March 11, 2016
Atlantic Radiology Imaging, P.C. v Metropolitan Prop. & Cas. Ins. Co. (2016 NY Slip Op 50321(U))
https://www.beynensonlaw.com/case-law/atlantic-radiology-imaging-p-c-v-metropolitan-prop-cas-ins-co-2016ny-slip-op-50321u/
- Decided
- March 11, 2016
- Citation
- 2016 NY Slip Op 50321(U)
- Posture
- Default or vacatur
- Outcome
- Insurer prevailed
- Later treatment
- Followed in 1 later decision (see Cited by)
- Legal questions
- Proof of mailing · 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 Atlantic Radiology Imaging, P.C. v Metropolitan Prop. & Cas. Ins. Co. (2016 NY Slip Op 50321(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Metropolitan Property and Casualty Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered May 9, 2014. The order denied plaintiff’s motion to vacate a prior order of the same court (Reginald A. Boddie, J.) entered August 8, 2012 which granted, on default, defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order entered May 9, 2014 is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint, alleging that the claims at issue had been timely and properly denied based upon plaintiff’s assignor’s failure to appear at duly scheduled examinations under oath (EUOs). On February 17, 2012, the return date of the motion, the parties stipulated that plaintiff would serve any written opposition to the motion and/or a cross motion by June 8, 2012, and that the return date of the motion would be adjourned to August 8, 2012. No written opposition was filed by the return date, and the Civil Court (Reginald A. Boddie, J.), in an order entered August 8, 2012, granted defendant’s unopposed motion for summary judgment dismissing the complaint.
On August 23, 2013, plaintiff moved to vacate the August 8, 2012 order, stating that plaintiff had a reasonable excuse for the default and a meritorious opposition to defendant’s motion. Plaintiff’s counsel, in a supporting affirmation, conceded that plaintiff had received notice of the entry of the order on August 23, 2012. She further stated that the default was a result of her extensive workload, and that “there was no briefing schedule scanned into our system for the submission for written opposition.” In addition, plaintiff had a meritorious opposition to defendant’s motion in that defendant had failed to establish that the EUO scheduling letters had been properly addressed and timely mailed, and that the assignor had failed to appear at the EUOs. Defendant opposed plaintiff’s motion.
In an order entered May 9, 2014, the Civil Court (Katherine A. Levine, J.) denied plaintiff’s motion on the ground that the motion was properly one for reargument and, therefore, should have been made before Judge Boddie. Plaintiff appeals from the May 9, 2014 order, and we affirm, albeit for reasons other than those stated by the Civil Court.
Contrary to the determination of the Civil Court, vacatur of an order granted upon the default of a party in opposing a motion should be sought by a motion pursuant to CPLR 5015, [*2]not by a motion for leave to renew or reargue (see e.g. Raciti v Sands Point Nursing Home, 54 AD3d 1014 [2008]; Friendly Physician, P.C. v GEICO Ins. Co., 29 Misc 3d 129[A], 2010 NY Slip Op 51772[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2010]). In addition, there is no requirement that a motion to vacate an order made upon default be made to the judge who signed the prior order (see CPLR 2221 [a] [1]; Patron v Mutual of Omaha Ins. Co., 129 AD2d 572 [1987]). Consequently, the Civil Court incorrectly determined that plaintiff’s motion was actually a motion for leave to reargue which should have been made before Judge Boddie.
In order to vacate the August 8, 2012 order based upon excusable default (CPLR 5015 [a] [1]), plaintiff was required to demonstrate a reasonable excuse for the default and a potentially meritorious opposition to defendant’s summary judgment motion (see Thapt v Lutheran Med. Ctr., 89 AD3d 837 [2011]; Bazoyah v Herschitz, 79 AD3d 1081 [2010]; Raciti v Sands Point Nursing Home, 54 AD3d 1014; Montague v Rivera, 50 AD3d 656 [2008]; St. Rose v McMorrow, 43 AD3d 1146 [2007]). Plaintiff’s excuse—that the default was a result of plaintiff’s counsel’s heavy caseload and the failure to scan the motion schedule into the office’s computer system—amounts to a claim of law office failure. As such excuse was vague, undetailed and unsubstantiated, it did not constitute a reasonable excuse for the default (see Chechen v Spencer, 68 AD3d 801 [2009]; Murray v New York City Health & Hosps. Corp., 52 AD3d 792, 793 [2008]; St. Luke’s Roosevelt Hosp. v Blue Ridge Ins. Co., 21 AD3d 946, 947 [2005]). Furthermore, plaintiff failed to explain its one-year delay, following its receipt of notice of the entry of the default order, in moving to vacate that order (see e.g. Johnson v Nello Homes, Inc., 159 AD2d 562 [1990]).
