Active Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51668(U))

Reported in New York Official Reports at Active Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51668(U))

Active Chiropractic, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51668(U)) [*1]
Active Chiropractic, P.C. v Praetorian Ins. Co.
2015 NY Slip Op 51668(U) [49 Misc 3d 145(A)]
Decided on November 13, 2015
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This opinion is uncorrected and will not be published in the printed Official Reports.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 13, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-803 Q C
Active Chiropractic, P.C. as Assignee of WILLIAM HARVEY, Respondent,

against

Praetorian Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered February 19, 2013. The order, insofar as appealed from, denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, 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, alleging that the claim at issue had been timely and properly denied based upon plaintiff’s assignor’s failure to appear at duly scheduled examinations under oath (EUOs). Insofar as is relevant to this appeal, the Civil Court denied defendant’s cross motion, finding that there was an issue of fact as to whether plaintiff’s assignor had failed to appear for the duly scheduled EUOs.

The affirmation submitted by defendant’s attorney in support of defendant’s cross motion sufficiently described the standard practices and procedures of his office for mailing EUO scheduling letters (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Furthermore, defendant established, based upon the personal knowledge of the attorney who was responsible for conducting the EUOs at issue, that plaintiff’s assignor had failed to appear for either of the 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, 11th & 13th Jud Dists 2013]). Contrary to the determination of the Civil Court, defendant’s annexation of EUO transcripts demonstrating that a different assignor had also failed to appear for that assignor’s EUOs did not demonstrate the existence of a triable issue of fact in the instant action. Since defendant demonstrated that plaintiff’s assignor had failed to comply with a condition precedent to coverage (see Stephen Fogel Psychological, P.C., 35 AD3d at 722) and that defendant had timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) the claim on that ground, defendant was entitled to summary judgment dismissing the complaint.

Accordingly, the order, insofar as appealed from, is reversed and defendant’s cross motion for summary judgment dismissing the complaint is granted.

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


Decision Date: November 13, 2015
Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51667(U))

Reported in New York Official Reports at Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51667(U))

Compas Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51667(U)) [*1]
Compas Med., P.C. v Praetorian Ins. Co.
2015 NY Slip Op 51667(U) [49 Misc 3d 145(A)]
Decided on November 13, 2015
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 13, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-695 Q C
Compas Medical, P.C. as Assignee of JEAN GUILLAUME, Appellant,

against

Praetorian Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered February 14, 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 modified by providing that the branch of plaintiff’s motion seeking summary judgment upon its third cause of action is granted and the branch of defendant’s cross motion seeking summary judgment dismissing the third cause of action is denied, and the matter is remitted to the Civil Court for the calculation of statutory interest and an assessment of attorney’s fees with respect to this cause of action; 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 and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

Contrary to plaintiff’s contention, defendant established that the independent medical examination (IME) and examination under oath (EUO) scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), that plaintiff’s assignor had failed to appear for the duly scheduled IMEs and EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]), and that defendant had timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) the claims underlying the first, second, and fourth through eighth causes of action on these grounds. Since defendant demonstrated that plaintiff’s assignor had failed to comply with a condition precedent to coverage (see Stephen Fogel Psychological, P.C., 35 AD3d at 722) and plaintiff failed to raise a triable issue of fact in opposition to defendant’s cross motion, defendant was entitled to summary judgment dismissing these causes of action.

However, with respect to the third cause of action, the record establishes that the claim at issue was not denied within 30 days of its receipt (see 11 NYCRR 65-3.8 [a] [1]) and defendant did not demonstrate that the 30-day claim determination period (see 11 NYCRR 65-3.8) had been tolled. As a result, since defendant is precluded from asserting, with respect to this claim, its defense that plaintiff’s assignor had failed to appear for the duly scheduled IMEs and EUOs (see Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 [2009]), plaintiff is entitled to summary judgment upon its third cause of action.

Accordingly, the order is modified by providing that the branch of plaintiff’s motion seeking summary judgment upon its third cause of action is granted and the branch of defendant’s cross motion seeking summary judgment dismissing the third cause of action is denied, and the matter is remitted to the Civil Court for the calculation of statutory interest and an assessment of attorney’s fees with respect to this cause of action pursuant to Insurance Law § 5106 (a) and the [*2]regulations promulgated thereunder.

