GBI Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50329(U))

Reported in New York Official Reports at GBI Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50329(U))

GBI Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 50329(U)) [*1]
GBI Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co.
2016 NY Slip Op 50329(U) [50 Misc 3d 148(A)]
Decided on March 15, 2016
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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 15, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : PESCE, P.J., ALIOTTA and ELLIOT, JJ.
2013-1477 K C
GBI Acupuncture, P.C., as Assignee of Brenetta Selver, Appellant, 

against

State Farm Mutual Automobile Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered April 30, 2013. The order granted defendant’s motion for summary judgment dismissing the complaint.

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, arguing that it had properly used the workers’ compensation fee schedule applicable to chiropractors who render the same services as acupuncturists to reimburse plaintiff for the acupuncture services plaintiff had rendered. The Civil Court granted defendant’s motion.

Plaintiff argues on appeal, as it did in the Civil Court, that defendant failed to establish that its fee schedule reductions were proper. We disagree and find that defendant demonstrated that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]).

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 15, 2016
Atlantic Radiology Imaging, P.C. v Metropolitan Prop. & Cas. Ins. Co. (2016 NY Slip Op 50321(U))

Reported in New York Official Reports at Atlantic Radiology Imaging, P.C. v Metropolitan Prop. & Cas. Ins. Co. (2016 NY Slip Op 50321(U))

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

Atlantic Radiology Imaging, P.C., as Assignee of Thania Chanlette, Appellant,

against

Metropolitan Property and Casualty Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered May 9, 2014. The order denied plaintiff’s motion to vacate a prior order of the same court (Reginald A. Boddie, J.) entered August 8, 2012 which granted, on default, defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order entered May 9, 2014 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, alleging that the claims at issue had been timely and properly denied based upon plaintiff’s assignor’s failure to appear at duly scheduled examinations under oath (EUOs). On February 17, 2012, the return date of the motion, the parties stipulated that plaintiff would serve any written opposition to the motion and/or a cross motion by June 8, 2012, and that the return date of the motion would be adjourned to August 8, 2012. No written opposition was filed by the return date, and the Civil Court (Reginald A. Boddie, J.), in an order entered August 8, 2012, granted defendant’s unopposed motion for summary judgment dismissing the complaint.

On August 23, 2013, plaintiff moved to vacate the August 8, 2012 order, stating that plaintiff had a reasonable excuse for the default and a meritorious opposition to defendant’s motion. Plaintiff’s counsel, in a supporting affirmation, conceded that plaintiff had received notice of the entry of the order on August 23, 2012. She further stated that the default was a result of her extensive workload, and that “there was no briefing schedule scanned into our system for the submission for written opposition.” In addition, plaintiff had a meritorious opposition to defendant’s motion in that defendant had failed to establish that the EUO scheduling letters had been properly addressed and timely mailed, and that the assignor had failed to appear at the EUOs. Defendant opposed plaintiff’s motion.

In an order entered May 9, 2014, the Civil Court (Katherine A. Levine, J.) denied plaintiff’s motion on the ground that the motion was properly one for reargument and, therefore, should have been made before Judge Boddie. Plaintiff appeals from the May 9, 2014 order, and we affirm, albeit for reasons other than those stated by the Civil Court.

Contrary to the determination of the Civil Court, vacatur of an order granted upon the default of a party in opposing a motion should be sought by a motion pursuant to CPLR 5015, [*2]not by a motion for leave to renew or reargue (see e.g. Raciti v Sands Point Nursing Home, 54 AD3d 1014 [2008]; Friendly Physician, P.C. v GEICO Ins. Co., 29 Misc 3d 129[A], 2010 NY Slip Op 51772[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2010]). In addition, there is no requirement that a motion to vacate an order made upon default be made to the judge who signed the prior order (see CPLR 2221 [a] [1]; Patron v Mutual of Omaha Ins. Co., 129 AD2d 572 [1987]). Consequently, the Civil Court incorrectly determined that plaintiff’s motion was actually a motion for leave to reargue which should have been made before Judge Boddie.

