Reported in New York Official Reports at Parisien v Kemper Ins. Co. (2022 NY Slip Op 51240(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Kemper Insurance Company and Unitrin Direct Insurance Company, Respondents.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Goldberg, Miller & Rubin, P.C. (Lindsay A. Padover of counsel), for respondents.
Appeal from an order of the Civil Court of the City of New York, Kings County (Matthew P. Blum, J.), dated October 13, 2021. The order granted a motion by defendant Unitrin Direct Insurance Company for summary judgment dismissing the complaint in its entirety and denied plaintiff’s cross motion for summary judgment.
ORDERED that, on the court’s own motion, the caption is amended to reflect the addition of Unitrin Direct Insurance Company as a party defendant, and the caption has been amended accordingly, and it is further,
ORDERED that the order is affirmed, with $25 costs.
Jules Francois Parisien, M.D., commenced this action against Kemper Insurance Company (Kemper) to recover assigned first-party no-fault benefits for services provided to Parisien’s assignor, Joshua David, who had allegedly been injured in an accident on October 25, 2016. Unitrin Direct Insurance Company (Unitrin) appeared in the action by serving and filing an answer in which it characterized itself as having been incorrectly sued as Kemper, thereby agreeing that the allegations in the complaint were properly asserted against it.
After the commencement of this action, Unitrin brought a declaratory judgment action in Supreme Court, New York County, against Parisien and David, among other parties, pertaining to the October 25, 2016 accident, and moved therein for summary judgment against Parisien, among other providers. In an order entered May 11, 2020, upon granting Unitrin’s motion for summary judgment against Parisien and other providers with respect to David, the Supreme Court declared that, because of David’s failure to comply with a condition precedent, Unitrin was not obligated to pay claims for reimbursement submitted by Parisien for services provided to David in connection with the October 25, 2016 accident. Unitrin thereafter moved in the Civil Court to dismiss the complaint “[p]ursuant to CPLR 3211 (a) (5) and 3212 . . . on the ground that plaintiff’s claim is barred by [the] doctrine of res judicata” based upon the Supreme Court order. Unitrin’s attorney also alleged in an affirmation in support of the motion that “plaintiff sued a non-existent entity, ‘Kemper Casualty Insurance Company,’ when the proper insurer is [Unitrin],” relying on an attached police report, and that “[o]n that basis alone” the complaint should be dismissed. Plaintiff cross-moved for summary judgment and opposed Unitrin’s motion. By order dated October 13, 2021, the Civil Court granted Unitrin’s motion to dismiss the complaint, finding that Unitrin was “the proper defendant in this action,” thereby, in effect, dismissing the complaint insofar as asserted against Kemper, and finding that the action, insofar as asserted against Unitrin based upon its answering the complaint, was barred by res judicata. The court further denied plaintiff’s cross motion.
Since Unitrin voluntarily appeared in the action and the Civil Court accepted Unitrin Direct Insurance Company as “the proper defendant in this action,” but the caption was not amended accordingly, on the court’s own motion, we amend the caption to reflect the addition of Unitrin Direct Insurance Company as a party defendant.
On appeal, the only issue raised by plaintiff with respect to so much of the Civil Court’s order as granted Unitrin’s motion is whether the May 11, 2020 Supreme Court order should have res judicata effect on this action, thereby warranting the dismissal of the complaint. Upon a review of the record, we find that the Civil Court did not improvidently exercise its discretion in determining that Unitrin was the proper defendant, as Unitrin proffered sufficient evidence to support its contention that it is “the proper insurer” (cf. Quality Health Supply Corp. v Hertz Co., 68 Misc 3d 131[A], 2020 NY Slip Op 50996[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]).
