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June 20, 2006

Lefferts Med., Inc. v Lumbermens Mut. Cas. Co. (2006 NY Slip Op 51136(U))

https://www.beynensonlaw.com/case-law/lefferts-med-inc-v-lumbermens-mut-cas-co-2006-ny-slip-op-51136u/

Court
Civil Court, Kings County
Judge
Edwards, J.
Decided
June 20, 2006
Citation
2006 NY Slip Op 51136(U) · 12 Misc 3d 1170(A)
Posture
Default or vacatur
Outcome
Insurer prevailed
Issues
Defaults and vacatur Timeliness and preclusion
Legal questions
Proof of mailing (see the maps)
Cite as
Lefferts Med., Inc. v Lumbermens Mut. Cas. Co., 12 Misc 3d 1170(A), 2006 NY Slip Op 51136(U) (Civ Ct, Kings County 2006)

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.

A provider that accepts and retains an insurer's late answer waives its right to obtain a default judgment. The Civil Court, Kings County, granted the insurer's motion to reargue and vacated the default judgment under CPLR 2221. The insurer supplied no competent evidence of the attorney's alleged deadline miscalculation, and its affidavits lacked sufficient mailing detail to establish timely denials or verification requests. Those deficiencies ordinarily defeated the required showing of a reasonable excuse and meritorious defense. However, the provider had accepted and retained the answer and offered no admissible evidence of when it received it. Because the default judgment was erroneously entered, the insurer did not need to establish either prong, and the provider was directed to accept the answer.

Reported in New York Official Reports at Lefferts Med., Inc. v Lumbermens Mut. Cas. Co. (2006 NY Slip Op 51136(U))

[*1]
Lefferts Med., Inc. v Lumbermens Mut. Cas. Co.
2006 NY Slip Op 51136(U) [12 Misc 3d 1170(A)]
Decided on June 20, 2006
Civil Court, Kings County
Edwards, J.
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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 20, 2006
Civil Court, Kings County


Lefferts Medical, Inc., a/a/o Stanley Buckmire and Tiffany Zeleny, Plaintiff,

against

Lumbermens Mutual Casualty Company, Defendant.




116908/04

Genine D. Edwards, J.

In this action to recover no-fault benefits, defendant moves for leave to reargue its Order to Show Cause and to vacate the default judgment entered against it on January 25, 2005. In order to support a motion to reargue, the defendant must demonstrate that the Court overlooked relevant facts or misapprehended the applicable law or for some other reason improperly decided the prior motion. CPLR §2221; Carillo v. PM Realty Group, 16 AD3d 611 (2nd Dept. 2005).

Viewing the defendant’s Order to Show Cause to vacate the default judgment from this perspective it is clear that the defendant was required to prove that it had a reasonable excuse for its default and a meritorious defense to the case. Presbyterian Hospital in the City of New York v. New York Central Mutual Insurance Company, 277 AD2d 299 (2nd Dept. 2000); New York and Presbyterian Hospital v. Travelers Property Casualty Insurance Company, 27 AD3d 708 (2nd Dept. 2006). Failure to prove one prong would confirm the default judgment. In this instance the defendant failed on both scores, no competent evidence was offered as to the defendant’s excuse for its untimely answer or its meritorious defense. Specifically, the defendant merely asserted that an attorney erroneously calculated the days for service of its answer. But the defendant failed to provide an affidavit of an individual with personal knowledge of this miscalculation. Hence, the defendant failed at its proof. A.B. Medical Services PLLC D.A.V. Chiropractic P.C. LVOV Acupuncture P.C. v. Allstate Insurance Company, 11 Misc 3d 128(A) (App. Term 2nd & 11th Jud. Dists. 2006).

Moreover, the affidavits proffered by defendant did not constitute a meritorious defense. Neither of the affidavits established that the denial of claim forms or verification requests were timely mailed. Indeed, merely alleging that the claims were “timely denied” or that the affiant [*2]had “personal knowledge” is not probative. The affidavits did not contain a detailed description of the mailing of the denial of claim forms or the verification requests in order to create a presumption of mailing. A.B. Medical Services PLLC D.A.V. Chiropractic P.C. Daniel Kim’s Acupuncture P.C. Royalton Chiropractic P.C. v. Specialty National Insurance Company, 2006 NY Slip Op 50810U (App. Term 2nd & 11th Jud. Dists. 2006); St. Luke’s Roosevelt Hospital v. Blue Ridge Insurance Company, 21 AD3d 946 (2nd Dept. 2005); New York Hospital Medical Center of Queens v. Insurance Company of the State of Pennsylvania, 16 AD3d 391 (2nd Dept. 2005); Mingmen Acupuncture Services P.C. v. Liberty Mutual Insurance Company, 2002 NY Slip Op. 40244(U) (App. Term 9th & 10th Jud. Dists. 2002). A meritorious defense goes to the essentials of the case; if established it constitutes a defense to the action. A proper affidavit or two would have demonstrated that the defendant timely denied the claims or timely requested verification of the claims, thus providing a defense to the action. A mere semblance of merit— the affidavits of Ms. Copp and Ms. Winant—misses the mark.