In order to vacate the August 8, 2012 order based upon excusable default (CPLR 5015 [a] [1]), plaintiff was required to demonstrate a reasonable excuse for the default and a potentially meritorious opposition to defendant’s summary judgment motion (see Thapt v Lutheran Med. Ctr., 89 AD3d 837 [2011]; Bazoyah v Herschitz, 79 AD3d 1081 [2010]; Raciti v Sands Point Nursing Home, 54 AD3d 1014; Montague v Rivera, 50 AD3d 656 [2008]; St. Rose v McMorrow, 43 AD3d 1146 [2007]). Plaintiff’s excuse—that the default was a result of plaintiff’s counsel’s heavy caseload and the failure to scan the motion schedule into the office’s computer system—amounts to a claim of law office failure. As such excuse was vague, undetailed and unsubstantiated, it did not constitute a reasonable excuse for the default (see Chechen v Spencer, 68 AD3d 801 [2009]; Murray v New York City Health & Hosps. Corp., 52 AD3d 792, 793 [2008]; St. Luke’s Roosevelt Hosp. v Blue Ridge Ins. Co., 21 AD3d 946, 947 [2005]). Furthermore, plaintiff failed to explain its one-year delay, following its receipt of notice of the entry of the default order, in moving to vacate that order (see e.g. Johnson v Nello Homes, Inc., 159 AD2d 562 [1990]).

Moreover, plaintiff did not demonstrate a potentially meritorious opposition to defendant’s motion for summary judgment. We find no merit to plaintiff’s contentions that defendant failed to establish that the EUO scheduling letters had been properly addressed and timely mailed, or that the assignor had failed to appear at the EUOs. In support of defendant’s motion for summary judgment, defendant submitted an affidavit of its administrative assistant and an affidavit of its Special Investigations Unit (SIU) investigator, accompanied by certified transcripts made after the assignor’s EUO nonappearances. These documents sufficiently described the standard practices and procedures of defendant’s office for proper and timely mailing of the EUO scheduling letters (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; ARCO Med. NY, P.C. v Lancer Ins. Co., 34 Misc 3d 134[A], 2011 NY Slip Op 52382[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]) and established that plaintiff’s assignor had failed to appear for either of the two duly scheduled EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]; Olmeur Med., P.C. v Nationwide Gen. Ins. Co., 41 Misc 3d 143[A], 2013 NY Slip Op 52031[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]), thereby demonstrating that plaintiff’s assignor had failed to comply with a condition precedent to coverage (see Stephen Fogel Psychological, P.C., 35 AD3d at 722).

Accordingly, the May 9, 2014 order is affirmed.

Weston, J.P., Pesce and Aliotta, JJ., concur.


Decision Date: March 11, 2016
Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2016 NY Slip Op 50319(U))

Reported in New York Official Reports at Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2016 NY Slip Op 50319(U))

Bay LS Med. Supplies, Inc. v Allstate Ins. Co. (2016 NY Slip Op 50319(U)) [*1]
Bay LS Med. Supplies, Inc. v Allstate Ins. Co.
2016 NY Slip Op 50319(U) [50 Misc 3d 147(A)]
Decided on March 11, 2016
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 March 11, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : WESTON, J.P., PESCE and ALIOTTA, JJ.
2014-1121 K C
Bay LS Medical Supplies, Inc., as Assignee of Pablo Lozano-Reyes, Respondent,

against

Allstate Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered November 1, 2013. The order granted plaintiff’s motion for summary judgment and denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, plaintiff’s motion for summary judgment is denied, and defendant’s cross motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). Defendant appeals from an order of the Civil Court granting plaintiff’s motion and denying defendant’s cross motion.

Defendant established that it had timely and properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) its EUO scheduling letters and its denial of claim forms, which denied the claims on the ground that plaintiff had failed to appear at duly scheduled EUOs. Although the Civil Court found that defendant had established plaintiff’s nonappearances, the court held, as plaintiff argues, that defendant’s EUO scheduling letters were defective. However, under the circumstances presented, as plaintiff does not claim to have responded in any way to defendant’s EUO requests, plaintiff’s objections regarding the EUO scheduling letters will not be heard (see Eagle Surgical Supply, Inc. v Allstate Ins. Co., 46 Misc 3d 128[A], 2014 NY Slip Op 51798[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]; Viviane Etienne Med. Care, P.C. v State Farm Mut. Auto. Ins. Co., 35 Misc 3d 127[A], 2012 NY Slip Op 50579[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]). In light of the foregoing, defendant’s cross motion should have been granted. We pass on no other issue.