“Under the doctrine of res judicata, a final adjudication of a claim on the merits precludes relitigation of that claim and all claims arising out of the same transaction or series of transactions by a party or those in privity with a party” (Ciraldo v JP Morgan Chase Bank, N.A., 140 AD3d 912, 913 [2016]; see Matter of Hunter, 4 NY3d 260, 269 [2005]; Schuylkill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 [1929]). Because Unitrin is the proper defendant in this action, the Civil Court correctly granted its motion, as any judgment in favor of plaintiff in this action would destroy or impair rights or interests established by the order in the [*2]declaratory judgment action (see Schuylkill Fuel Corp., 250 NY at 306-307; Flushing Traditional Acupuncture, P.C. v Kemper Ins. Co., 42 Misc 3d 133[A], 2014 NY Slip Op 50052[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]; EBM Med. Health Care, P.C. v Republic W. Ins., 38 Misc 3d 1, 2 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]).
We reach no other issue.
Accordingly, the order is affirmed.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: November 18, 2022
Reported in New York Official Reports at Masigla v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 51239(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Nationwide Affinity Insurance Company of America, Appellant.
Hollander Legal Group, P.C. (Allan S. Hollander and Christopher Volpe of counsel), for appellant. The Rybak Firm, PLLC, for respondent (no brief filed).
Appeal from an order of the Civil Court of the City of New York, Kings County (Jill R. Epstein, J.), entered February 9, 2021. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that plaintiff failed to appear for duly scheduled examinations under oath (EUOs) and plaintiff cross-moved for summary judgment. In an order entered February 9, 2021, the Civil Court denied the motion and cross motion, but implicitly found, in effect pursuant to CPLR 3212 (g), that defendant established the timely and proper mailing of the EUO scheduling letters and denial of claim forms, as well as plaintiff’s failure to appear for the scheduled EUOs. The Civil Court found that there was an issue of fact because the EUOs were scheduled to be held before plaintiff submitted the claims at issue and defendant did not schedule EUOs after these claims were submitted.
To establish its prima facie entitlement to summary judgment dismissing a complaint on the ground that a provider failed to appear for an EUO, an insurer must demonstrate, as a matter of law, that it twice duly demanded an EUO from the provider, that the provider twice failed to appear, and that the insurer issued a timely denial of the claim(s) on that ground (see Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 [2014])—all elements that, pursuant to CPLR 3212 (g), the Civil Court implicitly found to have been established.
Plaintiff’s contentions on appeal—that defendant could not deny plaintiff’s claims based upon plaintiff’s failure to appear for EUOs because such EUOs and nonappearances occurred prior to submission of the claims at issue, and that defendant needed to schedule additional EUOs after plaintiff submitted the claims at issue—lack merit (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2007]; National Med. & Surgical Supply, Inc. v ELRAC, Inc., 54 Misc 3d 131[A], 2017 NY Slip Op 50028[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]).
Accordingly, the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 18, 2022
Reported in New York Official Reports at Longevity Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51235(U))
Longevity Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co. |
2022 NY Slip Op 51235(U) [77 Misc 3d 131(A)] |
Decided on November 18, 2022 |
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 November 18, 2022
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2021-166 K C
against
State Farm Mutual Automobile Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Freiberg, Peck & Kang, LLP (Yilo J. Kang of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn Walker-Diallo, J.), entered December 18, 2020. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court granting defendant’s motion for summary judgment dismissing the complaint and denying plaintiff’s cross motion for summary judgment.
Contrary to plaintiff’s sole contention with respect to defendant’s motion, the affidavit executed by defendant’s claims specialist, along with the relevant supporting documents submitted in support of defendant’s motion, sufficiently demonstrated that defendant had previously paid another provider for the same piece of medical equipment which is the basis for the claim at issue in this case. Consequently, defendant established its prima facie entitlement to summary judgment dismissing the complaint and plaintiff failed to raise a triable issue of fact with respect thereto.
Accordingly, the order is affirmed.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 18, 2022
Reported in New York Official Reports at Tyorkin v New Jersey Mfrs. Ins. Group (2022 NY Slip Op 51234(U))
Tyorkin v New Jersey Mfrs. Ins. Group |
2022 NY Slip Op 51234(U) [77 Misc 3d 131(A)] |
Decided on November 18, 2022 |
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 November 18, 2022
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2020-481 K C
against
New Jersey Manufacturers Insurance Group, Respondent.
