July 17, 2014
American States Ins. Co. v Huff (2014 NY Slip Op 05366)
https://www.beynensonlaw.com/case-law/american-states-ins-co-v-huff-2014-ny-slip-op-05366/
- Decided
- July 17, 2014
- Citation
- 2014 NY Slip Op 05366 · 119 AD3d 478
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Distinguished in 1 and followed in 8 later decisions (see Cited by)
- Legal questions
- No-show defense: insurer's proof (see the maps)
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 American States Ins. Co. v Huff (2014 NY Slip Op 05366)
| American States Ins. Co. v Huff |
| 2014 NY Slip Op 05366 [119 AD3d 478] |
| July 17, 2014 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| 1 American States Insurance Company,
Respondent, v Gregory G. Huff et al., Defendants, and Alleviation Medical Services, P.C., et al., Appellants. |
The Rybak Firm, PLLC, Brooklyn (Damin J. Toell of counsel), for appellants.
Burke, Gordon & Conway, White Plains (Philip J. Dillon of counsel), for respondent.
Order, Supreme Court, New York County (Carol R. Edmead, J.), entered on or about March 22, 2013, which, insofar as appealed from as limited by the briefs, granted so much of plaintiff’s motion for summary judgment as sought a declaration that plaintiff properly disclaimed coverage of its insured, defendant Gregory Huff (defendants Alleviation Medical Services, P.C. and Great Health Care Chiropractic P.C.’s assignor), based, inter alia, on Huff’s breach of a condition precedent to coverage under the policy, and a permanent stay of any arbitration or court hearing for no-fault benefits arising from the underlying alleged accident involving Huff, and declared, among other things, that the disclaimer is proper, unanimously affirmed, with costs.
The instant action arises out of an automobile accident that occurred on or about April 28, 2011, involving a vehicle insured by plaintiff. The vehicle’s owner and driver, defendant Gregory Huff, assigned his no-fault insurance benefits to defendant medical providers. Plaintiff commenced this action, in effect, seeking a declaration that it is not obligated to pay these no-fault benefits to defendants because, among other reasons, Huff failed to complete an examination under oath (EUO), as required by the subject insurance policy. Thus, plaintiff asserts that Huff breached a condition precedent to coverage under the policy, and defendant medical providers are not entitled to recover Huff’s no-fault benefits.
We find that Supreme Court properly granted summary judgment in plaintiff’s favor. In support of its motion, plaintiff relied primarily upon Huff’s EUO, which was corroborated by the affidavit of plaintiff’s investigator who was present at the examination. The EUO established that Huff appeared for his EUO, but departed before questions regarding the accident and his injuries had been asked. The aborted EUO of Huff, the named insured, established a prima facie case that Huff had breached a condition precedent to coverage under the policy.
In opposition, defendants do not dispute what occurred at the EUO. Instead, defendants argue that the transcript of the EUO was inadmissible. We find, however, that the EUO [*2]transcript of Huff was admissible evidence on the motion for summary judgment as it was certified by the court reporter and is considered a party admission (see Zalot v Zieba, 81 AD3d 935, 936 [2d Dept 2011], lv denied 17 NY3d 703 [2011]). Even if this were not the case, the affidavit of plaintiff’s investigator confirms that Huff did not seek another EUO, a fact the insured does not dispute. Insofar as defendants complain that plaintiff did not seek another EUO, the record demonstrates that Huff, represented by counsel, was advised of the ramifications of his refusal to continue the EUO, and confirmed that he understood.
An assignee “stands in the shoes” of an assignor and thus acquires no greater rights than its assignor (see Arena Constr. Co. v Sackaris & Sons, 282 AD2d 489 [2d Dept 2001]; see also Dilon Med. Supply Corp. v Travelers Ins. Co., 7 Misc 3d 927, 930 [Civ Ct, Kings County 2005]). Since the defense of the breach of a condition precedent to coverage under the policy may indisputably be raised by plaintiff against Huff, it is available as against defendants, who accepted assignments of no-fault benefits (see Hammelburger v Foursome Inn Corp., 54 NY2d 580, 586 [1981]; Losner v Cashline, L.P., 303 AD2d 647, 648 [2d Dept 2003]). Concur—Sweeny, J.P., Renwick, Andrias, Richter and Kapnick, JJ.