However, defendant’s contention that the default judgment should not have been entered because the plaintiff never rejected the answer is persuasive. The default judgment was erroneously entered since plaintiff waived its right to enter a default judgment by accepting and retaining defendant’s answer. Abernathy v. Mo Ali, 3 Misc 3d 136(A) (App. Term 2nd & 11th Jud. Dists. 2004); Volin v. City Beach Catering Corporation, 166 AD2d 583 (2nd Dept. 1990); Jordan v. Aviles, 289 AD2d 532 (2nd Dept. 2001); Gonzalez v. Gonzalez, 240 AD2d 630 (2nd Dept. 1997); First Wisconsin Trust Company v. Hakimian, 237 AD2d 249 (2nd Dept. 1997). Plaintiff’s affirmation in opposition failed to provide one iota of admissible evidence as to when it received defendant’s answer. Thus, plaintiff cannot argue that it did not have reasonable time to reject the pleading. Considering the relevant caselaw, the default judgment should never have been entered.

Based upon the erroneous entry of the default judgment, the defendant is not obligated to set forth a reasonable excuse for failing to timely answer or a meritorious defense to this action. Compare, Goodyear v. Weinstein, 224 AD2d 387 (2d Dept. 1996); Gerhardt v. J & R Salacqua Contracting Co., Inc., 181 AD2d 719 (2d Dept. 1992) (where an erroneous default judgment was entered movant did not have to prove reasonable excuse or meritorious defense). It is accordingly,

Ordered that the defendant’s motion is granted, the default judgment is vacated and the plaintiff will accept defendant’s answer as attached to this motion.

This constitutes the decision and order of this Court.

Dated: Brooklyn, New York

June 20, 2006 _____________________________

Genine D. Edwards, J.C.C.

Legal questions

A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Proof of mailing

Open the full map

Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?

This decision: The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice (rules on the question, but another ground decided the case)

Held the insurer's affidavits showed no meritorious defense because they gave no detailed description of mailing the denials or verification requests, so no presumption of mailing arose; the default was vacated on another ground.

