May 22, 2009
Vitality Chiropractic, P.C. v State Farm Mut. Ins. Co. (2009 NY Slip Op 51026(U))
https://www.beynensonlaw.com/case-law/vitality-chiropractic-p-c-v-state-farm-mut-ins-co-2009-ny-slip-op51026u/
- Decided
- May 22, 2009
- Citation
- 2009 NY Slip Op 51026(U) · 23 Misc 3d 141(A)
- Posture
- Trial
- Outcome
- Insurer prevailed
- Legal questions
- No covered accident (founded belief) (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 Vitality Chiropractic, P.C. v State Farm Mut. Ins. Co. (2009 NY Slip Op 51026(U))
| Vitality Chiropractic, P.C. v State Farm Mut. Ins. Co. |
| 2009 NY Slip Op 51026(U) [23 Misc 3d 141(A)] |
| Decided on May 22, 2009 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., RIOS and STEINHARDT, JJ
2008-408 Q C.
against
State Farm Mutual Insurance Company, Respondent.
Appeal from a judgment of the Civil Court of the City of New York, Queens County (Anna Culley, J.), entered March 9, 2006. The judgment, after a nonjury trial, dismissed the complaint.
Judgment affirmed without costs.
At the trial in this action by a provider to recover assigned first-party no-fault
benefits, the parties stipulated that plaintiff established its prima facie case. Plaintiff then made a
motion in limine to have the court accord the December 2005 order, deciding a summary
judgment motion in a prior case between the parties, collateral estoppel effect in the instant
action. In the prior action, plaintiff rendered services to a different assignor for injuries he
sustained in the same accident as the assignor herein, and the order found that the affidavit of
defendant’s investigator was insufficient to support a founded belief that the loss did not arise out
of an insured incident. In the case at bar, the Civil Court denied plaintiff’s motion.
Defendant’s sole witness at trial was its investigator, and during her testimony,
plaintiff did not object to the admission into evidence of several auto claim service records, the
insurance policy, claim forms, and denial of claim forms. The court found in favor of defendant
and dismissed the complaint, holding that defendant “established that the assignor in this case
was involved in an insurance fraud scheme with the intent to defraud the carrier for medical
benefits.” The instant appeal by plaintiff ensued.
In support of its motion, plaintiff failed to show that the identical issues were
decided in the prior action, and [*2]are decisive in the present
action (see Luscher v Arrua, 21 AD3d 1005 [2005]). Moreover, a review of the record
indicates that defendant met its burden of proving that the loss did not arise out of an insured
incident. Accordingly, the Civil Court properly awarded judgment dismissing the complaint.
Pesce, P.J., Rios and Steinhardt, JJ., concur.
Decision Date: May 22, 2009
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 show the claimed injuries did not arise from a covered accident (staged, intentional, or unrelated)?
This decision: Insurer proved the injuries did not arise from a covered accident
Held that at trial the insurer met its burden of proving the loss did not arise from an insured incident, its investigator's testimony and unobjected records showing the assignor took part in an insurance fraud scheme.
Of the 234 decisions on this question in the Second Department courts and the Court of Appeals, 32 (this one included) are in the same category.
Similar decisions
- New Century Chiropractic, P.C. v State Farm Mut. Ins. Co. (2006 NY Slip Op 52236(U))The insurer's investigator established a founded belief that the injuries did not arise from an insured incident, raising a coverage issue.
- A.M. Med. Servs., P.C. v State Farm Mut. Ins. Co. (2007 NY Slip Op 52300(U))The insurer's investigator raised a triable issue as to whether the assignor's injuries arose from an insured incident.
- Flatbush Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2013 NY Slip Op 50758(U))The insurer proved timely mailing of EUO notices and denials, and the provider's failure to respond foreclosed its justification objections.
- Vital Chiropractic, P.C. v Nationwide Ins. Co. (2019 NY Slip Op 50425(U))The insurer proved IME nonappearances and timely denials for all but one claim, as to which receipt remained disputed.
- 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.