January 2, 2007
Comprehensive Mental v Allstate Ins. Co. (2007 NY Slip Op 50017(U))
https://www.beynensonlaw.com/case-law/comprehensive-mental-v-allstate-ins-co-2007-ny-slip-op-50017u/
- Decided
- January 2, 2007
- Citation
- 2007 NY Slip Op 50017(U) · 14 Misc 3d 130(A)
- Posture
- Summary judgment
- Outcome
- Provider prevailed
- Later treatment
- Followed in 2 later decisions (see Cited by)
- Legal questions
- No covered accident (founded belief) (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 Comprehensive Mental v Allstate Ins. Co. (2007 NY Slip Op 50017(U))
| Comprehensive Mental v Allstate Ins. Co. |
| 2007 NY Slip Op 50017(U) [14 Misc 3d 130(A)] |
| Decided on January 2, 2007 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 9th and 10th JUDICIAL DISTRICTS
PRESENT: : RUDOLPH, P.J., McCABE and LIPPMAN, JJ
2006-181 N C.
against
Allstate Ins. Co., Appellant.
Appeal from an order of the District Court of Nassau County, First District (Margaret C. Reilly, J.), entered July 14, 2005. The order, insofar as appealed from as limited by defendant’s brief, granted plaintiff’s motion for summary judgment.
Order, insofar as appealed from, affirmed without costs.
In this action to recover assigned first-party no-fault benefits, plaintiff’s motion for summary judgment was granted. The sole issue raised on appeal is whether defendant proffered sufficient evidence to demonstrate that there was a triable issue of fact as to whether the automobile accident in which plaintiff’s assignor was allegedly injured was staged and, thus, not a covered event (see Central Gen. Hosp. v Chubb Group of Ins.
Cos., 90 NY2d 195 [1997]). In opposition to plaintiff’s motion, defendant submitted an affidavit by its claims representative wherein she stated that she has reviewed defendant’s file. The file reveals that defendant has investigated plaintiff’s claim and pursuant to such investigation defendant believed that the accident was an intentional loss because plaintiff’s assignor and the driver of the vehicle were involved in multiple accidents within a short period of time. Such affidavit was insufficient to demonstrate the existence of a triable issue of fact (see Ocean Diagnostic Imaging P.C. v Allstate Ins. Co., 6 Misc 3d 134[A], 2005 NY Slip Op 50189[U] [App Term, 9th & 10th Jud Dists]; see also A.B. Med. Servs PLLC v Utica Mut. Ins. Co., 10 Misc 3d 50 [App Term, 2d & 11th Jud Dists 2005]). Accordingly, plaintiff’s motion for summary judgment was properly granted.
Rudolph, P.J., McCabe and Lippman, JJ., concur.
[*2]
Decision Date: January 2, 2007
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 show the claimed injuries did not arise from a covered accident (staged, intentional, or unrelated)?
This decision: Insurer's proof did not raise an issue or failed at trial; provider prevails on it
Held a claims representative's file-review affidavit, asserting the accident was intentional because the assignor and driver had multiple accidents, insufficient to raise a triable issue that the accident was staged.
Of the 234 decisions on this question in the Second Department courts and the Court of Appeals, 80 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Ocean Diagnostic Imaging P.C. v Allstate Ins. Co. (2005 NY Slip Op 50189(U)) FollowedThe insurer's conclusory submissions failed to raise a triable issue of staged-accident fraud.
- A.B. Med. Servs. PLLC v Utica Mut. Ins. Co. (2005 NY Slip Op 25456)The providers obtained partial summary judgment because defective EUO requests and incomplete IME follow-up failed to toll denial time.
Cited by
A label shows how the later decision treated this one.
- Webster Diagnostic Medicine, P.C. v State Farm Ins. Co. (2007 NY Slip Op 27134) FollowedThe insurer's conclusory fraud allegations and passenger EUO discrepancies failed to establish a founded belief of noncoverage.
- Medical Care G.M., P.C. v GEICO Ins. (2008 NY Slip Op 50379(U)) FollowedThe providers' summary judgment motion was granted because the insurer failed to support a founded belief of noncoverage with admissible evidence.
Similar decisions
- Allstate Social Work & Psychological Servs., P.L.L.C. v Utica Mut. Ins. Co. (2007 NY Slip Op 52042(U))The provider lacked a business-record foundation, while the insurer failed to prove verification mailing or lack of coverage.
- Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 24342)The insurer's investigator established a founded belief of a staged collision, raising a coverage issue despite an untimely denial.
- A.B. Med. Servs. PLLC v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 51031(U))The providers' ambiguous billing affidavit failed to establish a prima facie case, but the insurer also failed to obtain dismissal.
- LMS Med. Care, P.C. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 51072(U))The insurer failed to raise a triable coverage issue because its accident reports and other documents lacked admissible support.
- A.M. Med. Servs., P.C. v State Farm Mut. Ins. Co. (2007 NY Slip Op 52300(U))The insurer's investigator raised a triable issue as to whether the assignor's injuries arose from an insured incident.