Accordingly, the order is reversed, plaintiff’s motion for summary judgment is denied, and defendant’s cross motion for summary judgment dismissing the complaint is granted.

Weston, J.P., Pesce and Aliotta, JJ., concur.


Decision Date: March 11, 2016
Atlantic Radiology Imaging, P.C. v Esurance Ins. Co. (2016 NY Slip Op 50315(U))

Reported in New York Official Reports at Atlantic Radiology Imaging, P.C. v Esurance Ins. Co. (2016 NY Slip Op 50315(U))

Atlantic Radiology Imaging, P.C. v Esurance Ins. Co. (2016 NY Slip Op 50315(U)) [*1]
Atlantic Radiology Imaging, P.C. v Esurance Ins. Co.
2016 NY Slip Op 50315(U) [50 Misc 3d 147(A)]
Decided on March 11, 2016
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 March 11, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : PESCE, P.J., ALIOTTA and ELLIOT, JJ.
2013-1480 K C
Atlantic Radiology Imaging, P.C. as Assignee of Kareem Hoyte, Appellant,

against

Esurance Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered August 1, 2012. The order granted defendant’s motion for summary judgment dismissing the complaint.

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 which granted defendant’s motion for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs).

Contrary to plaintiff’s argument, the affidavit of defendant’s employee was sufficient to establish the mailing of the EUO scheduling letters (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]).

Plaintiff also argues that the affirmation by the managing partner of defendant’s law firm, which had been retained to conduct the EUOs, did not establish that the assignor had failed to appear for the EUOs. This argument lacks merit, as that affirmation was not the proof submitted by defendant to establish the assignor’s failure to appear.

As plaintiff has failed to demonstrate any basis to disturb the Civil Court’s order, the order is affirmed.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 11, 2016
EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50314(U))

Reported in New York Official Reports at EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50314(U))

EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50314(U)) [*1]
EMC Health Prods., Inc. v Allstate Ins. Co.
2016 NY Slip Op 50314(U) [50 Misc 3d 147(A)]
Decided on March 11, 2016
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 March 11, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : PESCE, P.J., ALIOTTA and ELLIOT, JJ.
2013-1458 K C
EMC Health Products, Inc. as Assignee of Peter Esquilin, Appellant, 

against

Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Katherine A. Levine, J.), entered May 10, 2013. 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 affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. Defendant opposed the motion and cross-moved for summary judgment dismissing the complaint on the ground that defendant did not provide insurance coverage for the vehicle in question on the date of the accident at issue. By order entered May 10, 2013, the Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

In support of its cross motion and in opposition to plaintiff’s motion, defendant submitted an affidavit by its employee, who described the details of a record search which she had performed and stated that her search had revealed that there was no Allstate Insurance Company policy covering the vehicle in question on the date of the accident. We find that defendant’s affidavit was sufficient to demonstrate, prima facie, that plaintiff’s claim did not arise out of a covered incident (see Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, 199 [1997]). As plaintiff failed to raise a triable issue of fact in opposition to defendant’s cross motion, the Civil Court properly denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint (see Zuckerman v City of New York, 49 NY2d 557 [1980]).

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 11, 2016
EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50313(U))

Reported in New York Official Reports at EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50313(U))

EMC Health Prods., Inc. v Allstate Ins. Co. (2016 NY Slip Op 50313(U)) [*1]
EMC Health Prods., Inc. v Allstate Ins. Co.
2016 NY Slip Op 50313(U) [50 Misc 3d 147(A)]
Decided on March 11, 2016
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 March 11, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : PESCE, P.J., ALIOTTA and ELLIOT, JJ.
2013-1456 K C
EMC Health Products, Inc. as Assignee of Manoucheka Francois, Respondent,

against

Allstate Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered May 13, 2013. The order granted plaintiff’s motion for summary judgment.

ORDERED that the order is modified by providing that the branches of plaintiff’s motion seeking summary judgment upon the third and fourth causes of action are denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first party no-fault benefits, plaintiff moved for summary judgment. By order entered May 13, 2013, the Civil Court granted plaintiff’s motion.