Law Office of Marina Josovich, P.C. (Marina Josovich of counsel), for appellant. Litchfield Cavo, LLP (Mark A. Everett of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), entered November 25, 2019. The order, insofar as appealed from as limited by the brief, denied the branch of plaintiff’s motion seeking leave to renew his prior motion for summary judgment and his opposition to the branch of defendant’s cross motion seeking summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In an action by a provider to recover assigned first-party no-fault benefits, by order entered June 21, 2019, the Civil Court (Odessa Kennedy, J.) denied plaintiff’s motion for summary judgment and granted the branch of defendant’s cross motion seeking summary judgment dismissing the complaint. Plaintiff appeals from an order of the Civil Court (Odessa Kennedy, J.) entered November 25, 2019, which, insofar as appealed from, denied the branch of his motion seeking leave to renew his prior motion and his opposition to defendant’s cross motion.
A motion for leave to renew must “be based upon new facts not offered on the prior motion that would change the prior determination” (CPLR 2221 [e] [2]) and must “contain [*2]reasonable justification for the failure to present such facts on the prior motion” (CPLR 2221 [e] [3]; see Kugler v Kugler, 174 AD3d 876, 877 [2019]). Contrary to plaintiff’s contention, he failed to demonstrate any basis upon which to grant him leave to renew, since the affidavits he submitted in support of his motion asserted no new facts, and, in any event, he failed to provide a reasonable justification for failing to submit the affidavits in support of his original motion for summary judgment and in opposition to defendant’s cross motion for summary judgment. “Plaintiff should have laid bare all of his evidence on the original motion” (Caffee v Arnold, 104 AD2d 352, 352 [1984]; see Popalardo v Marino, 83 AD3d 1029, 1030 [2011]; Mgrditchian v Donato, 141 AD2d 513 [1988]).
Accordingly, the order, insofar as appealed from, is affirmed.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: November 18, 2022
Reported in New York Official Reports at Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51232(U))
Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. |
2022 NY Slip Op 51232(U) [77 Misc 3d 131(A)] |
Decided on November 18, 2022 |
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 November 18, 2022
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2020-349 K C
against
State Farm Mutual Automobile Ins. Co., Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. James F. Butler & Associates (Mohammad Q. Rubbani of counsel), for respondent.
Appeal from a judgment of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered April 19, 2018. The judgment, after a nonjury trial, dismissed the complaint.
ORDERED that the judgment is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, a nonjury trial was held, limited to the issues of whether plaintiff had fully responded to defendant’s verification requests and whether verification was outstanding prior to the issuance of the denial. Following the trial, the Civil Court dismissed the complaint, finding that defendant sustained its burden of establishing that plaintiff had not fully responded to defendant’s verification requests and that verification was outstanding prior to the issuance of the denial.
In reviewing a determination made after a nonjury trial, the power of this court is as broad as that of the trial court, and this court may render the judgment it finds warranted by the facts, bearing in mind that the determination of a trier of fact as to issues of credibility is given substantial deference, as a trial court’s opportunity to observe and evaluate the testimony and demeanor of the witnesses affords it a better perspective from which to assess their credibility [*2](see Northern Westchester Professional Park Assoc. v Town of Bedford, 60 NY2d 492, 499 [1983]; Hamilton v Blackwood, 85 AD3d 1116 [2011]; Zeltser v Sacerdote, 52 AD3d 824, 826 [2008]). In the present case, the record supports the finding of the Civil Court, based upon its assessment of the proof adduced at trial, that plaintiff did not fully respond to defendant’s verification requests (see CPM Med Supply, Inc. v State Farm Fire & Cas. Ins. Co., 63 Misc 3d 140[A], 2019 NY Slip Op 50576[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]; City Care Acupuncture, P.C. v Allstate Prop. & Cas. Ins. Co., 58 Misc 3d 138[A], 2017 NY Slip Op 51839[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]) and that defendant had timely denied plaintiff’s claim on that ground (see 11 NYCRR 65-3.5 [o]). Consequently, we find no basis to disturb the Civil Court’s determination.
