August 5, 2015

Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2015 NY Slip Op 51229(U))

Headnote

The court considered the plaintiff's motion for summary judgment and the defendant's cross motion for summary judgment in an action to recover assigned first-party no-fault benefits. The main issue was whether the defendant had timely and properly denied the claims at issue based on the plaintiff's failure to appear for scheduled examinations under oath. The holding of the court was that the denial of claim form had been timely mailed to the plaintiff, and as the plaintiff failed to submit an affidavit in opposition to the defendant's cross motion, the defendant's proof was unrebutted. Therefore, the court reversed the order and granted the defendant's cross motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2015 NY Slip Op 51229(U))

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

Bay LS Medical Supplies, Inc. as Assignee of EMELIO ADAME, Respondent,

against

Allstate Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Anna Culley, J.), entered October 25, 2012. The order, insofar as appealed from, upon denying plaintiff’s motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, and denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, the CPLR 3212 (g) findings in plaintiff’s favor are vacated, and defendant’s cross motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that it had timely and properly denied the claims at issue based on plaintiff’s failure to appear for duly scheduled examinations under oath. Insofar as is relevant to this appeal, the Civil Court, upon denying plaintiff’s motion, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor, denied defendant’s cross motion, and held that the only remaining issue for trial was defendant’s proof of mailing with respect to the denial of claim form.

In support of its cross motion, defendant submitted an affidavit by its special investigator which set forth the standard mailing practices and procedures by which he mailed the denial of claim form at issue to plaintiff, and defendant also submitted a copy of the certified mail, return receipt card bearing the subject claim number, which reflected that plaintiff had signed for the envelope which, in accordance with the affiant’s standard office practice and procedure, contained the subject denial of claim form (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). As plaintiff failed to submit an affidavit in opposition to defendant’s cross motion, defendant’s proof that the denial of claim form had been timely mailed to plaintiff was unrebutted. In view of the foregoing, and as plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, the order, insofar as appealed from, is reversed and defendant’s cross motion for summary judgment dismissing the complaint is granted (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]).

Pesce, P.J., Aliotta and Solomon, JJ., concur.


Decision Date: August 05, 2015