September 23, 2022

Arguelles M.D., P.C. v American Ind. Ins. Co. (2022 NY Slip Op 50926(U))

https://www.beynensonlaw.com/case-law/arguelles-m-d-p-c-v-american-ind-ins-co-2022-ny-slip-op-50926u/

Court: Appellate Term, Second Department
Decided: September 23, 2022
Citation: 2022 NY Slip Op 50926(U)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Statute of limitations
Legal questions: No-fault statute of limitations (see the maps)

Cite as

Arguelles M.D., P.C. v American Ind. Ins. Co., 2022 NY Slip Op 50926(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022)

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.

The provider's action was time-barred because its submission evidence placed the payment due date more than six years before suit. The provider's owner stated that the claims were submitted on or before October 20, 2007, remained unpaid, and bore interest beginning 30 days after submission. Under Insurance Law § 5106 (a) and 11 NYCRR 65-3.8, the payment due date was therefore deemed to be in November 2007. The action commenced in 2018, after the contractual limitations period under CPLR 213 (2) expired, and the provider raised no factual issue concerning timeliness. The Appellate Term, Second Department, reversed the order, insofar as appealed from, and granted the insurers summary judgment dismissing the complaint.

Reported in New York Official Reports at Arguelles M.D., P.C. v American Ind. Ins. Co. (2022 NY Slip Op 50926(U))

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

Arguelles M.D., P.C., as Assignee of Darvell Tribe, Respondent,
against
American Independent Ins. Co., Omni Indemnity Company, American Independent Insurance Companies, Inc., and Good2Go Auto Insurance, Appellants.

Freiberg, Peck & Kang, LLP (Yilo J. Kang of counsel), for appellants. The Rybak Firm, PLLC (Oleg Rybak of counsel), for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Lorna J. McAllister, J.), entered January 25, 2019. The order, insofar as appealed from, denied defendants’ motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendants’ motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendants appeal from so much of an order of the Civil Court as denied defendants’ motion which had sought summary judgment dismissing the complaint on the ground, among others, that the action was barred by the statute of limitations.

In support of a cross motion for summary judgment, plaintiff submitted an affidavit by plaintiff’s owner who asserted that the subject claim forms were submitted to defendants on or before October 20, 2007, that the claims had not been paid, and that statutory interest was to be computed as of 30 days after each claim’s submission. Consequently, the payment due date, as implicitly alleged by plaintiff in its complaint and in the affidavit by plaintiff’s owner, must be deemed to have been in November 2007, that is, 30 days after defendants’ receipt of the claims (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.8; Shtarkman v MVAIC, 20 Misc 3d 132[A], [*2]2008 NY Slip Op 51447[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2008]). Plaintiff did not commence this action until 2018, after the six-year statute of limitations for contract actions, which is applicable to this cause of action (see CPLR 213 [2]; Mandarino v Travelers Prop. Cas. Ins. Co., 37 AD3d 775 [2007]), had expired. As plaintiff raised no issue of fact as to the timeliness of the action, defendants’ motion to dismiss based on the statute of limitations should have been granted (see A.M. Med., P.C. v Continental Ins. Co., 47 Misc 3d 128[A], 2015 NY Slip Op 50389[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; DJS Med. Supplies, Inc. v Clarendon Natl. Ins. Co., 32 Misc 3d 129[A], 2011 NY Slip Op 51304[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).

Accordingly, the order, insofar as appealed from, is reversed and defendants’ motion for summary judgment dismissing the complaint is granted.

ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 23, 2022

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.

No-fault statute of limitations

Open the full map

Which limitations period governs a first-party no-fault claim against an insurer, self-insurer or MVAIC: six or three years?

This decision: Claim against an insurer under a policy carries the six-year contract period (CPLR 213 [2]) (rules on the question, but another ground decided the case)

Held the claims, deemed overdue in November 2007, barred because the action was commenced in 2018, after the six-year contract limitations period applicable to no-fault claims against the insurers had expired.

Six years: insurerSix years: self-insurerThree years: self-insurerThree years: MVAICThis decisionCites it or cited by itCited or followed

Of the 56 decisions on this question in the Second Department courts and the Court of Appeals, 21 (this one included) are in the same category.

Cited in this decision

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

Shtarkman v MVAIC (2008 NY Slip Op 51447(U)) FollowedThe provider's claim against MVAIC was barred by the three-year limitations period measured from the pleaded payment due date.
Mandarino v Travelers Prop. Cas. Ins. Co. (2007 NY Slip Op 01693) FollowedA provider's action to recover no-fault benefits under an insurance policy is governed by the six-year contractual limitations period.
A.M. Med., P.C. v Continental Ins. Co. (2015 NY Slip Op 50389(U)) FollowedThe provider's action against the appealing insurer was untimely because it began more than six years after the no-fault claims accrued.
DJS Med. Supplies, Inc. v Clarendon Natl. Ins. Co. (2011 NY Slip Op 51304(U)) FollowedA no-fault claim accrues 30 days after the insurer receives it; a later denial does not postpone accrual.

Similar decisions

Cautious Care Med., P.C. v Omni Indem. Co. (2020 NY Slip Op 51384(U))A first-party no-fault cause of action accrues 30 days after the insurer receives the claim and carries a six-year limitations period.
Arguelles, M.D., P.C. v Omni Indem. Co. (2017 NY Slip Op 51771(U))The insurer's summary judgment dismissal on renewal, based on its assertion that it had not issued the policy, was upheld.
Vincent Med. Servs., P.C. v Omni Indem. Co. (2022 NY Slip Op 50141(U))The provider's action was time-barred because it was commenced more than six years after payment became due on its claims.
Arguelles, M.D., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51366(U))The insurer's medical-necessity showing was unrebutted for six claims, but its proof did not warrant dismissal of four others.
Arguelles M.D., P.C. v Omni Indem. Co. (2015 NY Slip Op 50789(U))The insurer established that it had not issued the policy covering the accident and that the provider had sued the wrong carrier.