  • Court of AppealsCt App 1
  • Appellate DivisionApp Div 34
  • Appellate TermApp Term 1,173
  • Trial courtsTrial 133
2015, Court of Appeals: 1 decision (1 Provider proved mailing)2023, Appellate Division: 1 decision (1 Insurer proved mailing)2020, Appellate Division: 1 decision (1 Insurer proved mailing)2016, Appellate Division: 3 decisions (1 Insurer proved mailing, 2 Insurer failed to prove)2015, Appellate Division: 2 decisions (2 Insurer failed to prove)2014, Appellate Division: 3 decisions (2 Insurer proved mailing, 1 Provider proved mailing)2013, Appellate Division: 1 decision (1 Provider proved mailing)2012, Appellate Division: 1 decision (1 Provider proved mailing)2011, Appellate Division: 5 decisions (2 Insurer proved mailing, 1 Insurer failed to prove, 2 Provider proved mailing)2010, Appellate Division: 1 decision (1 Provider proved mailing)2008, Appellate Division: 2 decisions (2 Insurer proved mailing)2007, Appellate Division: 5 decisions (1 Insurer proved mailing, 1 Insurer failed to prove, 2 Provider proved mailing, 1 Mixed rulings)2006, Appellate Division: 3 decisions (2 Insurer failed to prove, 1 Provider failed to prove)2005, Appellate Division: 2 decisions (2 Insurer failed to prove)2004, Appellate Division: 3 decisions (2 Insurer failed to prove, 1 Triable issue on mailing)2026, Appellate Division: 1 decision (1 Insurer failed to prove)2023, Appellate Term: 5 decisions (5 Insurer proved mailing)2022, Appellate Term: 43 decisions (32 Insurer proved mailing, 3 Insurer failed to prove, 1 Provider proved mailing, 2 Provider failed to prove, 5 Triable issue on mailing)2021, Appellate Term: 21 decisions (13 Insurer proved mailing, 2 Insurer failed to prove, 5 Triable issue on mailing, 1 Mixed rulings)2020, Appellate Term: 31 decisions (24 Insurer proved mailing, 2 Insurer failed to prove, 5 Triable issue on mailing)2019, Appellate Term: 78 decisions (59 Insurer proved mailing, 5 Insurer failed to prove, 2 Provider proved mailing, 11 Triable issue on mailing, 1 Mixed rulings)2018, Appellate Term: 73 decisions (46 Insurer proved mailing, 16 Insurer failed to prove, 1 Provider failed to prove, 9 Triable issue on mailing, 1 Mixed rulings)2017, Appellate Term: 110 decisions (60 Insurer proved mailing, 26 Insurer failed to prove, 4 Provider proved mailing, 18 Triable issue on mailing, 2 Mixed rulings)2016, Appellate Term: 99 decisions (44 Insurer proved mailing, 30 Insurer failed to prove, 2 Provider proved mailing, 1 Provider failed to prove, 19 Triable issue on mailing, 3 Mixed rulings)2015, Appellate Term: 95 decisions (65 Insurer proved mailing, 10 Insurer failed to prove, 1 Provider proved mailing, 3 Provider failed to prove, 8 Triable issue on mailing, 8 Mixed rulings)2014, Appellate Term: 66 decisions (55 Insurer proved mailing, 3 Insurer failed to prove, 1 Provider proved mailing, 3 Triable issue on mailing, 4 Mixed rulings)2013, Appellate Term: 73 decisions (62 Insurer proved mailing, 6 Insurer failed to prove, 1 Provider proved mailing, 1 Provider failed to prove, 3 Mixed rulings)2012, Appellate Term: 108 decisions (87 Insurer proved mailing, 12 Insurer failed to prove, 1 Provider proved mailing, 3 Provider failed to prove, 1 Triable issue on mailing, 4 Mixed rulings)2011, Appellate Term: 69 decisions (56 Insurer proved mailing, 8 Insurer failed to prove, 2 Provider proved mailing, 1 Triable issue on mailing, 2 Mixed rulings)2010, Appellate Term: 77 decisions (67 Insurer proved mailing, 4 Insurer failed to prove, 2 Provider proved mailing, 2 Provider failed to prove, 2 Mixed rulings)2009, Appellate Term: 52 decisions (29 Insurer proved mailing, 11 Insurer failed to prove, 6 Provider proved mailing, 2 Provider failed to prove, 4 Mixed rulings)2008, Appellate Term: 27 decisions (12 Insurer proved mailing, 11 Insurer failed to prove, 2 Provider proved mailing, 1 Provider failed to prove, 1 Mixed rulings)2007, Appellate Term: 29 decisions (9 Insurer proved mailing, 16 Insurer failed to prove, 2 Provider proved mailing, 2 Mixed rulings)2006, Appellate Term: 63 decisions (5 Insurer proved mailing, 18 Insurer failed to prove, 14 Provider proved mailing, 19 Provider failed to prove, 7 Mixed rulings)2005, Appellate Term: 26 decisions (2 Insurer proved mailing, 14 Insurer failed to prove, 6 Provider proved mailing, 3 Provider failed to prove, 1 Mixed rulings)2004, Appellate Term: 11 decisions (1 Insurer proved mailing, 4 Insurer failed to prove, 2 Provider proved mailing, 2 Provider failed to prove, 1 Triable issue on mailing, 1 Mixed rulings)2003, Appellate Term: 3 decisions (3 Provider proved mailing)2024, Appellate Term: 4 decisions (2 Insurer proved mailing, 1 Insurer failed to prove, 1 Provider failed to prove)2025, Appellate Term: 3 decisions (3 Insurer proved mailing)2026, Appellate Term: 7 decisions (2 Insurer proved mailing, 3 Insurer failed to prove, 2 Triable issue on mailing)2023, Trial courts: 4 decisions (2 Insurer proved mailing, 2 Provider proved mailing)2022, Trial courts: 4 decisions (2 Insurer proved mailing, 1 Provider proved mailing, 1 Mixed rulings)2021, Trial courts: 16 decisions (11 Insurer proved mailing, 1 Provider proved mailing, 2 Provider failed to prove, 2 Mixed rulings)2020, Trial courts: 4 decisions (2 Provider proved mailing, 2 Mixed rulings)2019, Trial courts: 4 decisions (3 Insurer failed to prove, 1 Triable issue on mailing)2018, Trial courts: 1 decision (1 Insurer proved mailing)2017, Trial courts: 5 decisions (3 Insurer proved mailing, 2 Insurer failed to prove)2016, Trial courts: 4 decisions (2 Insurer proved mailing, 1 Provider proved mailing, 1 Triable issue on mailing)2015, Trial courts: 3 decisions (3 Provider proved mailing)2013, Trial courts: 4 decisions (3 Insurer proved mailing, 1 Insurer failed to prove)2012, Trial courts: 10 decisions (5 Insurer proved mailing, 2 Insurer failed to prove, 2 Provider proved mailing, 1 Triable issue on mailing)2011, Trial courts: 3 decisions (2 Insurer proved mailing, 1 Insurer failed to prove)2010, Trial courts: 6 decisions (3 Insurer proved mailing, 1 Insurer failed to prove, 2 Provider proved mailing)2009, Trial courts: 9 decisions (4 Insurer proved mailing, 2 Insurer failed to prove, 3 Provider proved mailing)2008, Trial courts: 11 decisions (1 Insurer proved mailing, 1 Insurer failed to prove, 7 Provider proved mailing, 1 Provider failed to prove, 1 Mixed rulings)2007, Trial courts: 8 decisions (1 Insurer proved mailing, 5 Insurer failed to prove, 2 Provider proved mailing)2006, Trial courts: 7 decisions (1 Insurer proved mailing, 6 Insurer failed to prove)2005, Trial courts: 13 decisions (2 Insurer proved mailing, 8 Insurer failed to prove, 3 Provider failed to prove)2004, Trial courts: 8 decisions (5 Insurer failed to prove, 2 Provider proved mailing, 1 Provider failed to prove)2024, Trial courts: 2 decisions (1 Insurer failed to prove, 1 Provider failed to prove)2025, Trial courts: 2 decisions (2 Insurer proved mailing)2026, Trial courts: 5 decisions (3 Insurer proved mailing, 1 Provider proved mailing, 1 Provider failed to prove)This decision
20052010201520202025
Insurer proved mailingInsurer failed to proveProvider proved mailingProvider failed to proveTriable issue on mailingMixed rulingsThis decisionCites it or cited by itCited or followed