Legal questions
A question 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 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 insured's departure from his EUO before questions on the accident and injuries, shown by the admissible certified transcript and an investigator's affidavit, established breach of the EUO condition, available against his assignee providers.
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.
Cited in this decision
- Dilon Med. Supply Corp. v Travelers Ins. Co. (2005 NY Slip Op 25113)A medical supplier must respond to a proper request for a letter of medical necessity even if it lacks clinical expertise.
Cited by
A label shows how the later decision treated this one.
- Masigla v MVAIC (2020 NY Slip Op 51612(U)) DistinguishedMVAIC failed to prove the assignor's ineligibility at trial because the EUO transcript was inadmissible hearsay.
- Jamaica Dedicated Med. Care, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50756(U)) FollowedThe insurer failed to establish that the assignor materially misrepresented residence to obtain insurance at reduced premiums.
- Longevity Med. Supply, Inc. v MVAIC (2024 NY Slip Op 51164(U)) FollowedMVAIC established that the assignor was not a qualified person because the assignor owned the vehicle operated at the time of the accident.
- State Farm Fire & Cas. Co. v AA Acupuncture Serv., P.C. (2023 NY Slip Op 03562) FollowedThe insurer established viable default claims for noncoverage based on an intentional or staged collision and a claimant's EUO nonappearance.
- Compas Med., P.C. v ELRAC, Inc. (2015 NY Slip Op 50675(U)) FollowedThe provider was denied summary judgment because factual issues remained over denial timeliness and whether services were rendered.
- Global Liberty Ins. Co. v Evans (2019 NY Slip Op 07716) FollowedThe insurer failed to prove timely mailing of EUO letters, and factual issues remained about the assignor's departure from an EUO. The Appellate Division, First Department, affirmed denial of summary judgment declaring no coverage for the provider based on two alleged EUO failures.
- Integon Natl. Ins. Co. v Salazar-Ochoa (2026 NY Slip Op 50292(U)) FollowedAn insurer need not provide coverage for an intentionally caused collision, even to innocent third parties.
- Kalitenko v Nationwide Mut. Fire Ins. Co. (2026 NY Slip Op 50184(U)) FollowedThe assignor's vehicle qualified as a motorcycle requiring financial security, excluding the provider's claim from no-fault coverage.
- Jamaica Dedicated Medical Care. P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50605(U)) FollowedThe insurer failed to establish fraudulent policy procurement because the insured's residence remained disputed and its report relied on hearsay.
- Liberty Mut. Ins. Co. v Brutus (2022 NY Slip Op 50799(U))An insurer's material-misrepresentation defense is subject to the 30-day no-fault deadline for paying or denying claims.
Similar decisions
- Interboro Ins. Co. v Clennon (2014 NY Slip Op 00092)The assignor's two EUO nonappearances supported a declaration that the providers were not entitled to no-fault benefits.
- Hertz Corp. v Active Care Med. Supply Corp. (2015 NY Slip Op 00212)A provider's failure to attend EUOs violates a condition precedent to no-fault coverage and vitiates the policy.
- A.B. Med. Servs. PLLC v Allstate Ins. Co. (2006 NY Slip Op 50474(U))The insurer failed to establish an EUO-authorizing endorsement or admissible support for its fraud defense.
- Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 25336)The insurer's investigator affidavit raised a triable coverage issue based on a founded belief that the collision furthered insurance fraud.
- IDS Prop. Cas. Ins. Co. v Stracar Med. Servs., P.C. (2014 NY Slip Op 02902)The providers' unexcused EUO nonappearances materially breached a condition precedent to indemnity and warranted summary judgment for the insurer.