Metro Psychological Servs., P.C. v 21st Century N. Am. Ins. Co. (2015 NY Slip Op 50470(U))

Reported in New York Official Reports at Metro Psychological Servs., P.C. v 21st Century N. Am. Ins. Co. (2015 NY Slip Op 50470(U))

Metro Psychological Servs., P.C. v 21st Century N. Am. Ins. Co. (2015 NY Slip Op 50470(U)) [*1]
Metro Psychological Servs., P.C. v 21st Century N. Am. Ins. Co.
2015 NY Slip Op 50470(U) [47 Misc 3d 133(A)]
Decided on April 7, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 April 7, 2015

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS


PRESENT: : TOLBERT, J.P., GARGUILO and CONNOLLY, JJ.
2013-2295 N C
Metro Psychological Services, P.C. as Assignee of CHRISTINA DAVIS, Respondent,

against

21st Century North America Insurance Company, Appellant.

Appeal from an order of the City Court of Long Beach, Nassau County (Frank D. DiKranis, J.), entered March 20, 2013. The order denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, without costs, and defendant’s motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that it


had timely denied plaintiff’s claim based on the assignor’s failure to appear at scheduled examinations under oath (EUOs). The City Court found that defendant established that it had timely mailed the EUO scheduling letters, that the date and place of the EUOs were not unreasonable and that plaintiff’s assignor had failed to appear for the EUOs. However, the court held that defendant did not establish its prima facie entitlement to judgment as a matter of law because it did not show an objective justification for scheduling the EUOs. This appeal by defendant ensued.

In support of its motion for summary judgment dismissing the complaint, defendant submitted an affidavit of its counsel’s paralegal, who was responsible for creating EUO scheduling letters and who had personally mailed the letters. The affidavit established that the EUO notices had been sent to plaintiff’s assignor in accordance with the law office’s standard practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Richard Morgan Do, P.C. v State Farm Mut. Auto. Ins. Co., 22 Misc 3d 134[A], 2009 NY Slip Op 50242[U] [App Term, 9th & 10th Jud Dists 2009]; Chi Acupuncture, P.C. v Kemper Auto & Home Ins. Co., 14 Misc 3d 141[A], 2007 NY Slip Op 50352[U] [App Term, 9th & 10th Jud Dists 2007]). Defendant also proffered transcripts of the scheduled EUOs, which established that the assignor had failed to appear (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). In addition, defendant sufficiently established that the denial of claim form had been timely mailed (see St. Vincent’s Hosp. of Richmond, 50 AD3d at 1124). The opposing affirmation submitted by plaintiff’s counsel was insufficient to raise a triable issue of fact in opposition to defendant’s motion.

An appearance at an EUO “is a condition precedent to the insurer’s liability on the policy” (Stephen Fogel Psychological, P.C., 35 AD3d at 722). Contrary to the determination of the City [*2]Court, no provision of No-Fault Regulation 68 requires an insurer to set forth any objective standards for requesting an EUO (see Flow Chiropractic, P.C. v Travelers Home and Mar. Ins. Co., 44 Misc 3d 132[A], 2014 NY Slip Op 51142[U] [App Term, 9th & 10th Jud Dists 2014]).

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

Tolbert, J.P., Garguilo and Connolly, JJ., concur.


Decision Date: April 07, 2015
21st Century Acupuncture, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50445(U))

Reported in New York Official Reports at 21st Century Acupuncture, P.C. v Allstate Ins. Co. (2015 NY Slip Op 50445(U))

21st Century Acupuncture, P.C., a/a/o Andrew Diaz, Plaintiff-Respondent, –

against

Allstate Insurance Company, Defendant-Appellant.

Defendant appeals from an order the Civil Court of the City of New York, Bronx County (Elizabeth A. Taylor, J.), entered October 10, 2013, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Elizabeth A. Taylor, J.), entered October 10, 2013, reversed, with $10 costs, and defendant’s motion for summary judgment dismissing the complaint is granted. The Clerk is directed to enter judgment accordingly.

The defendant-insurer made a prima facie showing of entitlement to summary judgment dismissing the action for first-party no-fault benefits by establishing that it timely and properly mailed the notices for independent medical examinations (IMEs) to plaintiff’s assignor, and that the assignor failed to appear (see American Tr. Ins. Co. v Lucas, 111 AD3d 423 [2013]; American Tr. Ins. Co. v Solorzano, 108 AD3d 449 [2013]). Contrary to plaintiff’s contention, defendant submitted competent evidence of the assignor’s nonappearance in the form of the sworn affidavits of the scheduled examining acupuncturists and an employee of defendant’s third-party IME scheduler attesting to the affiants’ personal knowledge of their office practices and policies when an assignor fails to appear for a scheduled IME (see American Tr. Ins. Co. v Lucas, 111 AD3d at 424).