Moreover, plaintiff did not demonstrate a potentially meritorious opposition to defendant’s motion for summary judgment. We find no merit to plaintiff’s contentions that defendant failed to establish that the EUO scheduling letters had been properly addressed and timely mailed, or that the assignor had failed to appear at the EUOs. In support of defendant’s motion for summary judgment, defendant submitted an affidavit of its administrative assistant and an affidavit of its Special Investigations Unit (SIU) investigator, accompanied by certified transcripts made after the assignor’s EUO nonappearances. These documents sufficiently described the standard practices and procedures of defendant’s office for proper and timely mailing of the EUO scheduling letters (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; ARCO Med. NY, P.C. v Lancer Ins. Co., 34 Misc 3d 134[A], 2011 NY Slip Op 52382[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]) and established that plaintiff’s assignor had failed to appear for either of the two duly scheduled EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]; Olmeur Med., P.C. v Nationwide Gen. Ins. Co., 41 Misc 3d 143[A], 2013 NY Slip Op 52031[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]), thereby demonstrating that plaintiff’s assignor had failed to comply with a condition precedent to coverage (see Stephen Fogel Psychological, P.C., 35 AD3d at 722).
Accordingly, the May 9, 2014 order is affirmed.
Weston, J.P., Pesce and Aliotta, JJ., concur.
Decision Date: March 11, 2016
Legal questions (2)
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.
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)
Held the administrative assistant's and SIU investigator's affidavits sufficiently described standard office practices for proper and timely mailing of the EUO scheduling letters, so the provider showed no meritorious opposition.
Of the 1,384 decisions on this question in the Second Department courts and the Court of Appeals, 806 (this one included) are in the same category.
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 (rules on the question, but another ground decided the case)
Held the provider had no potentially meritorious opposition because the insurer's affidavits and certified transcripts proved proper addressing and timely mailing of the EUO letters and nonappearance at both EUOs.
Of the 851 decisions on this question in the Second Department courts and the Court of Appeals, 525 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Friendly Physician, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51772(U))The insurer established an excusable law office default and a meritorious medical necessity defense warranting vacatur.
- St. Luke’s Roosevelt Hosp. v Blue Ridge Ins. Co. (2005 NY Slip Op 06666)An insurer failed to establish a reasonable excuse or meritorious defense for vacating its default in opposing summary judgment.
- St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072)The insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.
- ARCO Med. N.Y., P.C. v Lancer Ins. Co. (2011 NY Slip Op 52382(U))A follow-up EUO request is not premature when sent within 10 days after failure to appear for the initial scheduled examination.
- Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 09604) FollowedAn insurer may deny benefits retroactively to the date of loss for failure to attend reasonably required IMEs under 11 NYCRR 65-1.1.
- Olmeur Med., P.C. v Nationwide Gen. Ins. Co. (2013 NY Slip Op 52031(U))The insurer cured a defective conformity certificate in reply and proved the assignor's EUO nonappearances with admissible evidence.
Cited by
A label shows how the later decision treated this one.
- July, P.T., P.C. v Metropolitan Group Prop. & Cas. Ins. (2022 NY Slip Op 50302(U)) FollowedThe insurer proved the assignor's EUO nonappearance through an investigator's affidavit and certified transcripts.
- MSB Physical Therapy, P.C. v Nationwide Ins. (2021 NY Slip Op 50750(U))EUO requests sent before receipt of a claim do not toll the insurer's 30-day period to pay or deny it.
- Parisien v Travelers Ins. Co. (2021 NY Slip Op 50396(U))The provider's requests for lengthy EUO adjournments failed to raise a triable issue concerning the two nonappearances.
Similar decisions
- Himalayans Acupuncture, P.C. v GEICO Cas. Co. (2022 NY Slip Op 50904(U))The insurer's detailed law-office-failure explanation and motion two days after entry of the default order supported vacatur.
- Astoria Wellness Med., P.C. v State Farm Mut. Auto Ins. Co. (2010 NY Slip Op 52008(U))The insurer failed to reasonably explain its failure to refile opposition papers after the clerk identified the filing error.
- Central Radiology Servs., P.C. v First Am. Ins. (2013 NY Slip Op 51031(U))The insurer submitted to personal jurisdiction by seeking default vacatur and leave to defend on the merits without a jurisdictional objection.
- Atlantic Radiology Imaging, P.C. v Interboro Mut. Ins. Co. (2016 NY Slip Op 51031(U))The insurer established a reasonable law-office-failure excuse and a meritorious defense warranting vacatur of its summary judgment default.
- Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co. (2020 NY Slip Op 50067(U))A later summary judgment order cannot establish a meritorious defense while an earlier default summary judgment order remains in effect.