October 24, 2005

Hospital for Joint Diseases v Hertz Corp. (2005 NY Slip Op 07932)

https://www.beynensonlaw.com/case-law/hospital-for-joint-diseases-v-hertz-corp-2005-ny-slip-op-07932/

Court: Appellate Division, Second Department
Decided: October 24, 2005
Citation: 2005 NY Slip Op 07932 · 22 AD3d 724
Posture: Other motion
Outcome: Insurer prevailed
Later treatment: Distinguished in 2 and followed in 1 later decisions (see Cited by)
Issues: Policy issues Declaratory judgment, res judicata

Cite as

Hospital for Joint Diseases v Hertz Corp., 22 AD3d 724 (2d Dept 2005)

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.

An insurer's contractual duties cease once it has paid the policy's full monetary limits. After the provider obtained summary judgment, the insurers showed that payments to other providers, an initial payment to this provider, and a final payment exhausted the $50,000 limit. The Appellate Division, Second Department, affirmed the order modifying the judgment to reflect satisfaction and quashing the information subpoena as academic. Collateral estoppel did not bar the exhaustion defense because the insurers had not previously had a full and fair opportunity to litigate that issue. The prior litigation had addressed only whether the injury and treatment were causally related to the motor vehicle accident.

Reported in New York Official Reports at Hospital for Joint Diseases v Hertz Corp. (2005 NY Slip Op 07932)

Hospital for Joint Diseases v Hertz Corp.

2005 NY Slip Op 07932 [22 AD3d 724]

October 24, 2005

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

Hospital for Joint Diseases, as Assignee of Miguel Salgado, Appellant,
v
Hertz Corporation et al., Respondents.

—[*1]

In an action to recover no-fault medical payments under an insurance contract, the plaintiff appeals from an order of the Supreme Court, Nassau County (Dunne, J.), dated January 4, 2005, which granted the defendants’ motion, inter alia, to modify the amount of a judgment of the same court dated August 5, 2004, which was in its favor and against the defendants in excess of the $50,000 statutory limit of the policy, and to quash an information subpoena.

Ordered that the order is affirmed, with costs.

The plaintiff hospital, as assignee of Miguel Salgado, commenced this action against the defendant insurers to recover no-fault medical payments under an insurance contract. In an order dated March 12, 2003, the Supreme Court, inter alia, denied the plaintiff’s motion for summary judgment on the complaint to recover no-fault medical payments, and the plaintiff appealed. By decision and order dated July 12, 2004, this Court reversed the order insofar as appealed from and granted the motion (see Hospital for Joint Diseases v Hertz Corp., 9 AD3d 392 [2004]). Thereafter, the Supreme Court entered judgment in favor of the plaintiff and against the defendants in the total sum of $52,841.88.

The defendants subsequently moved, inter alia, to modify the amount of the judgment which exceeded the $50,000 statutory limit of the policy, and to quash the information subpoena served upon them. The evidence submitted in support of the motion established, among other things, that the defendants’ payments to other health providers and the defendants’ payment of the plaintiff’s [*2]initial claim totaled $23,744.21, and that the defendants forwarded to the plaintiff the remaining amount they were obligated to pay under the policy, namely, $26,255.79, which resulted in the $50,000 policy limit being exhausted. The Supreme Court granted the defendants’ motion, finding that the defendants’ payment satisfied the judgment and exhausted the policy limit, and that the information subpoena was rendered academic.

“[W]here as here, an insurer has paid the full monetary limits set forth in the policy, its duties under the contract of insurance cease” (Presbyterian Hosp. in City of N.Y. v Liberty Mut. Ins. Co., 216 AD2d 448 [1995]; see Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533, 534 [2004]; New York & Presbyt. Hosp. v Progressive Cas. Ins. Co., 5 AD3d 568, 570 [2004]). Therefore, the Supreme Court properly granted the defendants’ motion, inter alia, to modify the judgment and to quash the information subpoena.

Contrary to the plaintiff’s contention, the defendants were not collaterally estopped from raising the issue of whether the limits of the policy were exhausted, as the defendants were not previously afforded a full and fair opportunity to contest that issue (see Kaufman v Eli Lilly & Co., 65 NY2d 449 [1985]). Rather, they were only previously afforded a full and fair opportunity to contest whether the subject injury and treatment were causally related to the motor vehicle accident.

The plaintiff’s remaining contentions are without merit. Schmidt, J.P., Cozier, Rivera and Fisher, JJ., concur.

Cited in this decision

A label shows how this decision treated the case it cites.

Hospital for Joint Diseases v Hertz Corp. (2004 NY Slip Op 06025)The defendants offered no evidence of a timely denial or of their asserted lack of causal relation between the accident, injury, and treatment.
Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co. (2004 NY Slip Op 05413) FollowedThe hospitals' first and fifth claims were dismissed because policy limits were exhausted and requested verification remained outstanding.
New York & Presbyt. Hosp. v Progressive Cas. Ins. Co. (2004 NY Slip Op 01750) FollowedThe insurer proved policy exhaustion on one hospital claim and absence of coverage on another, requiring dismissal of both.

Cited by

A label shows how the later decision treated this one.

Ortho Passive Motion Inc. v Allstate Ins. Co. (2017 NY Slip Op 27057) DistinguishedThe insurer's postjudgment motion based on policy exhaustion was denied because it failed to prove that pleaded defense at trial.
Breeze Acupuncture, P.C. v Allstate Ins. Co. (2018 NY Slip Op 50138(U)) DistinguishedThe insurer was barred from reducing a judgment based on policy exhaustion known before trial but first raised after judgment.
St. Barnabas Hosp. v Country Wide Ins. Co. (2010 NY Slip Op 09121) FollowedThe insurer was not collaterally estopped from seeking a judgment reduction based on partially exhausted policy limits.
Amato v State Farm Ins. Co. (2010 NY Slip Op 20431)A timely claim for treatment after an IME cutoff is presumed medically necessary, and the insurer must rebut that presumption.
Alev Med. Supply, Inc. v Progressive Ins. Co. (2010 NY Slip Op 50813(U))An insurer may not obtain discovery concerning defenses that are precluded and cannot be raised at trial.
Ortho Passive Motion, Inc. v Allstate Ins. Co. (2018 NY Slip Op 51749(U))The insurer failed to establish policy exhaustion when the claims became complete and obtained no modification of the provider's judgment.

Similar decisions

Hospital for Joint Diseases v Dollar Rent A Car (2006 NY Slip Op 00141)The insurer obtained vacatur of an unopposed summary judgment order by presenting a reasonable excuse and a possible meritorious defense.
New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 02731)The insurer proved exhaustion of policy limits before it became obligated to pay the provider's claim.
New York & Presbyt. Hosp. v Selective Ins. Co. of Am. (2007 NY Slip Op 06848)The insurer's conclusory medical affidavit failed to raise a factual issue that the treated condition was unrelated to the automobile accident.
Hospital for Joint Diseases v Allstate Ins. Co. (2005 NY Slip Op 06192)An insurer waived assignment objections by failing to timely object to hospital forms or seek verification of the assignments.
Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co. (2006 NY Slip Op 08214)An insurer waives claim-form and assignment defenses by failing to timely object to form adequacy or seek assignment verification.