October 12, 2010
Westchester Med. Ctr. v Government Empls. Ins. Co. (2010 NY Slip Op 07331)
https://www.beynensonlaw.com/case-law/westchester-med-ctr-v-government-empls-ins-co-2010-ny-slip-op-07331/
- Decided
- October 12, 2010
- Citation
- 2010 NY Slip Op 07331 · 77 AD3d 737
- Posture
- Summary judgment
- Outcome
- Provider prevailed
- Later treatment
- Distinguished in 2 and followed in 1 later decisions (see Cited by)
- Issues
- Policy issues
- Legal questions
- Claimant's prima facie case on motions (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 Westchester Med. Ctr. v Government Empls. Ins. Co. (2010 NY Slip Op 07331)
| Westchester Med. Ctr. v Government Empls. Ins. Co. |
| 2010 NY Slip Op 07331 [77 AD3d 737] |
| October 12, 2010 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| Westchester Medical Center, as Assignee of Glenda Jenkins,
Appellant, v Government Employees Insurance Company, Respondent. |
—[*1] Joseph Henig, P.C., Bellmore, N.Y., for appellant.
Teresa M. Spina, Woodbury, N.Y. (Jeanne M. Ortega of counsel), for respondent.
In an action to recover no-fault medical payments under an insurance contract, the plaintiff appeals from an order of the Supreme Court, Nassau County (Galasso, J.), entered December 17, 2009, which denied its motion for summary judgment on the complaint.
Ordered that the order is reversed, on the law, with costs, and the plaintiff’s motion for summary judgment on the complaint is granted.
In opposition to the plaintiff’s prima facie showing of entitlement to judgment as a matter of law (see Westchester Med. Ctr. v Progressive Cas. Ins. Co., 51 AD3d 1014, 1017 [2008]; Westchester Med. Ctr. v State Farm Mut. Auto. Ins. Co., 44 AD3d 750, 752 [2007]), the defendant failed to raise a triable issue of fact as to whether it properly denied the plaintiff’s claim for no-fault benefits based on the alleged intoxication of the plaintiff’s assignor at the time of the accident. Since the defendant failed to submit any evidence whatsoever from which the circumstances of the accident could be ascertained, the nature of the accident is unknown, and, thus, the defendant’s evidence, while presenting a factual question as to whether the plaintiff’s assignor was operating a vehicle in an intoxicated condition, was insufficient by itself to raise a triable issue of fact as to whether the plaintiff’s assignor was “injured as a result of operating a motor vehicle while in an intoxicated condition” (Insurance Law § 5103 [b] [2] [emphasis added]; see 11 NYCRR 65-3.14 [b]; cf. Westchester Med. Ctr. v Progressive Cas. Ins. Co., 51 AD3d at 1017; Westchester Med. Ctr. v State Farm Mut. Auto. Ins. Co., 44 AD3d at 752; Lynch v Progressive Ins. Co., 12 AD3d 570 [2004]; Scahall v Unigard Ins. Co., 222 AD2d 1070 [1995]; Cernik v Sentry Ins., 131 AD2d 952 [1987]; McCarthy v Commercial Union Ins. Co., 194 Misc 2d 295, 297 [2002]). Accordingly, while, under the circumstances of this case, there is no merit to the plaintiff’s remaining contentions concerning the facial sufficiency of the form used to deny the claim and the Supreme Court’s consideration of certain uncertified medical records (see Westchester Med. Ctr. v Progressive Cas. Ins. Co., 51 AD3d at 1017; Westchester Med. Ctr. v Allstate Ins. Co., 45 AD3d 579, 580 [2007]), its motion for summary judgment should nonetheless have been granted. Skelos, J.P., Santucci, Dickerson and Leventhal, 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.
On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?
This decision: Claimant's proof held to make out its prima facie case (rules on the question, but another ground decided the case)
Accepted the hospital's prima facie showing and granted it summary judgment, because the insurer's intoxication evidence, with no proof of the accident's circumstances, raised no triable issue.
Of the 1,065 decisions on this question in the Second Department courts and the Court of Appeals, 513 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2008 NY Slip Op 04867) FollowedAn insurer invoking the intoxication exclusion must establish that intoxication proximately caused the accident to obtain summary judgment.
- Westchester Med. Ctr. v State Farm Mut. Auto. Ins. Co. (2007 NY Slip Op 07690)The insurer failed to establish intoxication or causation as a matter of law, but raised factual issues defeating the provider's motion.
- Lynch v Progressive Ins. Co. (2004 NY Slip Op 08661)The insurer's intoxication defense presented factual issues concerning both intoxication and its causal connection to the accident.
- Westchester Med. Ctr. v Allstate Ins. Co. (2007 NY Slip Op 08447) FollowedThe hospital failed to establish that the insurer's timely NF-10 denial was too vague or deficient to constitute a proper response.
Cited by
A label shows how the later decision treated this one.
- NR Motion PT, P.C. v Allstate Ins. (2026 NY Slip Op 51460(U)) DistinguishedThe insurer failed to establish its intoxication exclusion or fee-schedule defense through competent, admissible evidence.
- Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 20512) DistinguishedThe provider's summary judgment motion was denied pending discovery into intoxication and felony-based coverage exclusions.
- Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50685(U)) FollowedThe insurer failed to establish that the assignor's alleged intoxication proximately caused the accident.
- NYU-Hospital for Joint Diseases v Esurance Ins. Co. (2011 NY Slip Op 04436)The insurer raised factual issues about timely denial and whether the assignor's injury resulted from driving while intoxicated.
- NYU-Hospital for Joint Diseases v Allstate Ins. Co. (2014 NY Slip Op 08613)The hospital failed to establish entitlement to summary judgment because its own papers included a timely and sufficient denial.
- Woo Yup Kang v Mercury Cas. Co. (2012 NY Slip Op 51821(U))The insurer failed to establish the assignor's intoxication at the time of the accident with sufficient admissible proof.
Similar decisions
- Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 01458)The insurer's defective denial and insufficient mailing proof precluded its intoxication exclusion defense.
- Westchester Med. Ctr. v Clarendon Natl. Ins. Co. (2008 NY Slip Op 09786)The insurer raised a triable issue whether it timely and properly denied a claim based on alleged intoxication after receiving verification.
- Westchester Med. Ctr. v Mapfre Ins. Co. of N.Y. (2014 NY Slip Op 05325)The insurer raised a triable issue whether its intoxication-based denial was timely and proper after receipt of additional verification.
- Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2008 NY Slip Op 04866)The insurer's DWI disposition certificate did not establish that intoxication caused the accident and resulting injuries.
- Westchester Med. Ctr. v One Beacon Ins. Co. (2008 NY Slip Op 52580(U))The insurer's intoxication evidence raised factual questions but did not establish that intoxication caused the accident.