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/
- 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)
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 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. |
[*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.
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.
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.
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.
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.
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.
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.