December 8, 2017
Pierre J. Renelique, M.D., P.C. v Travelers Ins. Co. (2017 NY Slip Op 51718(U))
https://www.beynensonlaw.com/case-law/pierre-j-renelique-m-d-p-c-v-travelers-ins-co-2017-ny-slip-op51718u/
- Decided
- December 8, 2017
- Citation
- 2017 NY Slip Op 51718(U) · 58 Misc 3d 127(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
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 Pierre J. Renelique, M.D., P.C. v Travelers Ins. Co. (2017 NY Slip Op 51718(U))
| Pierre J. Renelique, M.D., P.C. v Travelers Ins. Co. |
| 2017 NY Slip Op 51718(U) [58 Misc 3d 127(A)] |
| Decided on December 8, 2017 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 December 8, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2014-2113 Q C
against
Travelers Insurance Company, Respondent.
The Rybak Firm, PLLC (Damin J, Toell, Esq.), for appellant. Law Office of Aloy O. Ibuzor, for respondent (no brief filed).
Appeal from an order of the Civil Court of the City of New York, Queens County (Larry Love, J.), entered August 8, 2014. The order, insofar as appealed from, granted the branches of defendant’s motion seeking summary judgment dismissing the first and fourth through seventh causes of action.
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, plaintiff appeals from so much of an order of the Civil Court as granted the branches of defendant’s motion seeking summary judgment dismissing the first and fourth through seventh causes of action.
Contrary to plaintiff’s argument, the proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that the verification requests and denial of claim forms at issue had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]). Contrary to plaintiff’s only other contention on appeal, the proof submitted [*2]by defendant in support of its motion was sufficient to demonstrate that plaintiff had failed to appear for examinations under oath (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]).
Accordingly, the order, insofar as appealed from, is affirmed.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 08, 2017
Legal questions (3)
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.
Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?
This decision: The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice
Rejected the provider's challenge, holding the insurer's proof sufficient to give rise to a presumption that its verification requests and denial of claim forms had been properly mailed.
Of the 1,384 decisions on this question in the Second Department courts and the Court of Appeals, 806 (this one included) are in the same category.
Did the insurer prove its IME/EUO no-show defense: mailed, compliant scheduling requests and the claimant’s nonappearance?
This decision: Insurer proved mailed, compliant requests and the nonappearance; claimant's answers rejected
Held the insurer's proof sufficient to presume its verification requests had been properly mailed and to demonstrate that the provider failed to appear for the EUOs, rejecting the provider's contentions on appeal.
Of the 851 decisions on this question in the Second Department courts and the Court of Appeals, 525 (this one included) are in the same category.
Is an IME/EUO no-show defense precluded if the insurer did not timely deny the claim on that ground?
This decision: Timely denial required as part of the no-show defense, and the insurer showed it (rules on the question, but another ground decided the case)
Sustained the EUO no-show dismissal after finding the insurer's proof sufficient to presume that its verification requests and denial of claim forms had been properly mailed.
Of the 500 decisions on this question in the Second Department courts and the Court of Appeals, 334 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) FollowedThe insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.
- Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co. (2006 NY Slip Op 09604) FollowedAn insurer may deny benefits retroactively to the date of loss for failure to attend reasonably required IMEs under 11 NYCRR 65-1.1.
Similar decisions
- Renelique Med. Servs., P.C. v Travelers Ins. Co. (2018 NY Slip Op 50817(U))The insurer's proof established the provider's EUO nonappearances, and the provider's remaining argument was raised for the first time on appeal.
- Pierre J. Renelique, M.D., P.C. v American Ind. Ins. Co. (2019 NY Slip Op 51755(U))The insurer's motion to dismiss the provider's no-fault complaint for lack of personal jurisdiction was upheld on appeal.
- Pierre J. Renelique, M.D., P.C. v Park Ins. Co. (2018 NY Slip Op 50780(U))The insurer failed to establish proper IME scheduling because its letters went to an address different from the one on the NF-3 form.
- Pierre Jean Renelique, MD, P.C. v Farmington Cas. Co. (2016 NY Slip Op 51420(U))The insurer failed to establish proper mailing of the letters scheduling the assignor's IMEs through proof of office mailing practices.
- Parisien v Travelers Ins. Co. (2019 NY Slip Op 51162(U))The insurer established that five causes of action were premature because timely requested verification remained outstanding.