December 19, 2014

Faith Acupuncture, P.C. v Maya Assur. Co. (2014 NY Slip Op 51863(U))

Headnote

The insurer failed to establish proper mailing of IME scheduling letters and was denied summary judgment on its nonappearance defense. The provider appealed an order dismissing its action for assigned first-party no-fault benefits. The insurer's affidavit did not sufficiently describe a standard office practice or procedure ensuring that the scheduling letters were properly addressed and mailed. Without that showing, the insurer failed to demonstrate that the IMEs were properly scheduled or that the assignor failed to attend duly scheduled IMEs. The Appellate Term, Second Department, reversed the order and denied the insurer's motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Faith Acupuncture, P.C. v Maya Assur. Co. (2014 NY Slip Op 51863(U))

[*1]
Faith Acupuncture, P.C. v Maya Assur. Co.
2014 NY Slip Op 51863(U) [46 Misc 3d 134(A)]
Decided on December 19, 2014
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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 19, 2014
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-1953 K C

Faith Acupuncture, P.C. as Assignee of DOLORES GUAMAN-ZHININ, Appellant, December 19, 2014

against

MAYA ASSURANCE COMPANY, Respondent.


Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered June 22, 2012. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint.

Plaintiff correctly argues on appeal that the affidavit submitted by defendant did not sufficiently set forth a standard office practice or procedure that would ensure that the letters scheduling independent medical examinations (IMEs) had been properly addressed and mailed (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 a result, defendant failed to demonstrate that the IMEs had been properly scheduled, and thus, that plaintiff’s assignor had failed to appear at duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 722 [2006]). Consequently, defendant is not entitled to summary judgment dismissing the complaint.

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.

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


Decision Date: December 19, 2014