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
IMA Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51633(U))

Reported in New York Official Reports at IMA Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51633(U))

IMA Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51633(U)) [*1]
IMA Acupuncture, P.C. v Praetorian Ins. Co.
2015 NY Slip Op 51633(U)
Decided on November 9, 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 9, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-1153 Q C
IMA Acupuncture, P.C. as Assignee of ELISKA DUPUY, Respondent,

against

Praetorian Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Maureen A. Healy, J.), entered April 22, 2013. The order, insofar as appealed from and as limited by the brief, denied defendant’s cross 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, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that it had timely and properly denied the claims at issue based upon plaintiff’s assignor’s failure to appear for duly scheduled independent medical examinations (IMEs). By order entered April 22, 2013, insofar as appealed from and as limited by the brief, the Civil Court denied defendant’s cross motion and held that the sole issue for trial was whether plaintiff’s assignor had failed to appear for duly scheduled IMEs (see CPLR 3212 [g]).

While defendant submitted a sworn statement by the chiropractor who had been scheduled to perform the IMEs, the chiropractor failed to demonstrate by personal knowledge (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]), or by any other appropriate means (see e.g. Quality Psychological Servs., P.C. v Interboro Mut. Indem. Ins. Co., 36 Misc 3d 146[A], 2012 NY Slip Op 51628[U] [App Term, 2d, 11th & 13th Jud Dists 2012]), the nonappearance of plaintiff’s assignor for both of the IMEs. Therefore, defendant failed to establish its entitlement as a matter of law to summary judgment dismissing the complaint (see Stephen Fogel Psychological, P.C., 35 AD3d 720; Bright Med. Supply Co. v IDS Prop. & Cas. Ins. Co., 40 Misc 3d 130[A], 2013 NY Slip Op 51123[U] [App Term, 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, 11th & 13th Jud Dists 2012]).

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

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


Decision Date: November 09, 2015
New Way Med. Supply Corp. v Praetorian Ins. Co. (2015 NY Slip Op 51632(U))

Reported in New York Official Reports at New Way Med. Supply Corp. v Praetorian Ins. Co. (2015 NY Slip Op 51632(U))

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

New Way Medical Supply Corp. 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 (William A. Viscovich, J.), entered March 25, 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 branches of defendant’s cross motion seeking summary judgment dismissing the first, second, third and fifth 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 and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court denied plaintiff’s motion and granted defendant’s cross motion. The first, second, third and fifth causes of action were dismissed as premature because plaintiff had failed to provide requested verification. The fourth cause of action was dismissed based on the failure of plaintiff’s assignor to appear for independent medical examinations (IMEs) and examinations under oath (EUOs).

In support of the branches of defendant’s cross motion seeking summary judgment dismissing plaintiff’s first, second, third and fifth causes of action, defendant submitted an affidavit by its claims examiner which established that defendant had timely mailed its verification requests and follow-up verification requests (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant also demonstrated prima facie that it had not received the requested verification and, thus, that plaintiff’s first, second, third and fifth causes of action are premature (see 11 NYCRR 65-3.8 [a]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]). However, in opposition to the cross motion, plaintiff submitted an affidavit from plaintiff’s owner, which affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to, and received by, defendant (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]). In light of the foregoing, there is a triable issue of fact as to whether these causes of action are premature (see Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59 [App Term, 2d, 11th & 13th Jud Dists 2014]).

Contrary to plaintiff’s contention, defendant established that the IME and EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123), [*2]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 fourth cause of action on that ground. 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, defendant was entitled to summary judgment dismissing this cause of action.

Accordingly, the order is modified by providing that the branches of defendant’s cross motion seeking summary judgment dismissing plaintiff’s first, second, third and fifth causes of action are denied.

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


Decision Date: November 09, 2015
Compas Med., P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51631(U))

Reported in New York Official Reports at Compas Med., P.C. v Farm Family Cas. Ins. Co. (2015 NY Slip Op 51631(U))

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

Compas Medical, P.C. as Assignee of JONATHAN JOSEPH, Respondent,

against

Farm Family Casualty Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Pamela L. Fisher, J.), entered February 6, 2013. The order, insofar as appealed from as limited by the brief, granted the branches of plaintiff’s motion seeking summary judgment on the second, third, eighth and ninth causes of action and denied the branches of defendant’s cross motion seeking summary judgment dismissing those causes of action. A judgment was entered on March 13, 2013, pursuant to the February 6, 2013 order, awarding plaintiff the principal lump sum of $1,255.70 upon the second, third, and fifth through ninth causes of action. The appeal from the order is deemed to be from so much of the judgment as was in favor of plaintiff on the second, third, eighth and ninth causes of action (see CPLR 5501 [c]).