Accordingly, the judgment is affirmed.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 18, 2022
Reported in New York Official Reports at New Capital 1 Inc. v Kemper Independence Ins. Co. (2022 NY Slip Op 51033(U))
New Capital 1 Inc. v Kemper Independence Ins. Co. |
2022 NY Slip Op 51033(U) [76 Misc 3d 138(A)] |
Decided on October 24, 2022 |
Appellate Term, First 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 October 24, 2022
PRESENT: Hagler, J.P., Tisch, Michael, JJ.
570280/22
against
Kemper Independence Insurance Company, Defendant-Appellant.
Defendant appeals from an order of the Civil Court of the City of New York, New York County (Aija Tingling, J.), entered April 6, 2022, which denied its motion for summary judgment dismissing the complaint.
Per Curiam.
Order (Aija Tingling, J.), entered April 6, 2022, reversed, without costs, defendant’s motion for summary judgment granted and the complaint dismissed. The Clerk is directed to enter judgment accordingly.
In a separate action commenced by the defendant-insurer against various medical providers, including the plaintiff herein, the Supreme Court, New York County (Lynn R. Kotler, J.), declared that the defendant has no duty to pay the plaintiff’s no-fault claims arising from injuries allegedly sustained by its assignor, Carol Smart, in a February 15, 2019 motor vehicle accident. Based upon this Supreme Court judgment, the underlying action commenced by the plaintiff to recover first-party no-fault benefits for medical services rendered to Carol Smart for injuries sustained in the subject accident is barred under the doctrine of res judicata (see Pomona Med. Diagnostics, P.C. v. Metropolitan Cas. Ins. Co., 29 Misc 3d 138[A], 2010 NY Slip Op 52039[U] [App Term, 1st Dept 2010]; see also Abraham v Hermitage Ins. Co., 47 AD3d 855 [2008]). A different judgment in the underlying action would destroy or impair rights established by the judgment rendered by Supreme Court in the related action (see Schuykill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 [1929]; see also BDO Seidman LLP v Strategic Resources Corp., 70 AD3d 556, 560 [2010]). The Supreme Court judgment is a conclusive final determination, notwithstanding that it was entered on default, as res judicata applies to a judgment taken on default that has not been vacated (see McGookin v Berishai, 187 AD3d 472, 474 [2020]; Trisingh Enters. v Kessler, 249 AD2d 45, 46 [1998]).
Accordingly, the court should have granted defendant’s motion for summary judgment dismissing the instant action.
All concur
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Clerk of the Court
Decision Date: October 24, 2022
Reported in New York Official Reports at Health Value Med., P.C. v Country Wide Ins. (2022 NY Slip Op 51137(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Country Wide Insurance, Respondent.
Glinkenhouse Queen, Esqs. (Alan Queen of counsel), for appellant. Thomas Torto, for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Terrence C. O’Connor, J.), entered April 5, 2018. The order, in effect, denied plaintiff’s motion to recalculate, from a simple rate to a compound rate, an award of statutory no-fault interest in a judgment of that court entered March 17, 2017.
ORDERED that the order is reversed, with $30 costs, and plaintiff’s motion to recalculate, from a simple rate to a compound rate, an award of statutory no-fault interest in a judgment entered March 17, 2017 is granted.
This action by a provider to recover assigned first-party no-fault benefits for a claim submitted to defendant on or about February 9, 1999, arising from an accident that occurred on September 24, 1998, was settled on July 31, 2008. Defendant did not pay the settlement amount, and a judgment was subsequently entered on March 17, 2017 (see CPLR 5003-a) awarding statutory no-fault interest at a simple 2% per month rate. Plaintiff moved, pursuant to CPLR 5019 (a), to have the interest recalculated pursuant to the pre-2002 regulations, which required no-fault interest to be calculated at a compound rate (see former 11 NYCRR 65.15 [h] [1]). Plaintiff appeals from an order of the Civil Court which, in effect, denied its motion.