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


Decision Date: November 13, 2015
Great Health Care Chiropractic, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51665(U))

Reported in New York Official Reports at Great Health Care Chiropractic, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51665(U))

Great Health Care Chiropractic, P.C. v Travelers Ins. Co. (2015 NY Slip Op 51665(U)) [*1]
Great Health Care Chiropractic, P.C. v Travelers Ins. Co.
2015 NY Slip Op 51665(U) [49 Misc 3d 145(A)]
Decided on November 12, 2015
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 12, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-1460 K C
Great Health Care Chiropractic, P.C. as Assignee of BERNARD FITZGERALD, Appellant,

against

Travelers Insurance Company, 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 reversed, with $25 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 claim at issue had been timely and properly denied on the ground that plaintiff had failed to appear at duly scheduled examinations under oath (EUOs). Plaintiff opposed the motion. By order entered April 30, 2013, the Civil Court granted defendant’s motion.

Pursuant to the No-Fault Regulations, “any additional verification required by the insurer to establish proof of claim shall be requested within 15 business days of receipt of the [NF-3]” (11 NYCRR 65-3.5 [b] [emphasis added]). This rule applies to requests for EUOs (see e.g. Longevity Medical Supply, Inc. v IDS Property & Cas. Ins. Co., 44 Misc 3d 137[A], 2014 NY Slip Op 51244[U] [App Term, 2d, 11th & 13th Jud Dists 2014])” (O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134[A], 2015 NY Slip Op 50476[U] [App Term, 2d, 11th & 13th Jud Dists 2015]). As defendant’s moving papers reflect that defendant’s first EUO scheduling letter was mailed about 50 days after defendant had received the claim at issue in this action, defendant failed to demonstrate that it had properly denied the claim based upon plaintiff’s failure to comply with a condition precedent to coverage (see O & M Med., P.C., 47 Misc 3d 134[A], 2015 NY Slip Op 50476[U]; St. Vincent Med. Care, P.C. v Travelers Ins. Co., 26 Misc 3d 144[A], 2010 NY Slip Op 50446[U] [App Term, 2d, 11th & 13th Jud Dists 2010]).

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

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


Decision Date: November 12, 2015
Mind & Body Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51658(U))

Reported in New York Official Reports at Mind & Body Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51658(U))

Mind & Body Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51658(U)) [*1]
Mind & Body Acupuncture, P.C. v Praetorian Ins. Co.
2015 NY Slip Op 51658(U) [49 Misc 3d 144(A)]
Decided on November 12, 2015
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 12, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-1118 Q C
Mind & Body Acupuncture, P.C. as Assignee of PASCAL GRAMONT, Appellant,

against

Praetorian Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered March 26, 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 appeals from an order of the Civil Court which denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

Contrary to plaintiff’s contentions, the independent medical examination (IME) and examination under oath (EUO) scheduling letters were not mere delay letters. Moreover, defendant properly established that the scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), that plaintiff’s assignor had failed to appear for the duly scheduled IMEs and EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]), and that defendant had timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) the claims at issue. Since defendant demonstrated that plaintiff’s assignor had failed to comply with a condition precedent to coverage (see Stephen Fogel Psychological, P.C., 35 AD3d at 722) and plaintiff has failed to raise a triable issue of fact, defendant was entitled to summary judgment dismissing the complaint.

Accordingly, the order is affirmed.

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


Decision Date: November 12, 2015
Ap Orthopedic & Rehabilitation, P.C. v Allstate Ins. Co. (2015 NY Slip Op 51656(U))

Reported in New York Official Reports at Ap Orthopedic & Rehabilitation, P.C. v Allstate Ins. Co. (2015 NY Slip Op 51656(U))

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

AP Orthopedic & Rehabilitation, P.C. as Assignee of EUGENE COOPER and MYONG KUNG SONG, Respondent,

against

Allstate Insurance Company, Appellant.

Appeal from a judgment of the Civil Court of the City of New York, Queens County (Anna Culley, J.), entered December 18, 2012. The judgment, entered pursuant to a decision of the same court dated September 14, 2012, insofar as appealed from, after a nonjury trial, awarded plaintiff the principal sum of $8,220.17 on plaintiff’s third cause of action.

