December 20, 2004
Park v Long Is. Ins. Co. (2004 NY Slip Op 09485)
https://www.beynensonlaw.com/case-law/park-v-long-is-ins-co-2004-ny-slip-op-09485/
- Decided
- December 20, 2004
- Citation
- 2004 NY Slip Op 09485 · 13 AD3d 506
- Posture
- Summary judgment
- Outcome
- Provider prevailed
- Issues
- EUO no-show
- Legal questions
- No-show defense: insurer's proof (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 Park v Long Is. Ins. Co. (2004 NY Slip Op 09485)
| Park v Long Is. Ins. Co. |
| 2004 NY Slip Op 09485 [13 AD3d 506] |
| December 20, 2004 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| Catherine Park et al., Appellants, v Long Island Insurance Company, Respondent. |
—[*1]
In an action, inter alia, for a judgment declaring the parties’ rights under a certain insurance policy, the plaintiffs appeal from an order of the Supreme Court, Queens County (Polizzi, J.), dated July 8, 2003, which granted the defendant’s motion for summary judgment and denied those branches of their cross motion which were for summary judgment, or in the alternative, to reschedule the examination under oath of the plaintiff Tracy Dwight Park.
Ordered that the order is reversed, on the law, with costs, the motion is denied, the cross motion is granted, the defendant is directed to reschedule the examination under oath of the plaintiff Tracy Dwight Park, and the matter is remitted to the Supreme Court, Queens County, for the entry of a judgment declaring that the defendant’s denial of no-fault insurance benefits, in effect, on the ground that the plaintiffs engaged in a pattern of unreasonable and willful noncooperation was improper.
The plaintiff Tracy Dwight Park (hereinafter the injured plaintiff) allegedly was injured in a motor vehicle accident while operating a vehicle owned by the plaintiff Catherine Park, his spouse, and insured by the defendant. The plaintiffs submitted a claim for no-fault benefits to the defendant. The defendant sought to examine the injured plaintiff under oath in accordance with the terms of the insurance policy, but he refused to submit to the examination unless his wife was allowed to be present. In response, the defendant denied the plaintiffs’ claim for no-fault benefits [*2]on the ground that the plaintiffs failed to cooperate with its investigation. The plaintiffs commenced this action, inter alia, for a judgment declaring the parties’ rights under the insurance policy. The Supreme Court granted the defendant’s motion for summary judgment and denied those branches of the plaintiffs’ cross motion which were for summary judgment, or in the alternative, to reschedule the examination under oath of the injured plaintiff. The Supreme Court concluded that the plaintiffs’ failure to cooperate with the insurer constituted a material breach of the policy. We disagree.
The Supreme Court correctly concluded that the plaintiffs had “no right to be present at each others’ examinations since the examinations were requested pursuant to an insurance policy and not as part of a legal action” (Matter of Allstate Ins. Co. v Moshevev, 291 AD2d 401, 402 [2002]; see Dyno-Bite, Inc. v Travelers Cos., 80 AD2d 471 [1981]). Nevertheless, we conclude that the defendant failed to sustain its heavy burden of demonstrating that the plaintiffs engaged in a pattern of unreasonable and willful noncooperation so as to warrant denial of the claim (see Laiosa v Republic Ins. Co., 217 AD2d 605 [1995]; Allstate Ins. Co. v Durand, 286 AD2d 407 [2001]). Accordingly, the Supreme Court should have directed the insurance company to reschedule the injured plaintiff’s examination under oath.
Since this is a declaratory judgment action, the matter must be remitted to the Supreme Court, Queens County, for the entry of a judgment declaring that the defendant’s denial of no-fault insurance benefits, in effect, on the ground that the plaintiffs engaged in a pattern of unreasonable and willful noncooperation was improper (see Lanza v Wagner, 11 NY2d 317, 334 [1962], appeal dismissed 371 US 74 [1962], cert denied 371 US 901 [1962]). S. Miller, J.P., Schmidt, Rivera and Spolzino, JJ., concur.
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.
Did the insurer prove its IME/EUO no-show defense: mailed, compliant scheduling requests and the claimant’s nonappearance?
This decision: Claimant showed the nonappearance was excused or the request unreasonable or waived
Held the denial improper because the insured's refusal to proceed with the EUO unless his wife attended did not meet the insurer's heavy burden of showing a pattern of willful noncooperation, and ordered the EUO rescheduled.
Of the 858 decisions on this question in the Second Department courts and the Court of Appeals, 8 (this one included) are in the same category. One decision in other departments that cites or is cited by this one is on the full map.
Cited by
- Allstate Ins. Co. v Brown (2019 NY Slip Op 51560(U))The insurer failed to establish grounds to vacate an award rejecting its IME nonappearance defense on a rational evidentiary basis.
Similar decisions
- Park v Zurich American Ins. Co. (2011 NY Slip Op 51836(U))The insurer failed to show that its late-claim denials advised the provider that reasonable justification could excuse late submission.
- Parkview Med. & Surgical, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50400(U))The provider's proof of mailing and nonpayment did not establish an untimely denial or a timely denial lacking legal merit.
- SZ Med. P.C. v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 51842(U))The insurer's EUO defense failed because it did not establish that the policy contained an endorsement authorizing EUOs. The Appellate Term, First Department, reversed the denial of the providers' summary judgment motion, granted the motion, and remanded for statutory interest, attorney fees, and entry of judgment.
- Park Neurological Servs. P.C. v GEICO Ins. (2004 NY Slip Op 24210)The insurer's denial did not set forth a factual basis and medical rationale for lack of medical necessity, precluding its medical-necessity defense.
- Jae Ook Park v GEICO Gen. Ins. Co. (2011 NY Slip Op 52379(U))The provider failed to establish its prima facie case because it did not show an untimely or legally insufficient denial.