Plaintiff correctly argues that the claim involved herein is governed by the former regulations providing for compound interest because the accident occurred prior to the effective date of the current regulations, which now provide for a simple rate of interest (see 11 NYCRR 65-3.9 [a], effective April 5, 2002; Matter of B.Z. Chiropractic, P.C. v Allstate Ins. Co., 197 AD3d 144, 155-156 [2021]). Consequently, plaintiff’s motion should have been granted. We note that, contrary to the statement of the Civil Court, postjudgment interest in a no-fault action [*2]is governed by Insurance Law § 5106 and its implementing regulations, not the CPLR (see Matter of B.Z. Chiropractic, P.C. v Allstate Ins. Co., 197 AD3d 144).
Accordingly, the order is reversed and plaintiff’s motion to recalculate, from a simple rate to a compound rate, an award of statutory no-fault interest in a judgment entered March 17, 2017 is granted.
ALIOTTA, P.J., GOLIA and BUGGS, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: October 21, 2022
Reported in New York Official Reports at Good Samaritan Hosp. v MVAIC Ins. Co. (2022 NY Slip Op 51100(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS
against
MVAIC Insurance Company, Appellant.
Marshall & Marshall, PLLC (Frank D’Esposito and David Gierasch of counsel), for appellant. Dash Law Firm, P.C. (James Errera of counsel), for respondent.
Appeal from an order of the District Court of Suffolk County, Third District (C. Stephen Hackeling, J.), dated April 6, 2021. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.
ORDERED that the order is reversed, without costs, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.
In this action by a provider to recover assigned first-party no-fault benefits, defendant Motor Vehicle Accident Indemnification Corporation (sued herein as MVAIC Insurance Company) appeals from an order of the District Court dated July 1, 2021 denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment.
Defendant established its prima facie entitlement to summary judgment by submitting evidence demonstrating that it timely denied plaintiff’s claim submitted in January 2018 for no-fault benefits, on the ground of untimeliness, as the claim was submitted more than 45 days after the date services were rendered (see 11 NYCRR 65-1.1) and that its denial informed plaintiff that it could excuse the delay if plaintiff provided “reasonable justification” for the late [*2]submission (see 11 NYCRR 65-3.3 [e]; Stand-Up MRI of the Bronx, P.C. v MVAIC Ins. Co., 76 Misc 3d 128[A], 2022 NY Slip Op 50789[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2022]; Mount Sinai Hosp. of Queens v Country Wide Ins. Co., 43 Misc 3d 139[A], 2014 NY Slip Op 50780[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2014]; see also Schottenstein Pain & Neuro, PLLC v MVAIC, 72 Misc 3d 131[A], 2021 NY Slip Op 50643[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]).
In opposition, plaintiff failed to raise a triable issue of fact as to whether it provided defendant with a reasonable justification for its untimely submission of the claim, as plaintiff failed to explain why, after learning that there was no insurance covering the accident, it first submitted the claim to the assignor’s personal health insurer instead of MVAIC, and why it took months before it first purportedly sent the claim to MVAIC (see Stand-Up MRI of the Bronx, P.C., 2022 NY Slip Op 50789[U]; Excel Surgery Ctr., LLC v MVAIC, 68 Misc 3d 134[A], 2020 NY Slip Op 51016[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2020]; Mount Sinai Hosp. of Queens, 2014 NY Slip Op 50780[U]; see also Schottenstein Pain & Neuro, PLLC, 2021 NY Slip Op 50643[U]).
Plaintiff also failed to raise a triable issue of fact as to whether it actually first submitted the claim to MVAIC on October 17, 2017, the basis for plaintiff’s argument that defendant’s February 5, 2018 denial was untimely. To establish this mailing, plaintiff neither presented an affidavit by one with personal knowledge of the mailing nor provided sufficient practices and procedures of mailing, but rather relied on a certificate of mailing, which, under the circumstances presented, was insufficient to fill in the gaps in plaintiff’s proof of mailing.