ORDERED that, on the court’s own motion, the notice of appeal from the decision dated September 14, 2012 is deemed a premature notice of appeal from so much of the judgment entered December 18, 2012 as awarded plaintiff the principal sum of $8,220.17 on plaintiff’s third cause of action (see CPLR 5520 [c]); and it is further,

ORDERED that the judgment, insofar as appealed from, is affirmed, with $25 costs.

At a nonjury trial of this action by a provider to recover assigned first-party no-fault benefits, insofar as is relevant to this appeal, the parties’ attorneys stipulated that the only issue to be tried concerned the third cause of action, for which plaintiff sought to recover the principal sum of $8,220.17. It was further stipulated that defendant’s witness was an expert. The trial proceeded solely upon defendant’s defense of lack of medical necessity. Following the trial, the Civil Court found in favor of plaintiff on the third cause of action.

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 (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 determination of the Civil Court, based upon its assessment of the credibility of defendant’s witness and the proof adduced at trial, that defendant failed to demonstrate that the services rendered were not medically necessary. As we find no basis to disturb the Civil Court’s findings, the judgment, insofar as appealed from, is affirmed.

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


Decision Date: November 12, 2015
Healthway Med. Care, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51654(U))

Reported in New York Official Reports at Healthway Med. Care, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51654(U))

Healthway Med. Care, P.C. v Country Wide Ins. Co. (2015 NY Slip Op 51654(U)) [*1]
Healthway Med. Care, P.C. v Country Wide Ins. Co.
2015 NY Slip Op 51654(U) [49 Misc 3d 144(A)]
Decided on November 12, 2015
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 12, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-891 Q C
Healthway Medical Care, P.C. as Assignee of MARCUS HIPPOLYTE, Appellant,

against

Country Wide Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered April 4, 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 appeals from an order of the Civil Court which denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

The affidavit of defendant’s no-fault litigation supervisor submitted in support of defendant’s cross motion established that defendant had timely mailed its denial of claim forms in accordance with its standard office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), which forms denied the claims on the ground that the assignor had not submitted proper notice of the accident to defendant within 30 days of the accident. Defendant’s cross-moving papers further demonstrated that defendant had first learned of the accident more than 30 days after it had occurred. As defendant established its prima facie entitlement to judgment as a matter of law, the burden shifted to plaintiff. Despite being informed by the denial of claim forms that it had the opportunity to “submit[] written proof providing clear and reasonable justification for the failure” to timely advise defendant of the accident (11 NYCRR 65-1.1; 65-2.4), plaintiff did not present any evidence that it had availed itself of the opportunity or that it had given timely notice.

Accordingly, the order is affirmed.

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


Decision Date: November 12, 2015
Palafox PT, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51653(U))

Reported in New York Official Reports at Palafox PT, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51653(U))

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

Palafox PT, P.C. as Assignee of KATHERINE FERMIN, 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 (Katherine A. Levine, J.), entered January 31, 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, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint. The Civil Court found that defendant had timely and properly denied the claims at issue on the ground that plaintiff had failed to comply with a condition precedent to coverage, in that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). On appeal, plaintiff argues that defendant failed to prove that it had mailed its EUO scheduling letters and denial of claim forms, or that plaintiff had failed to appear for the EUOs; that defendant lacked justification for its EUO requests; that defendant’s motion should have been denied pursuant to CPLR 3212 (f), as plaintiff had not received discovery regarding the reasonableness of defendant’s EUO requests; and that defendant failed to prove that plaintiff had willfully obstructed defendant’s investigation.

Contrary to plaintiff’s arguments, the affidavits submitted by defendant established that the EUO scheduling letters and the denial of claim forms had been timely mailed in accordance with defendant’s standard office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). In addition, the affirmation submitted by defendant’s attorney, who was present in his office to conduct the EUO of plaintiff on the scheduled dates, was sufficient to establish that plaintiff had failed to appear.

