June 3, 2022

Pavlova v Nationwide Ins. (2022 NY Slip Op 50559(U))

Headnote

The relevant facts considered by the court in this case were that the plaintiff, Ksenia Pavlova, as the assignee of Pollen, Faith, brought an action to recover assigned first-party no-fault benefits from the defendant, Nationwide Ins. The defendant had moved for summary judgment to dismiss the complaint on the grounds that the plaintiff's assignor had failed to appear for duly scheduled examinations under oath (EUOs), and the plaintiff had also filed a cross motion for summary judgment. The main issue decided by the court was whether the insurer had twice duly demanded an EUO from the assignor, that the assignor had twice failed to appear, and that the insurer had issued a timely denial of the claims. The holding of the court was that the insurer had established proper mailing of the EUO scheduling letters and had therefore demonstrated its prima facie entitlement to summary judgment dismissing the complaint, affirming the order of the Civil Court.

Reported in New York Official Reports at Pavlova v Nationwide Ins. (2022 NY Slip Op 50559(U))

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

Ksenia Pavlova, D.O., as Assignee of Pollen, Faith, Appellant,

against

Nationwide Ins., Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Hollander Legal Group, P.C. (Allan S. Hollander of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), dated June 28, 2019. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs), and denied plaintiff’s cross motion for summary judgment.

To establish its prima facie entitlement to summary judgment dismissing a complaint on the ground that a provider’s assignor had failed to appear for an EUO, an insurer must demonstrate, as a matter of law, that it had twice duly demanded an EUO from the assignor, that the assignor had twice failed to appear, and that the insurer had issued a timely denial of the claims (see Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 [2014]; Parisien v Metlife Auto & Home, 54 Misc 3d 143[A], 2017 NY Slip Op 50208[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]; Palafox PT, P.C. v State Farm Mut. Auto. Ins. Co., 49 Misc 3d 144[A], 2015 NY Slip Op 51653[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). A review of the record establishes that, contrary to plaintiff’s sole contention with respect to defendant’s motion, defendant established proper mailing of the EUO scheduling letters. As a result, defendant established its prima facie entitlement to summary judgment dismissing the complaint (see Interboro Ins. Co. v Clennon, 113 AD3d at 597). Plaintiff’s contention that defendant needed, [*2]but failed, to demonstrate that the EUO scheduling letters were timely mailed after defendant’s receipt of the NF-2 form is raised for the first time on appeal and, in any event, lacks merit, and is contrary to Insurance Law article 51 and the regulations promulgated thereunder (see Excel Prods., Inc. v Ameriprise Auto & Home, 71 Misc 3d 136[A], 2021 NY Slip Op 50435[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]; City Anesthesia Healthcare, P.C. v Erie Ins. Co. of NY, 70 Misc 3d 141[A], 2021 NY Slip Op 50135[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]; 11 NYCRR 65-3.5 [a], [d]; Appendix 13).

Accordingly, the order is affirmed.

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


ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 3, 2022