Accordingly, the order is reversed, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.
GARGUILO, P.J., EMERSON and DRISCOLL, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: October 14, 2022
Reported in New York Official Reports at Parisien v Travelers Ins. Co. (2022 NY Slip Op 51136(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Travelers Insurance Company, Appellant.
Law Office of Aloy O. Ibuzor (Janice A. Robinson of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Sandra E. Roper, J.), entered September 6, 2019. The order, insofar as appealed from as limited by the brief, denied the branch of defendant’s motion seeking summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.
ORDERED that the order, insofar as appealed from, is modified by providing that plaintiff’s cross motion for summary judgment is denied; as so modified, the order, insofar as appealed from, is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for, among other things, summary judgment dismissing the complaint on the ground that the action was premature as plaintiff had failed to respond to defendant’s timely requests for additional verification. Plaintiff opposed the motion and cross-moved for summary judgment. By order entered September 6, 2019, insofar as appealed from as limited by the brief, the Civil Court denied the branch of defendant’s motion seeking summary judgment dismissing the complaint and granted plaintiff’s cross motion.
Defendant demonstrated, prima facie, that it had timely mailed initial and follow-up requests for verification (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), and that it had not received the requested verification. However, the affidavit submitted by plaintiff in opposition to defendant’s motion was sufficient to raise an issue of fact as to whether the requested verification had been mailed to, and received by, defendant (see Compas Med., P.C. v Praetorian Ins. Co., 49 Misc 3d 152[A], 2015 NY Slip Op 51776[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). As a result, there is an issue of fact as to whether plaintiff’s action is premature.
Accordingly, the order, insofar as appealed from, is modified by providing that plaintiff’s cross motion for summary judgment is denied.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:Paul Kenny
Chief Clerk
Decision Date: September 30, 2022
Reported in New York Official Reports at Remedy Chiropractic, P.C. v Nationwide Ins. (2022 NY Slip Op 50935(U))
Remedy Chiropractic, P.C. v Nationwide Ins. |
2022 NY Slip Op 50935(U) [76 Misc 3d 135(A)] |
Decided on September 23, 2022 |
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 September 23, 2022
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, CHEREÉ A. BUGGS, JJ
2021-148 K C
against
Nationwide Ins., Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Hollander Legal Group , P.C. (Allan S. Hollander and Christopher Volpe of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn Walker-Diallo, J.), dated October 9, 2020. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.
ORDERED that the order is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that plaintiff had failed to provide requested verification. Plaintiff opposed the motion and cross-moved for summary judgment. By order dated October 9, 2020, the Civil Court granted defendant’s motion and dismissed the complaint on the ground that the action was premature due to plaintiff’s failure to provide requested verification, and denied plaintiff’s cross motion.
Defendant demonstrated, prima facie, that it had timely mailed initial and follow-up requests for verification (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and that it had not received all of the requested verification. In opposition, plaintiff’s owner merely stated that he had mailed the requested verification “to the extent such response was proper and in [his] possession.” In addition, the day after plaintiff’s owner purportedly mailed its response to defendant’s verification requests, an attorney representing plaintiff provided part of the requested verification, stating that plaintiff was not providing the [*2]remainder of defendant’s requested verification because plaintiff believed the remaining requests were objectionable. Thus, contrary to plaintiff’s contention on appeal, plaintiff failed to establish a triable issue of fact by demonstrating that it had provided the requested verification or had set forth a reasonable justification for the failure to comply with defendant’s verification requests (see 11 NYCRR 65-3.8 [b] [3]). Consequently, we find no basis to disturb the order (see Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 75 Misc 3d 143[A], 2022 NY Slip Op 50623[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]; CPM Med Supply, Inc. v State Farm Fire & Cas. Ins. Co., 63 Misc 3d 140[A], 2019 NY Slip Op 50576[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]).
Accordingly, the order is affirmed.
ALIOTTA, P.J., WESTON and BUGGS, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 23, 2022