With respect to plaintiff’s contention that defendant failed to demonstrate justification for its EUO requests, the Appellate Division, Second Department, has held that where an insurer moves for summary judgment dismissing the complaint on the ground that a provider’s assignor failed to appear for an EUO, to establish its prima facie case, the insurer need only establish “as a matter of law that it twice duly demanded an [EUO] from the [provider’s] assignor, who had allegedly been injured in a motor vehicle accident, that the assignor twice failed to appear, and that the [insurer] issued a timely denial of the claims arising from the [provider’s] treatment of the assignor” (Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 [2014]). Moreover, a review of the record in Interboro Ins. Co. v Clennon (113 AD3d 596) reveals that in that case, the provider argued, as does plaintiff herein, that the insurer’s motion should have been denied pursuant to CPLR 3212 (f), as the provider had not received discovery regarding the reasonableness of defendant’s EUO requests, and that, even if there had been a failure to appear for two duly scheduled EUOs, the insurer had to show that the failure to appear constituted willful obstruction of the insurer’s investigation. In finding for the insurer, the Appellate Division, Second [*2]Department, stated the following:


“the [providers] failed to establish that summary judgment was premature in light of outstanding discovery. A party who contends that a summary judgment motion is premature is required to demonstrate that discovery might lead to relevant evidence or [that] the facts essential to justify opposition to the motion were exclusively within the knowledge and control of the movant’ (Cajas-Romero v Ward, 106 AD3d 850, 852 [2013]; see CPLR 3212 [f]). Here, in support of their contention that the [insurer’s] motion was premature, the [providers] did not establish what information they hoped to discover that would demonstrate the existence of a triable issue of fact” (113 AD3d at 597).

Similarly, in the instant case, plaintiff did not establish what information it hoped to discover that would demonstrate the existence of a triable issue of fact (cf. American Tr. Ins. Co. v Jaga Med. Servs., P.C., 128 AD3d 441 [2015]).

Accordingly, the order is affirmed.

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


Decision Date: November 12, 2015
Karina K. Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51624(U))

Reported in New York Official Reports at Karina K. Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51624(U))

Karina K. Acupuncture, P.C. a/a/o Gary Blackstock, Plaintiff-Appellant,

against

State Farm Mutual Automobile Ins. Co. Defendant-Respondent.

Plaintiff appeals from a judgment of the Civil Court of the City of New York, New York County (Robert R. Reed, J.), entered November 15, 2013, which, upon a prior order granting summary judgment, dismissed the complaint.

Per Curiam.

Judgment (Robert R. Reed, J.), entered November 15, 2013, reversed, with $30 costs, defendant’s motion denied, and the complaint reinstated.

Civil Court erred by treating defendant’s motion made pursuant to CPLR 3211(a)(1) and (7) as a motion for summary judgment without providing adequate notice to the parties (see CPLR 3211[c]; Mihlovan v Grozavu, 72 NY2d 506, 508 [1988]). The parties’ motion papers clearly indicated their intent to treat the motion as one made pursuant to CPLR 3211, and the case does not involve a purely legal question without any disputed issues of fact (see Brathwaite v Frankel, 98 AD3d 444, 445 [2012]; see also Drug Policy Alliance v The New York City Tax Commission, 131 AD3d 815 [2015]).

Treating the motion as one for dismissal pursuant to CPLR 3211, we conclude that it should have been denied. Accepting plaintiff’s allegations as true, and according them the benefit of every possible favorable inference, as we must in the context of a motion to dismiss the pleadings (Leon v Martinez, 84 NY2d 83, 87-88 [1994]), we find the complaint sufficient to state a cause of action for recovery of first-party no-fault benefits pursuant to an automobile insurance policy issued by defendant (see Genovese v State Farm Mut. Auto. Ins. Co., 106 AD3d 866, 868 [2013]; Innovative MR Imaging, P.C. v New York Cent. Mut. Fire Ins. Co., 38 Misc 3d 147[A], 2013 NY Slip Op 50359[U][App Term, 1st Dept 2013]).

Contrary to defendant’s contention, the affidavits submitted in support of its defense – that plaintiff is not entitled to no-fault coverage because it breached a condition precedent under the policy by failing to appear for examinations under oath (EUOs) (see 11 NYCRR 65-1.1) – do not “‘establish conclusively that [plaintiff] has no [claim or] cause of action'” (Lawrence v Graubard Miller, 11 NY3d 588, 595 [2008], quoting Rovello v Orofino Realty Co., 40 NY2d 633, 636 [*2][1976]), and are “not properly considered on a motion to dismiss pursuant to CPLR 3211 (a)(7)” (GEM Holdco, LLC v Changing World Tech., L.P., 127 AD3d 598, 599 [2015]; see Lee v Dow Jones & Co., Inc., 121 AD3d 548 [2014]; Sokol v Leader, 74 AD3d 1180 [2010]). Nor (as defendant effectively concedes), were the affidavits “essentially undeniable” so as to qualify as documentary evidence (see CPLR 3211[a][1]) that conclusively establishes its defense or definitively refutes any claim that plaintiff may have to recover under the policy (see Mason v First Cent. Natl. Life Ins. Co. of NY, 86 AD3d 854, 855 [2011]).

