August 19, 2008
Mid Atl. Med., P.C. v Victoria Select Ins. Co. (2008 NY Slip Op 51758(U))
https://www.beynensonlaw.com/case-law/mid-atl-med-p-c-v-victoria-select-ins-co-2008-ny-slip-op-51758u/
- Decided
- August 19, 2008
- Citation
- 2008 NY Slip Op 51758(U) · 20 Misc 3d 143(A)
- Posture
- Motion to dismiss (CPLR 3211)
- Outcome
- Split result
- Later treatment
- Followed in 1 later decision (see Cited by)
- Legal questions
- Effect of insurer's declaratory judgment (see the maps)
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.
Reported in New York Official Reports at Mid Atl. Med., P.C. v Victoria Select Ins. Co. (2008 NY Slip Op 51758(U))
| Mid Atl. Med., P.C. v Victoria Select Ins. Co. |
| 2008 NY Slip Op 51758(U) [20 Misc 3d 143(A)] |
| Decided on August 19, 2008 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS
PRESENT: : RIOS, J.P., PESCE and GOLIA, JJ
2007-162 K C. NO. 2007-162 K C
against
Victoria Select Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Delores J. Thomas, J.), entered November 3, 2006. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion to dismiss the complaint.
Order modified by providing that defendant’s cross motion to dismiss the complaint is
denied; as so modified, affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff
moved for summary judgment and defendant cross-moved to dismiss the complaint pursuant to
CPLR 3211 (a) (5), based upon a Virginia court’s order rescinding the subject insurance policy.
The court below denied plaintiff’s motion for summary judgment and granted defendant’s cross
motion to dismiss the complaint. Plaintiff appeals.
An objection based on CPLR 3211 (a) (5) must be raised either by motion made
before service of the responsive pleading is required or in the responsive pleading (see
CPLR 3211 [e]). As defendant did neither, its post-answer cross motion to dismiss should have
been denied.
[*2]
Turning to plaintiff’s motion for summary judgment,
we note that defendant raised no issue below or on appeal with respect to plaintiff’s establishment
of its prima facie case, and we therefore do not pass on the propriety of the determination of the
court below with respect thereto.
In opposition to plaintiff’s motion, defendant made the same collateral estoppel
argument it proffered in support of its cross motion to dismiss. It submitted a petition
commencing an action in a Virginia court seeking a declaratory judgment voiding the subject
insurance policy on the ground that the insured made material misrepresentations on his
application for insurance including, inter alia, that he resided in, and his car was to be garaged in,
Virginia. Defendant further submitted an uncertified order of a Virginia court, dated April 4,
2005, which provided that the subject insurance policy was “rescinded, void ab initio,
and of no effect.”
We note at the outset that defendant may not invoke the doctrine of collateral
estoppel against plaintiff herein because plaintiff was not a party to the Virginia proceeding,
which was commenced by defendant herein against its insured. Prior to the commencement of
the Virginia proceeding, plaintiff was assigned the instant claims by two eligible injured persons,
neither of whom are the named insured but both of whom were allegedly eligible for benefits
under said policy. Plaintiff was therefore not “afforded a full and fair opportunity to contest” the
Virginia order, nor was it in privity with one who was (see Gramatan Home Invs. Corp. v
Lopez, 46 NY2d 481, 485-487 [1979]). We find, however, that the submission of the
aforementioned documents is sufficient to demonstrate a defense based upon a “founded belief
that the alleged injur[ies] do[ ] not arise out of an insured accident” (Central Gen. Hosp. v
Chubb Group of Ins. Cos., 90 NY2d 195, 199 [1997]). Thus, defendant has raised a triable
issue of fact as to whether there was coverage under the subject insurance policy (see Hernandez v City of New York, 35
AD3d 812, 813 [2006]; Matter of Eagle Ins. Co. v
Singletary, 279 AD2d 56 [2000]; Central Gen. Hosp. v Chubb Group of Ins.
Cos., 90
NY2d 195 [1997], supra). Therefore, plaintiff’s motion for summary judgment was
properly denied (see Zuckerman v City of New York, 49 NY2d 557 [1980]).
Rios, J.P., and Pesce, J., concur.
Golia, J., concurs in a separate memorandum.
Respondent.
Golia, J., concurs in the result only, in the following memorandum:
I am constrained to agree with the ultimate disposition in the decision reached by
the majority. I, however, wish to note that I do not agree with certain propositions of law set forth
in cases cited therein which are inconsistent with my prior expressed positions and generally
contrary to my views.
I do not believe this Court can choose to abrogate its responsibility to pass upon the
most fundamental and pre-eminent issue to be determined in any litigation, that being whether or
not [*3]the plaintiff has established a prima facie case (see
Uptodate
Med. Serv., P.C v Lumbermens Mut. Cas. Co., Misc 3d , 2008 NY Slip
Op 51502[U] [App Term, 2d & 11th Jud Dists 2008] [dissenting op by Golia, J.]; see
also Alvarez v Prospect Hosp., 68 NY2d 320 [1986]).
Decision Date: August 19, 2008
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.
Does an insurer’s no-coverage declaratory judgment, or pending declaratory action, bar or stay a no-fault claimant’s action?
This decision: No preclusion because the claimant (or insurer) was not a party or privy to the DJ (rules on the question, but another ground decided the case)
Held the Virginia order rescinding the policy had no collateral estoppel effect because the provider was not a party and its assignments predated that proceeding, though the order raised a triable coverage issue defeating summary judgment.
Of the 164 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
- Uptodate Med. Servs., P.C. v Lumbermens Mut. Cas. Co. (2008 NY Slip Op 51502(U))The insurer failed to prove timely mailing of verification requests and denials, precluding its medical-necessity defense.
Cited by
A label shows how the later decision treated this one.
- Magic Recovery Med. & Surgical Supply Inc. v State Farm Mut. Auto. Ins. Co. (2010 NY Slip Op 20130) FollowedThe provider was not collaterally estopped by default declaratory judgments in actions where it was neither a party nor in privity.
Similar decisions
- Mid Atl. Med. P.C. v Victoria Select Ins. Co. (2006 NY Slip Op 52039(U))Virginia law governed the policy's retroactive rescission because Virginia had the most significant contacts with the insurance contract.
- A.M. Med. Servs., P.C. v New York Cent. Mut. Ins. (2006 NY Slip Op 51662(U))The insurer proved mailing of one medical necessity denial but failed to prove verification mailing for four other claims.
- V.S. Med. Servs., P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 50304(U))The provider's summary judgment motion was denied because the insurer's investigator affidavit raised a triable coverage issue.
- Align for Health Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51862(U))The insurer failed to prove timely verification requests, and the provider failed to lay a business-records foundation.
- A.B. Med. Servs. PLLC v State-Wide Ins. Co. (2005 NYSlipOp 50785(U))The insurer's attorney affirmation and unsworn reports failed to raise a triable staged-collision issue without an excuse for inadmissibility.