December 8, 2017

KHL Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51709(U))

Headnote

The court considered the denial of plaintiff's motion for summary judgment and the granting of the defendant's cross motion for summary judgment dismissing the complaint. The main issue was the failure of the plaintiff's assignor to appear for scheduled examinations under oath. The holding of the case was that, while defendant did not demonstrate entitlement to summary judgment dismissing the complaint, plaintiff also failed to establish that the claims at issue had not been timely denied or that the defendant had issued a timely denial of claim. Therefore, defendant's cross motion for summary judgment dismissing the complaint was denied.

Reported in New York Official Reports at KHL Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51709(U))

KHL Acupuncture, P.C. v Allstate Ins. Co. (2017 NY Slip Op 51709(U)) [*1]
KHL Acupuncture, P.C. v Allstate Ins. Co.
2017 NY Slip Op 51709(U) [58 Misc 3d 127(A)]
Decided on December 8, 2017
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This opinion is uncorrected and will not be published in the printed Official Reports.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 8, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2014-1695 K C

KHL Acupuncture, P.C., as Assignee of Zakeeyah Sergeant, Appellant,

against

Allstate Ins. Co., Respondent.

Zara Javakov, P.C. (Zara Javakov, Esq.), for appellant. McDonnell, Adels & Klestzick, PLLC, respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered May 21, 2014. 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. Defendant’s cross motion was based on plaintiff’s assignor’s failure to appear for duly scheduled examinations under oath.

Plaintiff correctly argues on appeal that the affidavits submitted by defendant did not sufficiently set forth a standard office practice or procedure that would ensure that the verification requests and denial of claim forms had been timely mailed (see St. Vincent’s Hosp. of [*2]Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Thus, defendant did not demonstrate its entitlement to summary judgment dismissing the complaint.

However, contrary to plaintiff’s contention, the affidavit plaintiff submitted in support of its motion failed to establish that the claims at issue had not been timely denied (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]) or that defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see 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 Dept, 2d, 11th & 13th Jud Dists 2011]). As a result, plaintiff’s motion for summary judgment was properly denied.

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.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 08, 2017