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March 15, 2024

Longevity Med. Supply, Inc. v Nationwide Ins. Co. (2024 NY Slip Op 50406(U))

https://www.beynensonlaw.com/case-law/longevity-med-supply-inc-v-nationwide-ins-co-2024-ny-slip-op50406u/

Court
Appellate Term, Second Department
Decided
March 15, 2024
Citation
2024 NY Slip Op 50406(U) · 82 Misc 3d 130(A)
Posture
Summary judgment
Outcome
Provider prevailed
Issues
Policy issues
Legal questions
No covered accident (founded belief) (see the maps)
Cite as
Longevity Med. Supply, Inc. v Nationwide Ins. Co., 82 Misc 3d 130(A), 2024 NY Slip Op 50406(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2024)

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.

The insurer failed to establish that the assignor's injuries arose from an assault rather than use or operation of an insured vehicle. In the provider's action for assigned no-fault benefits, the insurer sought summary judgment on the ground that the assignor was not an eligible injured person under Insurance Law § 5103 and 11 NYCRR 65-1.1 (d) (a). The hospital records containing the statements relied upon were uncertified, and no foundation was established under CPLR 4518 (a) or (c). Even if admissible, the records did not eliminate material factual questions about the cause of the injuries. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, denying the insurer's motion.

Reported in New York Official Reports at Longevity Med. Supply, Inc. v Nationwide Ins. Co. (2024 NY Slip Op 50406(U))

[*1]
Longevity Med. Supply, Inc. v Nationwide Ins. Co.
2024 NY Slip Op 50406(U) [82 Misc 3d 130(A)]
Decided on March 15, 2024
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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 15, 2024
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : CHEREÉ A. BUGGS, J.P., LISA S. OTTLEY, PHILLIP HOM, JJ
2023-1065 K C

Longevity Medical Supply, Inc., as Assignee of Celestine, Winston, Respondent,

against

Nationwide Insurance Company, Appellant.


Law Offices of Brian Rayhill (Lawrence Wolkow of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Sandra E. Roper, J.), entered February 8, 2023. The order, insofar as appealed from and as limited by the brief, denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, insofar as is relevant to this appeal, defendant moved for summary judgment dismissing the complaint on the ground that plaintiff’s assignor was not an eligible injured person (EIP) for receipt of no-fault benefits as his injuries did not arise from the use or operation of an insured vehicle (see Insurance Law § 5103; 11 NYCRR 65-1.1 [d] [a]). Defendant contended that plaintiff’s assignor’s injuries were the result of an assault after the subject motor vehicle accident, relying on the truth of plaintiff’s assignor’s factual assertions contained within uncertified records of the Kings County Hospital Center, where plaintiff’s assignor was admitted one hour after the subject accident. Conceding that the statements were hearsay, defendant’s attorney argued that they were admissible as exceptions as party statements and/or statements relevant to diagnosis and treatment. By order entered February 8, 2023, insofar as appealed from, the Civil Court denied defendant’s motion.

A review of the records shows that, contrary to defendant’s contentions, defendant failed to establish, as a matter of law, that plaintiff’s assignor was not an EIP as defined by the [*2]Insurance Law and no-fault regulations. Hospital and medical records are admissible to support a summary judgment motion if the records are certified pursuant to CPLR 4518 (c) or the proponent of the records submits foundational testimony pursuant to CPLR 4518 (a) (see Berkovits v Chaaya, 138 AD3d 1050 [2016]; Matter of Kai B., 38 AD3d 882 [2007]). Here, as plaintiff correctly contends, the hospital records were not certified and defendant failed to otherwise establish a proper foundation for their admissibility. Therefore, the statements relied upon by defendant were not admissible (see Yassin v Blackman, 188 AD3d 62 [2020]; Berkovits, 138 AD3d 1050; Matter of Kai B., 38 AD3d 882). Consequently, defendant failed to proffer competent evidence to establish, as a matter of law, its defense that plaintiff’s assignor was not an EIP (see Alvarez v Prospect Hosp., 68 NY2d 320 [1986]; see e.g. Psychology & Massage Therapy Assoc., PLLC v Progressive Cas. Ins. Co., 12 Misc 3d 140[A], 2006 NY Slip Op 51351[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2006]), and defendant’s motion was properly denied.

It is noted that, even if the hospital records and the statements contained therein were admissible, defendant would still not be entitled to summary judgment dismissing the complaint, as defendant’s motion failed to eliminate all material questions of fact as to whether plaintiff’s assignor’s injuries were the result of an assault and not the result of the use or operation of a motor vehicle.

Accordingly, the order, insofar as appealed from, is affirmed.

BUGGS, J.P., OTTLEY and HOM, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: March 15, 2024

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.

No covered accident (founded belief)

Open the full map

Did the insurer show the claimed injuries did not arise from a covered accident (staged, intentional, or unrelated)?

This decision: Insurer's motion denied: proof did not establish the defense prima facie; defense still open

Held the insurer failed to establish that the assignor's injuries resulted from a post-accident assault rather than the vehicle's use, because the uncertified hospital records were inadmissible and, even if admitted, left questions of fact.

