March 1, 2019

Bronx Chiropractic Care, P.C. v State Farm Ins. (2019 NY Slip Op 51041(U))

Headnote

The relevant facts the court considered were that Bronx Chiropractic Care, P.C. was seeking to recover assigned first-party no-fault benefits from State Farm insurance. State Farm moved for summary judgment to dismiss the complaint on the grounds that Bronx Chiropractic Care had failed to appear for scheduled examinations under oath (EUOs). The main issue decided was whether State Farm was entitled to summary judgment dismissing the complaint. The holding of the case was that the court reversed the order and granted State Farm's motion for summary judgment dismissing the complaint, as it was determined that State Farm had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, as well as the plaintiff's failure to appear for the EUOs. Therefore, the court found that Bronx Chiropractic Care had failed to meet its obligations and State Farm was entitled to summary judgment.

Reported in New York Official Reports at Bronx Chiropractic Care, P.C. v State Farm Ins. (2019 NY Slip Op 51041(U))

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

Bronx Chiropractic Care, P.C., as Assignee of Joseph Mayorga and Oscar Mayorga, Respondent,

against

State Farm Insurance, Appellant.

Rivkin Radler, LLP (Stuart M. Bodoff and Cheryl F. Korman of counsel), for appellant. Zara Javakov, P.C. (Zara Javakov of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered March 9, 2015. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint.

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

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). By order entered March 9, 2015, the Civil Court denied the motion, but found, in effect pursuant to CPLR 3212 (g), that defendant had established the timely and proper mailing of the EUO scheduling letters and the denial of claim forms, as well as plaintiff’s failure to appear for the EUOs. The Civil Court further found that the only remaining issues for trial were the location of the office in which defendant generated the EUO scheduling letters, and the reasonableness of and justification for defendant’s EUO requests. Defendant appeals, contending that it was entitled to summary judgment dismissing the complaint.

To establish its prima facie entitlement to summary judgment dismissing a complaint on the ground that a provider had failed to appear for an EUO, an insurer must demonstrate, as a matter of law, that it had twice duly demanded an EUO from the provider, that the provider had twice failed to appear, and that the insurer had issued a timely denial of the claim (see Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 [2014]; Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co., 59 Misc 3d 145[A], 2018 NY Slip Op 50736[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018]). Plaintiff challenges the Civil Court’s implicit CPLR 3212 (g) findings in favor of defendant. However, a review of the record establishes that the Civil Court correctly determined that defendant had established the timely and proper mailing of the EUO scheduling [*2]letters and the denial of claim forms, as well as plaintiff’s failure to appear for the EUOs. As a result, the Civil Court should have granted defendant’s motion for summary judgment. We note that neither defendant’s transmittal of the claims from one of its offices to another of its offices nor the location of the office within which the timely EUO scheduling letters were generated raises a triable issue of fact.

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

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: March 01, 2019