April 10, 2012

Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50685(U))

https://www.beynensonlaw.com/case-law/westchester-med-ctr-v-new-york-cent-mut-fire-ins-co-2012-ny-slip-op50685u/

Court: Appellate Term, Second Department
Decided: April 10, 2012
Citation: 2012 NY Slip Op 50685(U) · 35 Misc 3d 131(A)
Posture: Summary judgment
Outcome: Split result
Issues: Policy issues Provider's prima facie case
Legal questions: Claimant's prima facie case on motions (see the maps)

Cite as

Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 35 Misc 3d 131(A), 2012 NY Slip Op 50685(U) (App Term, 2d Dept, 9th & 10th Jud Dists 2012)

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.

The insurer failed to establish that the assignor's alleged intoxication proximately caused the accident. In the provider's action for assigned no-fault benefits, the District Court denied the provider's summary judgment motion and granted the insurer's cross motion dismissing the complaint. The Appellate Term, Second Department, modified the order to deny the insurer's cross motion and otherwise affirmed. The insurer submitted no evidence from which the accident's circumstances could be ascertained, leaving its intoxication defense unsupported under Insurance Law § 5103 (b) (2) and 11 NYCRR 65-3.14 (b) (1). The provider's motion remained denied because it had not demonstrated prima facie entitlement to judgment as a matter of law.

Reported in New York Official Reports at Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 50685(U))

[*1]

Westchester Med. Ctr. v New York Cent. Mut. Fire Ins. Co.

2012 NY Slip Op 50685(U) [35 Misc 3d 131(A)]

Decided on April 10, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 April 10, 2012

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS

PRESENT: : MOLIA, J.P., NICOLAI and LaCAVA, JJ
2011-1144 N C.

Westchester Medical Center as Assignee of PEDRO CORTESARELLANO, Appellant, —
against
New York Central Mutual Fire Insurance Company, Respondent.

Appeal from an order of the District Court of Nassau County, First District (Andrea Phoenix, J.), dated February 24, 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 modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, the District Court properly denied plaintiff’s motion for summary judgment on the ground
that plaintiff had not demonstrated its prima facie entitlement to judgment as a matter of law (see New York Hosp. Med. Ctr. of Queens v Statewide Ins. Co., 33 Misc 3d 130[A], 2011 NY Slip Op 51863[U] [App Term, 9th & 10th Jud Dists 2011]).

However, the District Court should have denied defendant’s cross motion for summary judgment dismissing the complaint as well. Defendant failed to submit any evidence from which the circumstances of the accident could be ascertained, and its proof was therefore insufficient to demonstrate that plaintiff’s assignor’s alleged intoxicated condition was a proximate cause of the accident (see Insurance Law § 5103 [b] [2]; Insurance Department Regulations [11 NYCRR] § 65-3.14 [b] [1]; Westchester Med. Ctr. v Government Empls. Ins. Co., 77 AD3d 737 [2010]; Lynch v Progressive Ins. Co., 12 AD3d 570 [2004]).

Accordingly, the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.

Molia, J.P., Nicolai and LaCava, JJ., concur.
Decision Date: April 10, 2012

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.

Claimant's prima facie case on motions

Open the full map

On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?

This decision: Insufficient: claim forms not shown admissible as business records / merits of claim not proved

Held the hospital failed to demonstrate its prima facie entitlement to summary judgment, so its motion was properly denied. The court relied solely on precedent requiring a business-records foundation for the claim forms.

Proof sufficientMailing/receipt not shownOverdue not shownBusiness-record foundation lackingOther element missingThis decisionCites it or cited by itCited or followed

Of the 1,065 decisions on this question in the Second Department courts and the Court of Appeals, 208 (this one included) are in the same category.

Cited in this decision

A label shows how this decision treated the case it cites.

New York Hosp. Med. Ctr. of Queens v Statewide Ins. Co. (2011 NY Slip Op 51863(U)) FollowedThe hospital's third-party affidavit failed to establish its claim forms as business records proving the services rendered.
Westchester Med. Ctr. v Government Empls. Ins. Co. (2010 NY Slip Op 07331) FollowedThe insurer's intoxication defense failed because its evidence did not connect the assignor's alleged intoxication to the injuries.
Lynch v Progressive Ins. Co. (2004 NY Slip Op 08661) FollowedThe insurer's intoxication defense presented factual issues concerning both intoxication and its causal connection to the accident.

Similar decisions

Westchester Med. Ctr. v Travelers Prop. Cas. Ins. Co. (2012 NY Slip Op 50589(U))The provider's summary judgment motion was denied because it failed to demonstrate prima facie entitlement to judgment.
Inwood Hill Med., P.C. v Metropolitan Prop. & Cas. Ins. Co. (2009 NY Slip Op 51264(U))The insurer was precluded from asserting a workers' compensation defense because it failed to establish timely mailing of its denial.
Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2012 NY Slip Op 50590(U))The providers' summary judgment motion was denied because they failed to demonstrate prima facie entitlement to judgment.
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 Allstate Ins. Co. (2008 NY Slip Op 06146)The insurer raised a factual issue about the provider's compliance with timely verification requests for toxicology information.