  • Court of AppealsCt App 1
  • Appellate DivisionApp Div 16
  • Appellate TermApp Term 171
  • Trial courtsTrial 46
2011, Court of Appeals: 1 decision (1 Defense not shown)2023, Appellate Division: 1 decision (1 Defense established)2022, Appellate Division: 1 decision (1 Defense established)2016, Appellate Division: 1 decision (1 Insurer's motion fails)2015, Appellate Division: 1 decision (1 Insurer's motion fails)2009, Appellate Division: 1 decision (1 Defense not shown)2008, Appellate Division: 1 decision (1 Defense not shown)2007, Appellate Division: 3 decisions (2 Triable issue, 1 Defense not shown)2006, Appellate Division: 1 decision (1 Insurer's motion fails)2005, Appellate Division: 2 decisions (2 Defense not shown)2004, Appellate Division: 3 decisions (3 Defense not shown)2026, Appellate Division: 1 decision (1 Defense not shown)2021, Appellate Term: 1 decision (1 Insurer's motion fails)2019, Appellate Term: 4 decisions (2 Defense established, 1 Triable issue, 1 Insurer's motion fails)2018, Appellate Term: 5 decisions (4 Defense established, 1 Triable issue)2017, Appellate Term: 8 decisions (2 Defense established, 2 Triable issue, 3 Insurer's motion fails, 1 Defense not shown)2016, Appellate Term: 1 decision (1 Insurer's motion fails)2015, Appellate Term: 2 decisions (2 Defense established)2014, Appellate Term: 1 decision (1 Defense established)2012, Appellate Term: 3 decisions (2 Defense established, 1 Defense not shown)2011, Appellate Term: 4 decisions (2 Triable issue, 2 Insurer's motion fails)2010, Appellate Term: 2 decisions (1 Defense established, 1 Triable issue)2009, Appellate Term: 13 decisions (5 Defense established, 5 Triable issue, 3 Defense not shown)2008, Appellate Term: 9 decisions (3 Triable issue, 6 Defense not shown)2007, Appellate Term: 23 decisions (13 Triable issue, 2 Insurer's motion fails, 8 Defense not shown)2006, Appellate Term: 30 decisions (21 Triable issue, 9 Defense not shown)2005, Appellate Term: 37 decisions (1 Defense established, 24 Triable issue, 12 Defense not shown)2004, Appellate Term: 22 decisions (16 Triable issue, 6 Defense not shown)2003, Appellate Term: 1 decision (1 Defense not shown)2024, Appellate Term: 1 decision (1 Insurer's motion fails)2025, Appellate Term: 2 decisions (1 Defense established, 1 Insurer's motion fails)2013, Appellate Term: 1 decision (1 Defense established)2023, Appellate Term: 1 decision (1 Triable issue)2023, Trial courts: 2 decisions (2 Insurer's motion fails)2020, Trial courts: 1 decision (1 Insurer's motion fails)2019, Trial courts: 3 decisions (1 Defense established, 1 Triable issue, 1 Defense not shown)2016, Trial courts: 1 decision (1 Insurer's motion fails)2013, Trial courts: 1 decision (1 Triable issue)2011, Trial courts: 2 decisions (2 Defense not shown)2010, Trial courts: 2 decisions (1 Triable issue, 1 Defense not shown)2008, Trial courts: 5 decisions (1 Defense established, 2 Triable issue, 2 Defense not shown)2007, Trial courts: 3 decisions (1 Defense established, 2 Triable issue)2006, Trial courts: 7 decisions (2 Defense established, 5 Defense not shown)2005, Trial courts: 7 decisions (1 Defense established, 6 Defense not shown)2004, Trial courts: 5 decisions (5 Defense not shown)2026, Trial courts: 6 decisions (2 Defense established, 3 Triable issue, 1 Insurer's motion fails)2014, Trial courts: 1 decision (1 Defense not shown)This decision
20052010201520202025
Defense establishedTriable issueInsurer's motion failsDefense not shownThis decision

Of the 234 decisions on this question in the Second Department courts and the Court of Appeals, 20 (this one included) are in the same category.

Cited in this decision

  • Psychology & Massage Therapy Assoc., PLLC v Progressive Cas. Ins. Co. (2006 NYSlipOp 51351(U))The insurer's conclusory assertion that the assignor did not reside with the insured failed to raise a coverage issue.

Similar decisions

  • Longevity Med. Supply, Inc. v Nationwide Ins. (2020 NY Slip Op 51133(U))An assignor must attend a requested EUO whether the insurer demands it before or after submission of the claim form.
  • Longevity Med. Supply, Inc. v Praetorian Ins. Co. (2016 NY Slip Op 50924(U))The insurer's affidavits established that the assignor failed to appear for duly scheduled IMEs. The provider sued to recover assigned no-fault benefits, and the Civil Court denied the insurer's summary judgment motion while limiting the trial issue under CPLR 3212 (g) to the assignor's nonappearance.
  • Longevity Med. Supply, Inc. v Global Liberty Ins. Co. (2020 NY Slip Op 50527(U))The insurer was awarded summary judgment based on a declaratory judgment barring no-fault benefits for the accident.
  • Vital Chiropractic, P.C. v Nationwide Ins. Co. (2019 NY Slip Op 50425(U))The insurer proved IME nonappearances and timely denials for all but one claim, as to which receipt remained disputed.
  • Longevity Med. Supply, Inc. v 21st Century Ins. Co. (2019 NY Slip Op 52041(U))The insurer's uncertified police report failed to establish the out-of-state contacts asserted for forum non conveniens dismissal.
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