Defendant’s contention—that plaintiff failed to make a prima facie showing of its entitlement to summary judgment because plaintiff did not establish that the supplies furnished by plaintiff had actually been delivered to plaintiff’s assignor and by whom they had been delivered—lacks merit, as it is not part of plaintiff’s prima facie case to establish these facts (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]; Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556 [2008]). Since defendant has raised no other issue in the Civil Court or on appeal with respect to plaintiff’s establishment of its prima facie case, we do not pass on the propriety of the determination of the Civil Court with respect thereto.

Defendant argues that plaintiff’s motion should have been denied because defendant raised a triable issue of fact by demonstrating that it had timely denied plaintiff’s claims on the grounds of lack of medical necessity and that the fees sought exceeded the amount permitted by the workers’ compensation fee schedule. We find that defendant’s opposition papers were sufficient to establish that the denial of claim forms pertaining to the claims underlying the third and fourth causes of action had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Consequently, the branches of plaintiff’s motion seeking summary judgment upon the third and fourth causes of action should have been denied, as defendant in its opposition papers raised triable issues of fact with respect to these causes of action. However, as defendant failed to establish that it had timely mailed the denial of claim forms pertaining to the claims underlying the first and second causes of action, there is no basis to disturb so much of the order as granted the branches of plaintiff’s motion seeking summary judgment upon these causes of action.

Accordingly, the order is modified by providing that the branches of plaintiff’s motion seeking summary judgment upon the third and fourth causes of action are denied.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 11, 2016
XVV, Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50312(U))

Reported in New York Official Reports at XVV, Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50312(U))

XVV, Inc. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50312(U)) [*1]
XVV, Inc. v New York Cent. Mut. Fire Ins. Co.
2016 NY Slip Op 50312(U) [50 Misc 3d 146(A)]
Decided on March 11, 2016
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 March 11, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : PESCE, P.J., ALIOTTA and ELLIOT, JJ.
2013-1451 K C
XVV, Inc. as Assignee of Jose Espinosa, Respondent,

against

New York Central Mutual Fire Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered April 19, 2013. The order denied defendant’s motion for summary judgment dismissing the complaint.

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 it had timely and properly denied the claim at issue based upon plaintiff’s assignor’s failure to appear for duly scheduled independent medical examinations (IMEs). The Civil Court denied defendant’s motion.

Defendant’s motion papers failed to establish that the letters scheduling the IMEs of plaintiff’s assignor had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Consequently, defendant failed to demonstrate that the IMEs had been properly scheduled and, thus, that defendant is entitled to summary judgment dismissing the complaint based on plaintiff’s assignor’s failure to appear at duly scheduled IMEs.

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 11, 2016
Great Health Care Chiropractic, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50311(U))

Reported in New York Official Reports at Great Health Care Chiropractic, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50311(U))

Great Health Care Chiropractic, P.C. v Allstate Ins. Co. (2016 NY Slip Op 50311(U)) [*1]
Great Health Care Chiropractic, P.C. v Allstate Ins. Co.
2016 NY Slip Op 50311(U) [50 Misc 3d 146(A)]
Decided on March 11, 2016
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 March 11, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : PESCE, P.J., ALIOTTA and ELLIOT, JJ.
2013-1439 K C
Great Health Care Chiropractic, P.C. as Assignee of Remech Hall, Appellant,

against

Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered May 2, 2013. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint, alleging that the claims at issue had been timely and properly denied on the ground that plaintiff’s assignor had failed to appear at duly scheduled examinations under oath (EUOs). Plaintiff opposed the motion. By order entered May 2, 2013, the Civil Court granted defendant’s motion.

In support of its motion, defendant failed to establish that the initial and follow-up EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). As a result, defendant failed to demonstrate that the EUOs had been properly scheduled and, thus, that plaintiff’s assignor had failed to appear at duly scheduled EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 722 [2006]). Consequently, defendant is not entitled to summary judgment dismissing the complaint.

Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 11, 2016
Acupuncture Healthcare Plaza I, P.C. v Truck Ins. Exch. (2016 NY Slip Op 50309(U))

Reported in New York Official Reports at Acupuncture Healthcare Plaza I, P.C. v Truck Ins. Exch. (2016 NY Slip Op 50309(U))

Acupuncture Healthcare Plaza I, P.C. v Truck Ins. Exch. (2016 NY Slip Op 50309(U)) [*1]
Acupuncture Healthcare Plaza I, P.C. v Truck Ins. Exch.
2016 NY Slip Op 50309(U) [50 Misc 3d 146(A)]
Decided on March 11, 2016
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 March 11, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS


PRESENT: : PESCE, P.J., ALIOTTA and ELLIOT, JJ.
2013-1418 K C
Acupuncture Healthcare Plaza I, P.C. as Assignee of Bernard Absolv, Appellant,

against

Truck Insurance Exchange, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Reginald A. Boddie, J.), entered May 1, 2013. The order granted defendant’s motion for summary judgment dismissing the complaint.

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, arguing that it had properly used the workers’ compensation fee schedule applicable to chiropractors who render the same services as acupuncturists to reimburse plaintiff for the acupuncture services plaintiff had rendered. The Civil Court granted defendant’s motion.

Contrary to plaintiff’s contention, raised in the Civil Court and on appeal, defendant established that the denial of claim form at issue had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant further demonstrated that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Consequently, defendant established its entitlement to judgment as a matter of law.

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 11, 2016
Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50307(U))

Reported in New York Official Reports at Compas Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50307(U))

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

Compas Medical, P.C. as Assignee of Naija Lowery, Respondent,

against

New York Central Mutual Fire Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered July 31, 2012. 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 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 third cause of action on the ground that defendant had never received the claim underlying that cause of action, and dismissing the remaining causes of action on the grounds that defendant had timely and properly denied the relevant claims based upon plaintiff’s assignor’s failure to appear for duly scheduled independent medical examinations (IMEs) and that the fees sought exceeded the amounts permitted by the workers’ compensation fee schedule. In addition, defendant alleged that the claim underlying the sixth cause of action had been untimely submitted. Plaintiff cross-moved for summary judgment. By order entered July 31, 2012, insofar as appealed from, the Civil Court denied defendant’s motion. While defendant submitted properly sworn statements by the chiropractor and doctor who had been scheduled to perform the IMEs, neither health care professional demonstrated personal knowledge of the nonappearance of plaintiff’s assignor for the examinations. Therefore, defendant failed to establish, with respect to the first, second, and fourth through seventh causes of action, its entitlement to judgment as a matter of law dismissing these claims on the ground that plaintiff’s assignor had failed to appear for duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]; Bright Med. Supply Co. v IDS Prop. & Cas. Ins. Co., 40 Misc 3d 130[A], 2013 NY Slip Op 51123[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]; Quality Health Prods. v Hertz Claim Mgt. Corp., 36 Misc 3d 154[A], 2012 NY Slip Op 51722[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]).

The affidavit of defendant’s no-fault litigation examiner established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) the denial of claim form underlying the sixth cause of action, which also denied the claim on the ground that plaintiff had failed to submit written proof of claim to defendant within 45 days of the services rendered (see 11 NYCRR 65-2.4 [c], 65-3.3 [e]). However, in opposition to the motion, plaintiff submitted an affidavit from plaintiff’s owner, which affidavit was sufficient to give rise to a presumption that the claim form had been timely mailed to, and received by, defendant (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [*2][2001]). In light of the foregoing, contrary to defendant’s contention, there is a triable issue of fact as to whether the claim at issue was timely submitted to defendant.

Although defendant also denied the claims underlying the first, second, and fourth through seventh causes of action based upon the workers’ compensation fee schedule, defendant failed to establish as a matter of law that the fees charged exceeded the amounts set forth in the workers’ compensation fee schedule (see Rogy Med., P.C. v Mercury Cas. Co., 23 Misc 3d 132[A], 2009 NY Slip Op 50732[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]) or that there had been duplicate billing. Therefore, defendant was not entitled to summary judgment dismissing the first, second, and fourth through seventh causes of action on this ground.

To the extent defendant sought summary judgment dismissing the third cause of action on the ground that defendant had never received the claim form underlying this cause of action, defendant’s conclusory denial of receipt was insufficient to make a prima facie showing of defendant’s entitlement to summary judgment dismissing that cause of action (see e.g. Compas Med., P.C. v Farm Family Cas. Ins. Co., 38 Misc 3d 142[A], 2013 NY Slip Op 50254[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]).

Accordingly, the order, insofar as appealed from, is affirmed.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 11, 2016