Of the 1,341 decisions on this question in the Second Department courts and the Court of Appeals, 256 (this one included) are in the same category.

Cited in this decision

  • New York & Presbyt. Hosp. v Travelers Prop. Cas. Ins. Co. (2006 NY Slip Op 02344)The insurer's motion for default vacatur and a late answer was granted based on a reasonable excuse and a meritorious defense.
  • A.B. Med. Servs. PLLC v Specialty Natl. Ins. Co. (2006 NY Slip Op 50810(U))The providers failed to establish submission of their claims, and the insurer showed grounds to open its default.
  • St. Luke’s Roosevelt Hosp. v Blue Ridge Ins. Co. (2005 NY Slip Op 06666)An insurer failed to establish a reasonable excuse or meritorious defense for vacating its default in opposing summary judgment.
  • New York Hosp. Med. Ctr. of Queens v Insurance Co. of State of Pa. (2005 NY Slip Op 01691)The insurer failed to establish a meritorious defense required to vacate the provider's default judgment.

Similar decisions

  • Neurology & Acupuncture Serv., P.C. v Lumbermens Mut. Cas. Co. (2006 NY Slip Op 52517(U))A provider's retention of an insurer's late answer without timely objection waives untimeliness and precludes a default judgment.
  • Comfort Zone Chiropractic, P.C. v Lumbermens Mut. Cas. Co. (2007 NY Slip Op 50151(U))A provider's retention of a late answer without timely objection precludes a default judgment against the insurer.
  • Amaze Med. Supply, Inc. v Lumbermens Mut. Cas. Co. (2004 NY Slip Op 51110(U))The insurer failed to establish a meritorious defense sufficient to excuse its late answer and defeat a default judgment.
  • AVA Acupuncture P.C. v Lumbermens Mut. Cas. Co. (2007 NY Slip Op 50263(U))A provider that retains an untimely answer without timely objection waives the lateness and cannot obtain a default judgment on that ground.
  • New Age Med., P.C. v GEICO Gen. Ins. Co. (2020 NY Slip Op 50316(U))The insurer failed to excuse its year-long delay in correcting an answer rejected for bearing the wrong index number.
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