ORDERED that the judgment, insofar as appealed from, is modified by vacating so much thereof as was in favor of plaintiff on the third, eighth and ninth causes of action, as well as so much of the order entered February 6, 2013 as granted the branches of plaintiff’s motion seeking summary judgment upon those causes of action, those branches of plaintiff’s motion are denied, and the matter is remitted to the Civil Court for the entry of a new judgment in favor of plaintiff upon the second and fifth through seventh causes of action, and for all further proceedings; as so modified, the judgment 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. By order entered February 6, 2013, the Civil Court granted the branches of plaintiff’s motion seeking summary judgment upon the second, third, and fifth through ninth causes of action and denied the branches of defendant’s cross motion seeking summary judgment dismissing those causes of action. As limited by its brief, defendant appeals from so much of the order as granted the branches of plaintiff’s motion seeking summary judgment on the second, third, eighth and ninth causes of action and denied the branches of defendant’s cross motion seeking summary judgment dismissing those causes of action. A judgment was entered on March 13, 2013, pursuant to the February 6, 2013 order, awarding plaintiff the principal lump sum of $1,255.70 upon the second, third, and fifth through ninth causes of action. The appeal from the order is deemed to be from so much of the judgment as was in favor of plaintiff on the second, third, eighth and ninth causes of action (see CPLR 5501 [c]).

The affidavit by defendant’s claims representative was sufficient to establish that [*2]defendant did not receive the claim forms underlying plaintiff’s third, eighth and ninth causes of action. However, since the affidavit from plaintiff’s owner demonstrated that the claim forms had been mailed to defendant, there is an issue of fact as to whether defendant’s time to pay or deny these claims ever began to run (see Compas Med., P.C. v 21st Century Ins. Co., 47 Misc 3d 128[A], 2015 NY Slip Op 50388[U] [App Term, 2d, 11th & 13th Jud Dists 2015]; Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59 [App Term, 2d, 11th & 13th Jud Dists 2014]; cf. Bright Med. Supply Co. v Tri State Consumer Ins. Co., 40 Misc 3d 130[A], 2013 NY Slip Op 51122[U] [App Term, 2d, 11th & 13th Jud Dists 2013]). As a result, plaintiff is not entitled to summary judgment on its third, eighth and ninth causes of action.

Upon receiving the claim underlying the second cause of action, defendant sent letters notifying plaintiff that defendant was delaying payment thereon, but the letters did not request any specific verification. Consequently, contrary to defendant’s contention, these delay letters did not toll the statutory time period within which defendant was required to pay or deny the claim underlying the second cause of action (see Points of Health Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133[A], 2010 NY Slip Op 51338[U] [App Term, 2d, 11th & 13th Jud Dists [2010]). As the first letter that defendant sent to schedule plaintiff’s assignor’s examination under oath was sent more than 30 days after defendant had received the claim underlying the second cause of action, the 30-day period within which defendant was required to pay or deny this claim had already expired.

Accordingly, the judgment, insofar as appealed from, is modified by vacating so much thereof as was in favor of plaintiff on the third, eighth and ninth causes of action, as well as so much of the order entered February 6, 2013 as granted the branches of plaintiff’s motion seeking summary judgment upon those causes of action, those branches of plaintiff’s motion are denied, and the matter is remitted to the Civil Court for the entry of a new judgment in favor of plaintiff upon the second and fifth through seventh causes of action, and for all further proceedings.

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


Decision Date: November 09, 2015
Alleviation Med., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51630(U))

Reported in New York Official Reports at Alleviation Med., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51630(U))

Alleviation Med., P.C. v Allstate Ins. Co. (2015 NY Slip Op 51630(U)) [*1]
Alleviation Med., P.C. v Allstate Ins. Co.
2015 NY Slip Op 51630(U)
Decided on November 9, 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 9, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-1003 Q C
Alleviation Medical, P.C. as Assignee of CLIFTON LYONS, Appellant,

against

Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Larry Love, J.), entered April 17, 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 cross-moved for summary judgment dismissing the complaint on the ground that the alleged injuries did not arise out of a covered loss. The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

Plaintiff’s arguments on appeal are being raised for the first time. In any event, they are insufficient to defeat defendant’s cross motion (see Andromeda Med. Care, P.C. v NY Cent. Mut. Fire Ins. Co., 26 Misc 3d 126[A], 2009 NY Slip Op 52601[U] [App Term, 2d, 11th & 13th Jud Dists 2009]).

