May 14, 2007

Executive MRI Imaging, P.C. v State Farm Ins. Co. (2007 NY Slip Op 50994(U))

Headnote

The relevant facts considered by the court included the denial of plaintiff's motion for summary judgment in an action by a provider to recover first-party no-fault benefits. The main issue decided in this case was whether the defendant proffered sufficient evidence to demonstrate that there was an issue of fact as to whether the injuries sustained by the plaintiff's assignor arose from an insured incident. The holding of the court was that the affidavit submitted by the defendant's investigator was sufficient to demonstrate that the denial of coverage was based on a "founded belief that the alleged injuries do not arise out of an insured incident." As a result, the court reversed the order and denied the plaintiff's motion for summary judgment.

Reported in New York Official Reports at Executive MRI Imaging, P.C. v State Farm Ins. Co. (2007 NY Slip Op 50994(U))

Executive MRI Imaging, P.C. v State Farm Ins. Co. (2007 NY Slip Op 50994(U)) [*1]

Executive MRI Imaging, P.C. v State Farm Ins. Co.

2007 NY Slip Op 50994(U) [15 Misc 3d 139(A)]

Decided on May 14, 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This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on May 14, 2007

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., WESTON PATTERSON and GOLIA, JJ
2006-285 Q C.

Executive MRI Imaging, P.C. as assignee of Tearra Taylor, Respondent,
against
State Farm Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Howard G. Lane, J.), entered September 30, 2005. The order granted plaintiff’s motion for summary judgment.

Order reversed without costs and plaintiff’s motion for summary judgment denied.

In this action by a provider 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 an issue of fact as to whether the injuries plaintiff’s assignor allegedly sustained arose from
an insured incident (see Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, 199 [1997]). Upon a review of the record, we find that the affidavit submitted by defendant’s investigator was sufficient to demonstrate that defendant’s denial was based on a “founded belief that the alleged injur[ies] do[] not arise out of an insured incident” (id. at 199). Accordingly, since defendant demonstrated the existence of a triable issue of fact as to whether there was a lack of coverage (see Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, supra; Zuckerman v City of New York, 49 NY2d 557 [1980]), plaintiff was not entitled to summary judgment.

Pesce, P.J., Weston Patterson and Golia, JJ., concur.
Decision Date: May 14, 2007