June 17, 2013
Ss Med. Care, P.C. v Hartford Ins. Co. (2013 NY Slip Op 51032(U))
https://www.beynensonlaw.com/case-law/ss-med-care-p-c-v-hartford-ins-co-2013-ny-slip-op-51032u/
- Decided
- June 17, 2013
- Citation
- 2013 NY Slip Op 51032(U) · 40 Misc 3d 126(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 Ss Med. Care, P.C. v Hartford Ins. Co. (2013 NY Slip Op 51032(U))
| Ss Med. Care, P.C. v Hartford Ins. Co. |
| 2013 NY Slip Op 51032(U) [40 Misc 3d 126(A)] |
| Decided on June 17, 2013 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
2011-1514 K C.
against
Hartford Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered April 11, 2011. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that defendant had timely and properly denied plaintiff’s claims based upon plaintiff’s assignor’s failure to appear for duly scheduled examinations under oath (EUOs). The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.
Contrary to plaintiff’s sole argument on appeal with respect to defendant’s cross motion, defendant properly demonstrated that it had mailed the EUO scheduling letters and denials at issue (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). As plaintiff raises no other argument with respect to the granting of [*2]defendant’s cross motion, the order denying plaintiff’s motion for summary judgment and granting defendant’s cross motion for summary judgment dismissing the complaint is affirmed.
Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: June 17, 2013
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
Held the insurer properly demonstrated that it had mailed the EUO scheduling letters and denials, rejecting the provider's sole argument.
Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 809 (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
Upheld dismissal on the EUO no-show because the insurer proved mailing of the scheduling letters and denials, the only point the provider contested.
Of the 858 decisions on this question in the Second Department courts and the Court of Appeals, 527 (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)
Held the insurer entitled to dismissal on its EUO no-show defense because it properly showed mailing of both the EUO scheduling letters and the denials, rejecting the provider's sole mailing challenge.
Of the 508 decisions on this question in the Second Department courts and the Court of Appeals, 338 (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.
- Delta Diagnostic Radiology, P.C. v Chubb Group of Ins. (2007 NY Slip Op 27345) FollowedAn insurer may prove mailing by describing its standard procedure for properly addressing and mailing items.
Similar decisions
- Careful Complete Med., P.C. v Hartford Ins. Co. (2017 NY Slip Op 51858(U))The insurer established the provider's EUO nonappearance and proper mailing of the scheduling letters and denial forms.
- Compas Med., P.C. v Hartford Ins. Co. (2017 NY Slip Op 50953(U))The insurer's submissions established a presumption that its IME nonappearance denials were timely and properly mailed.
- SS Med. Care, P.C. v Nationwide Ins. (2013 NY Slip Op 51109(U))The insurer failed to establish proper mailing of EUO and IME scheduling notices supporting its nonappearance defenses.
- Right Aid Med. Supply Corp. v Hartford Ins. Co. (2015 NY Slip Op 51236(U))The insurer failed to prove EUO nonappearance because its papers did not establish counsel's presence at the designated location.
- Compas Med., P.C. v American Tr. Ins. Co. (2019 NY Slip Op 51257(U))The insurer established timely mailing of the EUO scheduling letters and the assignor's failure to appear.