  • First Class Med., P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 50593(U))The insurer established two EUO nonappearances and timely denials, warranting dismissal with prejudice rather than dismissal as premature.
  • Barakat Med. Care, P.C. v Nationwide Ins. Co. (2015 NY Slip Op 51677(U))An insurer need not state objective reasons for assignor EUOs as part of its prima facie showing for summary judgment on nonappearance.
  • Bridgeview Supply Corp. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 50190(U))An insurer need not state objective reasons for requesting EUOs as part of its prima facie showing for summary judgment based on nonappearance.
  • GLM Med., P.C. v State Farm Mut. Auto. Ins. Co. (2011 NY Slip Op 50194(U))EUO scheduling letters need not highlight the time and place in bold or larger type.
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