Accordingly, the order is affirmed.

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


Decision Date: November 09, 2015
Alleviation Med. Servs., P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51628(U))

Reported in New York Official Reports at Alleviation Med. Servs., P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51628(U))

Alleviation Med. Servs., P.C. v American Tr. Ins. Co. (2015 NY Slip Op 51628(U)) [*1]
Alleviation Med. Servs., P.C. v American Tr. Ins. Co.
2015 NY Slip Op 51628(U)
Decided on November 9, 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 9, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-942 Q C
Alleviation Medical Services, P.C. as Assignee of ROSE FICY, Appellant,

against

American Transit Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Maureen A. Healy, J.), entered March 15, 2013. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment.

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, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. Plaintiff appeals from so much of an order of the Civil Court entered March 15, 2013 as denied plaintiff’s motion, finding that defendant had demonstrated the existence of a triable issue of fact.

Because plaintiff failed to establish either that defendant had failed to pay or deny the claim within the requisite 30-day period (see Insurance Law § 5106 [a]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d, 11th & 13th Jud Dists 2011]), plaintiff failed to demonstrate its prima facie entitlement to summary judgment. As a result, the burden never shifted to defendant and, thus, we need not reach plaintiff’s contention that defendant failed to demonstrate the existence of a triable issue of fact.

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

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


Decision Date: November 09, 2015
New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51627(U))

Reported in New York Official Reports at New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 51627(U))

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

New Way Medical Supply Corp. as Assignee of JACQUELINE RIVERA, Appellant,

against

State Farm Mutual Automobile Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Jodi Orlow, J.), entered March 21, 2013. The order, insofar as appealed from as limited by the brief, granted defendant’s cross motion for summary judgment dismissing the complaint to the extent of dismissing without prejudice so much of the complaint as sought to recover upon a claim for $909 for supplies furnished on November 9, 2010 and dismissing with prejudice so much of the complaint as sought to recover upon claims for supplies furnished on September 7, 2010 and November 9, 2010.

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, plaintiff appeals, as limited by its brief, from so much of an order of the Civil Court as granted defendant’s cross motion for summary judgment dismissing the complaint to the extent of dismissing without prejudice so much of the complaint as sought to recover upon a claim for $909 for supplies furnished on November 9, 2010 and dismissing with prejudice so much of the complaint as sought to recover upon claims for supplies furnished on September 7, 2010 and November 9, 2010, which defendant denied pursuant to the workers’ compensation fee schedule.

Contrary to plaintiff’s contention, defendant demonstrated prima facie that it had not received the verification requested with respect to plaintiff’s claim for $909 for supplies furnished on November 9, 2010 and plaintiff did not show that such verification had been provided to defendant prior to the commencement of the action. As a result, the 30-day period within which defendant was required to pay or deny the claim did not begin to run (see 11 NYCRR 65-3.8 [a]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]; Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 [2004]; D & R Med. Supply v American Tr. Ins. Co., 32 Misc 3d 144[A], 2011 NY Slip Op 51727[U] [App Term, 2d, 11th & 13th Jud Dists 2011]). Consequently, so much of plaintiff’s complaint as sought to recover upon this claim is premature.

Similarly, the affidavit by defendant’s claims representative was sufficient to demonstrate prima facie that defendant had properly denied plaintiff’s claims for supplies furnished on September 7, 2010 and November 9, 2010 pursuant to the workers’ compensation fee schedule. In opposition to defendant’s cross motion, plaintiff failed to raise a triable issue of fact with respect thereto. In addition, the arguments which plaintiff has raised for the first time on appeal [*2]are not properly before this court, and we decline to consider them (see Joe v Upper Room Ministries, Inc., 88 AD3d 963 [2011]; Gulf Ins. Co. v Kanen, 13 AD3d 579 [2004]).

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

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


Decision Date: November 09, 2015