June 10, 2022

Metro Health Prods., Inc. v MVAIC (2022 NY Slip Op 50588(U))

https://www.beynensonlaw.com/case-law/metro-health-prods-inc-v-mvaic-2022-ny-slip-op-50588u/

Court: Appellate Term, Second Department
Decided: June 10, 2022
Citation: 2022 NY Slip Op 50588(U) · 75 Misc 3d 139(A)
Posture: Trial
Outcome: Insurer prevailed
Issues: MVAIC Timeliness and preclusion Provider's prima facie case
Legal questions: Claimant's prima facie case at trial · MVAIC eligibility: qualified covered person (see the maps)

Cite as

Metro Health Prods., Inc. v MVAIC, 75 Misc 3d 139(A), 2022 NY Slip Op 50588(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022)

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 provider failed at trial to justify a late MVAIC notice of claim or show court permission to file it late. A prior order under CPLR 3212 (g) limited trial to reasonable justification under Insurance Law § 5208 (b) (1) or leave under Insurance Law § 5208 (b) (2). The provider called no witnesses and attempted neither showing. Because timely notice is a condition precedent to benefits under Insurance Law § 5208 and Insurance Law § 5221 (b) (2), the provider failed to establish its prima facie case. The Appellate Term, Second Department, reversed the provider's judgment and remitted for judgment dismissing the complaint in MVAIC's favor, reaching no other issue.

Reported in New York Official Reports at Metro Health Prods., Inc. v MVAIC (2022 NY Slip Op 50588(U))

[*1]

Metro Health Prods., Inc. v MVAIC

2022 NY Slip Op 50588(U) [75 Misc 3d 139(A)]

Decided on June 10, 2022

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 10, 2022

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

PRESENT: : THOMAS P. ALIOTTA, P.J., WAVNY TOUSSAINT, DONNA-MARIE E. GOLIA, JJ
2020-775 K C

Metro Health Products, Inc., as Assignee of Melendez, Angel, Respondent,

against

MVAIC, Appellant.

Marshall & Marshall (Frank D’Esposito of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from a judgment of the Civil Court of the City of New York, Kings County (Michael Gerstein, J.), entered November 22, 2019. The judgment, after a nonjury trial, awarded plaintiff the principal sum of $3,451.17.

ORDERED that the judgment is reversed, with $30 costs, and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the complaint.

After a nonjury trial in this action by a provider to recover assigned first-party no-fault benefits, the Civil Court awarded judgment to plaintiff against defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC) in the principal sum of $3,451.17.

At the outset of the trial, it was noted that, by a prior order, the issue for trial would be limited (see CPLR 3212 [g]) to whether the applicant had reasonable justification for failing to timely submit a notice of claim (see Insurance Law § 5208 [b] [1]) or whether the applicant had obtained leave of court to permit it to be filed late (see Insurance Law § 5208 [b] [2]). Plaintiff called no witnesses and made no attempt to establish either a reasonable justification for failing to timely submit a notice of claim or that the applicant had obtained leave to of court to permit it to be filed late.

“The filing of a timely affidavit providing the MVAIC with notice of intention to file a claim is a condition precedent to the right to apply for payment from [MVAIC]. Compliance with the statutory requirement of timely filing a notice of claim must be established in order to demonstrate that the claimant is a covered person, within the meaning of the statute, entitled to recover no-fault benefits from the MVAIC” (Avicenna Med. Arts, P.L.L.C. v MVAIC, 53 Misc 3d [*2]142[A], 2016 NY Slip Op 51535[U], *1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016] [internal quotation marks and citation omitted]; see Insurance Law §§ 5208 [a] [1], [3]; 5221 [b] [2]). As plaintiff did not establish that it was not reasonably possible to file a notice of claim within a timely manner (see Insurance Law § 5208 [b] [1]) or that leave of court had been obtained to permit the notice of claim to be filed late (see Insurance Law § 5208 [b] [2]), plaintiff failed to establish its prima facie case (see Insurance Law §§ 5202 [b]; 5208, 5221 [b] [2]). In light of the foregoing, we reach no other issue.

Accordingly, the judgment is reversed and the matter is remitted to the Civil Court for the entry of a judgment in favor of defendant dismissing the complaint.

ALIOTTA, P.J., TOUSSAINT and GOLIA, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 10, 2022

Legal questions (2)

Questions 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.

Claimant's prima facie case at trial

Open the full map

What must a no-fault claimant prove at trial to make out its prima facie case for overdue benefits?

This decision: Insufficient at trial for another reason (MVAIC eligibility, assignment, eligibility for benefits)

Held after trial that the provider failed its prima facie case against MVAIC because it showed neither a reasonable justification for the late notice of claim nor leave of court to file it late.

Proof sufficientMailing/receipt not shownOverdue not shownBusiness-record foundation lackingOther element missingThis decisionCites it or cited by itCited or followed

Of the 93 decisions on this question in the Second Department courts and the Court of Appeals, 25 (this one included) are in the same category.

MVAIC eligibility: qualified covered person

Open the full map

Against MVAIC, was the claimant shown to be a qualified, covered person meeting article 52’s conditions?

This decision: Eligibility is treated as the claimant's burden / condition precedent and the claimant did not prove it; claim fails or is premature

Held that the provider, calling no witnesses, failed to show a reasonable justification for not timely filing the notice of claim or leave of court to file late, so it did not establish covered-person status.

Found not eligibleClaimant's proof lackingMVAIC failed to proveFound eligibleUnresolved / for trialDefense precluded/waivedThis decisionCites it or cited by itCited or followed

Of the 223 decisions on this question in the Second Department courts and the Court of Appeals, 99 (this one included) are in the same category.

Cited in this decision

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

Avicenna Med. Arts, P.L.L.C. v MVAIC (2016 NY Slip Op 51535(U)) FollowedThe provider failed at trial to establish submission of the notice-of-intention affidavit required for no-fault recovery from MVAIC. Its billing manager testified that the claims had been mailed, and the Civil Court awarded judgment after a nonjury trial.

Similar decisions

Medical Diversified Servs., Inc. v MVAIC (2017 NY Slip Op 51848(U))The provider failed to establish its prima facie case at trial because it did not prove submission of a notice-of-intention affidavit to MVAIC. Its witness testified that the claims had been mailed, but timely filing of the affidavit was a condition precedent to payment under Insurance Law § 5208 (a) (1) and (3).
Yklik, Inc. v Mvaic (2016 NY Slip Op 50874(U))The provider failed at trial to establish MVAIC coverage because it did not prove submission of a notice of intention to make a claim.
Peace of Mind, Social Work, P.C. v MVAIC (2011 NY Slip Op 51834(U))The provider failed to establish its prima facie case at trial because it offered no proof of submitting a notice of intention to claim to MVAIC. Its billing witness testified only to creation and mailing of the claim form and nonpayment.
SK Prime Med. Supply, Inc. v MVAIC (2015 NY Slip Op 51663(U))The provider failed to prove the assignor's New York residency and submission of a notice of intention to claim benefits from MVAIC. At a nonjury trial, the provider's witness established only that a claim form had been created, mailed, and unpaid.
Bronx Acupuncture Therapy, P.C. v MVAIC (2019 NY Slip Op 51694(U))A claimant must establish timely filing of a notice-of-intention affidavit to recover no-fault benefits from MVAIC. Under Insurance Law § 5208 (a) (1) and (3) and § 5221 (b) (2), filing is a condition precedent to payment and must be shown to establish covered-person status.