Appellate Term, First Department
Oct 24, 2022
2022 NY Slip Op 51033(U)
Insurer prevailed
An unvacated default declaratory judgment barring payment of the provider's no-fault claims precludes a benefits action under res judicata. The insurer obtained a Supreme Court judgment declaring that it had no duty to pay the provider's claims arising from the assignor's accident. A different judgment in the provider's benefits action would destroy or impair rights established by that declaration. The declaratory judgment constituted a conclusive final determination even though it was entered on default, because it had not been vacated. The Appellate Term, First Department, reversed the order denying the insurer's summary judgment motion, granted the motion, and dismissed the complaint.
Appellate Term, Second Department
Oct 21, 2022
2022 NY Slip Op 51137(U)
Provider prevailed
A no-fault claim arising from an accident before April 5, 2002 is governed by the former regulations requiring compound interest. The provider obtained a judgment after the insurer failed to pay a settlement, but interest was calculated at a simple 2% monthly rate. The Appellate Term, Second Department, reversed the Civil Court, Queens County, order and granted the provider's CPLR 5019 (a) motion to recalculate interest at a compound rate. Former 11 NYCRR 65.15 (h) (1) governed because the accident preceded the effective date of 11 NYCRR 65-3.9 (a). Following Matter of B.Z. Chiropractic, P.C. v Allstate Ins. Co., the court also explained that Insurance Law § 5106 and its implementing regulations govern postjudgment no-fault interest.
Appellate Term, Second Department
Oct 14, 2022
2022 NY Slip Op 51100(U)
Insurer prevailed
MVAIC established that the provider's claim was submitted late, and the provider failed to justify the delay or prove an earlier mailing. The Appellate Term, Second Department, reversed the order, granted MVAIC summary judgment dismissing the complaint, and denied the provider's cross motion. MVAIC timely denied the claim submitted more than 45 days after services were rendered under 11 NYCRR 65-1.1 and offered an opportunity to justify the delay under 11 NYCRR 65-3.3 (e). The provider did not explain its submission to the assignor's health insurer or subsequent delay. Its certificate of mailing, without personal knowledge or sufficient mailing procedures, did not establish an earlier submission that would render MVAIC's denial untimely.
Trial court, Second Department
Oct 13, 2022
2022 NY Slip Op 50997(U)
Provider prevailed
The insurer's EUO defense failed because its initial request and its denial following the second nonappearance were untimely. The Civil Court, Queens County, denied the insurer's summary judgment motion and granted the provider's cross motion. The first EUO request, made 25 days after receipt of the bill, was untimely under 11 NYCRR 65-3.5 (b); a delay letter merely announcing future verification did not toll the payment deadline. Under 11 NYCRR 65-3.8 (b) (3), outstanding EUO verification did not bar denial. The 30-day period ran from the second nonappearance, and scheduling two more EUOs concerning the same claim did not extend it. The provider's bills and the insurer's denial forms established receipt, nonpayment and entitlement to summary judgment.
Trial court, Second Department
Oct 12, 2022
2022 NY Slip Op 50995(U)
Insurer prevailed
An unvacated default declaratory judgment precludes a provider's benefits action involving the same parties and accident under res judicata. The insurer obtained a Supreme Court declaration that it owed no duty to pay no-fault claims arising from the accident and moved, without opposition, for summary judgment in the provider's Civil Court action. The Civil Court, Queens County, granted the motion and dismissed the complaint. The parties and subject matter were identical, and a judgment for the provider would adversely affect rights established by the declaration. The default judgment remained a conclusive final determination because the default had not been vacated; the court did not reach the insurer's alternative collateral estoppel argument.
Trial court, Second Department
Oct 6, 2022
2022 NY Slip Op 50982(U)
Split result
CPLR 3404 does not authorize dismissal of a Civil Court action for abandonment, but unreasonable delay can suspend no-fault interest. On remand, the Civil Court, Queens County, denied the insurer's abandonment motion but fixed interest accrual, if the provider prevailed, at the filing of a notice of trial. CPLR 3404 did not apply to Civil Court or to an action without a notice of trial. The insurer raised 22 NYCRR 208.14 (c) only in reply, and that provision did not authorize dismissal for neglect to prosecute. The inactive marking did not prevent prosecution or require a restoration motion. The provider's years of inactivity warranted suspending interest under 11 NYCRR 65-3.9 (d).