Defendant’s remaining contentions are unpreserved and/or without merit.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.


I concur I concur I concur
Decision Date: November 12, 2015
Healthy Way Acupuncture, P.C. v Amica Mut. Ins. Co. (2015 NY Slip Op 51623(U))

Reported in New York Official Reports at Healthy Way Acupuncture, P.C. v Amica Mut. Ins. Co. (2015 NY Slip Op 51623(U))

Healthy Way Acupuncture, P.C. v Amica Mut. Ins. Co. (2015 NY Slip Op 51623(U)) [*1]
Healthy Way Acupuncture, P.C. v Amica Mut. Ins. Co.
2015 NY Slip Op 51623(U)
Decided on November 12, 2015
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 November 12, 2015

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT
PRESENT: Schoenfeld, J.P., Shulman, Hunter, Jr., JJ.
570815/15
Healthy Way Acupuncture, P.C., a/a/o Samuel Vazquez, Plaintiff-Appellant,

against

Amica Mutual Ins. Company, Defendant-Respondent.

Plaintiff appeals from an order of the Civil Court of the City of New York, New York County (Alexander M. Tisch, J.), dated January 7, 2015, which granted defendant’s motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Alexander M. Tisch, J.), dated January 7, 2015, affirmed, with $10 costs.

The affidavits and other documentary evidence submitted by defendant in support of its motion for summary judgment established, prima facie, that it timely denied (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) plaintiff’s claim for assigned first-party no-fault benefits on the ground that the fees plaintiff charged for the acupuncture services rendered to its assignor exceeded the amount permitted by the worker’s compensation fee schedule (see Akita Med. Acupuncture, P.C. v Clarendon Ins. Co., 41 Misc 3d 134[A], 2013 NY Slip Op 51860[U][App Term, 1st Dept [2013]; Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept 2009]). The mistake contained in the notary’s jurat (as to the year) was properly disregarded, since no substantial right of a party was affected (see CPLR 2001).

In opposition, plaintiff failed to raise a triable issue as to the efficacy of defendant’s mailing of the denial or the calculation of the fee. Accordingly, defendant’s motion for summary judgment dismissing the claim – which sought the difference between the amount charged for the services and payments made to plaintiff pursuant to the fee schedule – was properly granted.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.


I concur I concur I concur
Decision Date: November 12, 2015
EMA Acupuncture v Statewide Ins. Co. (2015 NY Slip Op 51622(U))

Reported in New York Official Reports at EMA Acupuncture v Statewide Ins. Co. (2015 NY Slip Op 51622(U))

EMA Acupuncture v Statewide Ins. Co. (2015 NY Slip Op 51622(U)) [*1]
EMA Acupuncture v Statewide Ins. Co.
2015 NY Slip Op 51622(U)
Decided on November 12, 2015
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 November 12, 2015

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT
PRESENT: Schoenfeld, J.P., Shulman, Hunter, Jr., JJ.
570432/15
EMA Acupuncture, a/a/o Yelena Antasevich, Plaintiff-Respondent,

against

Statewide Insurance Company, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, Bronx County (Julia I. Rodriguez, J.), dated March 20, 2009, which granted plaintiff’s motion for summary judgment on the complaint.

Per Curiam.

Order (Julia I. Rodriguez, J.), dated March 20, 2009, affirmed, with $10 costs.

In opposition to plaintiff’s prima facie showing of entitlement to judgment as a matter of law on its complaint to recover first-party no-fault benefits (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), defendant failed to raise a triable issue. While defendant contended that the claim was premature because plaintiff failed to respond to its verification requests, the affidavit of defendant’s no-fault claims supervisor, who had no personal knowledge that the verification letters were actually mailed, and described in only the most general terms her office’s mailing practices and procedures, was insufficient to raise an issue of fact (see Westchester Med. Ctr. v Countrywide Co., 45 AD3d 676, 677 [2007]). Accordingly, Civil Court properly granted plaintiff’s motion for summary judgment. In view of our determination, we reach no other issues.


THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concur I concur I concur
Decision Date: November 12, 2015