May 18, 2015

Great Health Care Chiropractic, P.C. v Unitrin Advantage Ins. Co. (2015 NY Slip Op 50782(U))

Headnote

The court considered the issue of whether the plaintiff, Great Health Care Chiropractic, P.C., was entitled to recover first-party no-fault benefits from Unitrin Advantage Insurance Company. The main issue was whether the defendant had established that the letters scheduling examinations under oath (EUOs) had been timely mailed to the plaintiff's assignor, as required for the defendant to be entitled to summary judgment dismissing the complaint. The court held that the defendant had failed to establish the timely mailing of the EUO scheduling letters and therefore was not entitled to summary judgment. Additionally, the court found that the plaintiff's motion for summary judgment was properly denied, as the plaintiff's moving papers failed to demonstrate entitlement to judgment as a matter of law. Therefore, the court modified the order to provide that the defendant's cross motion for summary judgment dismissing the complaint is denied.

Reported in New York Official Reports at Great Health Care Chiropractic, P.C. v Unitrin Advantage Ins. Co. (2015 NY Slip Op 50782(U))

Great Health Care Chiropractic, P.C. v Unitrin Advantage Ins. Co. (2015 NY Slip Op 50782(U)) [*1]
Great Health Care Chiropractic, P.C. v Unitrin Advantage Ins. Co.
2015 NY Slip Op 50782(U) [47 Misc 3d 150(A)]
Decided on May 18, 2015
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This opinion is uncorrected and will not be published in the printed Official Reports.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 18, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-14 Q C
Great Health Care Chiropractic, P.C. as Assignee of ALANNA WARREN, Appellant,

against

Unitrin Advantage Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered November 21, 2012. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied; as so modified, the order is affirmed, without costs.

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

As plaintiff correctly argues, neither the affidavit executed by defendant’s claim representative nor the affirmation executed by the attorney from the law firm defendant had retained to schedule and conduct the examinations under oath (EUOs) of plaintiff’s assignor, established actual mailing of the EUO scheduling letters or that they were mailed pursuant to a standard office practice or procedure. Consequently, defendant failed to establish that the EUO scheduling letters had been timely mailed to plaintiff’s assignor (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 was not entitled to summary judgment dismissing the complaint based on the assignor’s alleged failure to appear at duly scheduled EUOs.

Contrary to plaintiff’s contention, its motion for summary judgment was properly denied, as plaintiff’s moving papers failed to demonstrate plaintiff’s prima facie entitlement to judgment as a matter of law by establishing either that defendant had failed to pay or deny the claim within the requisite 30-day period (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]), or that defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see Insurance Law § 5106 [a]; Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d, 11th & 13th Jud Dists 2011]).

Accordingly, the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.

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


Decision Date: May 18, 2015