Appellate Division, First Department
Nov 5, 2026
2026 NY Slip Op 06524
Insurer prevailed
The provider's coverage claims were barred by res judicata despite an arbitration award predating the default declaratory judgment. The Appellate Division, First Department, reversed the order, granted the insurer's summary judgment motion dismissing those claims, and denied the provider's cross motion to dismiss the complaint. Res judicata can apply to default judgments and bars claims raised or required to be raised in an earlier suit between the same parties. Both actions concerned disclaimers based on injuries and treatment unrelated to a covered event and failure to subscribe EUO transcripts. The award's issuance and affirmance before the default judgment did not defeat preclusion because the insurer commenced the prior declaratory judgment action nearly two months before the provider sought arbitration.
Trial court, First Department
Nov 6, 2026
2026 NY Slip Op 26206
Insurer prevailed
The insurer established objective justification for continued EUOs through a transcript showing that accident and treatment questions remained. The Civil Court, Bronx County, granted the insurer summary judgment dismissing the complaint and denied the provider's cross motion. The initial EUO ended at an agreed stopping time before those topics were reached, and the assignor's representative agreed to continue. The transcript satisfied 11 NYCRR 65-3.5 (e) despite scheduling letters that said only that a continuance was needed. Emails sent one day before each continued EUO did not excuse nonappearance; neither produced mutual rescheduling or offered alternative dates. The court left open whether the insurer had to justify the initial EUO, which the assignor attended.
