June 10, 2022
Dr. Orenbakh Psychologist, P.C. v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 50566(U))
https://www.beynensonlaw.com/case-law/dr-orenbakh-psychologist-p-c-v-nationwide-affinity-ins-co-of-am-2022-ny-slipop-50566u/
- Decided
- June 10, 2022
- Citation
- 2022 NY Slip Op 50566(U)
- Posture
- Summary judgment
- Outcome
- Split result
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 Dr. Orenbakh Psychologist, P.C. v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 50566(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Nationwide Affinity Ins. Co. of America, Appellant.
Hollander Legal Group, P.C. (Alan S. Hollander, of counsel), for appellant. Kopelevich & Feldsherova, P.C. (David Landfair of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), entered August 20, 2019. The order denied defendant’s motion for summary judgment dismissing the complaint and, upon a search of the record, awarded plaintiff summary judgment upon the claim which defendant received on February 2, 2016.
ORDERED that the order is modified by providing that the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims which defendant received on February 8, 2016 through March 10, 2016 are granted; as so modified, the order is affirmed, without costs.
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 August 20, 2019, the Civil Court found that there were issues of fact with respect to the mailing of the EUO scheduling letters and whether plaintiff failed to appear. The court held that defendant’s denial of the claim it received on February 2, 2016 was untimely and, upon a search of the record, awarded plaintiff summary judgment upon that claim.
Upon a review of the record, we find that defendant sufficiently established that the EUO scheduling letters had been mailed in accordance with defendant’s standard office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; JCC Med., P.C. v Lancer Ins. Co., 71 Misc 3d 140[A], 2021 NY Slip Op 50485[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]; Parisien v Ameriprise Ins., 68 Misc 3d 131[A], 2020 NY Slip Op 50990[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]), and the affirmations from the attorney who was prepared to conduct the EUOs as well as the [*2]certified transcripts of the EUOs demonstrated that plaintiff had failed to appear for either of the scheduled EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). In addition, the record further shows that defendant timely denied the claims which defendant received on February 8, 2016 through March 10, 2016 on the ground that plaintiff had failed to appear for the scheduled EUOs (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123). As plaintiff failed to raise a triable issue of fact in opposition to this showing, the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon those claims should have been granted.
With respect to the remaining claim, defendant admitted that it received the claim form on February 2, 2016 and that the first EUO scheduling letter was not mailed until March 4, 2016, more than 30 days after receipt of that claim. Thus, defendant did not demonstrate that it is not precluded from raising its proffered defense as to this claim, as the EUO request was a nullity as to that claim (see Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins., 48 Misc 3d 139[A], 2015 NY Slip Op 51220[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). Consequently, the branch of defendant’s motion seeking summary judgment upon that claim was properly denied. Defendant raises no other issue with respect to so much of the order as, upon a search of the record, awarded summary judgment to plaintiff upon this claim. Thus, we leave that part of the order undisturbed.
Accordingly, the order is modified by providing that the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims which defendant received on February 8, 2016 through March 10, 2016 are granted.
ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 10, 2022
Legal questions (3)
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.
Is an IME/EUO no-show defense precluded if the insurer did not timely deny the claim on that ground?
This decision: No-show defense is subject to preclusion and fails for want of a timely, proper denial
Held the insurer not shown free of preclusion on one claim because its first EUO letter went out over 30 days after receipt, a nullity; other claims were timely denied on the no-show ground.
Of the 508 decisions on this question in the Second Department courts and the Court of Appeals, 166 (this one included) are in the same category.
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
Held, reversing a finding of fact issues, that the insurer sufficiently established mailing of the EUO scheduling letters under its standard office practices and procedures.
Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 809 (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 did not show its requests met the regulatory timing, follow-up or justification requirements (rules on the question, but another ground decided the case)
Held the insurer proved mailing and nonappearance for most claims, but for one claim the initial EUO request came more than 30 days after receipt and was a nullity.
Of the 858 decisions on this question in the Second Department courts and the Court of Appeals, 102 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) FollowedThe insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.
- JCC Med., P.C. v Lancer Ins. Co. (2021 NY Slip Op 50485(U))Proof of timely first-class mailing of EUO scheduling letters makes proof that copies were also sent by certified mail unnecessary.
- Parisien v Ameriprise Ins. (2020 NY Slip Op 50990(U))The insurer proved the provider's EUO nonappearances, including one at a location changed at the provider's request, and a timely denial.
- 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.
- Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins. (2015 NY Slip Op 51220(U)) FollowedThe insurer's EUO requests were untimely because they followed receipt of the bills by more than 15 business days and 30 calendar days.
Similar decisions
- Arcadia Acupuncture, P.C. v Nationwide Ins. Co. (2021 NY Slip Op 51258(U))The provider obtained partial judgment for untimely denials, but disputed EUO convenience barred judgment on later claims.
- Hands On Physical Therapy Care v Nationwide Ins. (2022 NY Slip Op 50797(U))The insurer failed to establish timely EUO nonappearance denials for the provider's first three causes of action.
- Allstate Chiropractic, P.C. v Nationwide Affinity Ins. Co. of Am. (2023 NY Slip Op 50299(U))The insurer failed to establish timely denials because scheduling another EUO did not extend the deadline after the second nonappearance.
- K.O. Med., P.C. v IDS Prop. Cas. Ins. Co. (2019 NY Slip Op 50687(U))The insurer's EUO request was a nullity for four claims because it was sent more than 30 days after receipt.
- Bridgeview Supply Corp. v Nationwide Mut. Ins. Co. (2026 NY Slip Op 50190(U))An insurer need not state objective reasons for requesting EUOs as part of its prima facie showing for summary judgment based on nonappearance.