In opposition, plaintiff did not specifically deny the assignor’s nonappearance or otherwise raise a triable issue with respect thereto, or as to the mailing or reasonableness of the underlying notices (see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 [2011], lv denied 17 NY3d 705 [2011]; see also American Tr. Ins. Co. v Marte-Rosario, 111 AD3d 442 [2013]). Accordingly, when the assignor failed to appear for the requested acupuncture IME, defendant had the right to deny all claims retroactively to the date of loss, regardless of whether the denials were timely issued (see American Tr. Ins. Co. v Lucas, 111 AD3d at 424), and even though defendant initially denied certain of the claims on different grounds (see Unitrin, 82 AD3d at 560).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.


I concur I concur I concur
Decision Date: April 02, 2015
Parkview Med. & Surgical, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50491(U))

Reported in New York Official Reports at Parkview Med. & Surgical, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50491(U))

Parkview Med. & Surgical, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50491(U)) [*1]
Parkview Med. & Surgical, P.C. v Praetorian Ins. Co.
2015 NY Slip Op 50491(U) [47 Misc 3d 135(A)]
Decided on March 26, 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 March 26, 2015

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


PRESENT: : WESTON, J.P., SOLOMON and ELLIOT, JJ.
2014-1282 K C
Parkview Medical & Surgical, P.C. as Assignee of MARLO SELBY, Respondent,

against

Praetorian Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Steven Z. Mostofsky, J.), entered January 7, 2014. The order, insofar as appealed from as limited by the brief, denied the branch of defendant’s motion seeking summary judgment dismissing the first cause of action.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branch of defendant’s motion seeking summary judgment dismissing the first cause of action is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint, and plaintiff cross-moved for summary judgment. Insofar as is relevant to this appeal, the Civil Court denied the branch of defendant’s motion seeking summary judgment dismissing the first cause of action. On appeal, defendant argues that the first cause of action should have been dismissed as premature.

The affidavit of defendant’s claims examiner established that defendant had timely mailed its verification request and follow-up verification request (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Defendant demonstrated that it had not received the verification requested, and plaintiff did not show that the verification had been provided to defendant prior to the commencement of the action. Thus, with respect to the first cause of action, the 30-day period within which defendant was required to pay or deny the claim did not begin to run, and the Civil Court should have dismissed the first cause of action as premature (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]).

Accordingly, the order, insofar as appealed from, is reversed, and the branch of defendant’s motion seeking summary judgment dismissing the first cause of action is granted.

Weston, J.P., Solomon and Elliot, JJ., concur.


Decision Date: March 26, 2015
Renelique v American Tr. Ins. Co. (2015 NY Slip Op 50482(U))

Reported in New York Official Reports at Renelique v American Tr. Ins. Co. (2015 NY Slip Op 50482(U))

Renelique v American Tr. Ins. Co. (2015 NY Slip Op 50482(U)) [*1]
Renelique v American Tr. Ins. Co.
2015 NY Slip Op 50482(U) [47 Misc 3d 134(A)]
Decided on March 26, 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 March 26, 2015

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


PRESENT: : WESTON, J.P., SOLOMON and ELLIOT, JJ.
2013-1578 Q C
Pierre Jean Jacques Renelique as Assignee of TIFFANY OVERTON, Appellant,

against

American Transit Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered June 13, 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, and defendant opposed the motion and cross-moved for summary judgment dismissing the complaint on the ground of outstanding verification. The Civil Court denied plaintiff’s motion and granted defendant’s cross motion, finding that the action was premature since plaintiff had not responded to defendant’s requests for additional verification.

CPLR 2219 (a) requires that an order deciding a motion recite the papers upon which the motion was decided (see Matter of Dondi, 63 NY2d 331, 339 [1984]). Although plaintiff’s appellate brief indicates that plaintiff may have served papers in opposition to defendant’s cross motion for summary judgment, the order appealed from recites that the court did not consider any papers opposing defendant’s cross motion. As a result, this court’s review is limited to plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint.

With respect to defendant’s cross motion for summary judgment dismissing the complaint, the affidavits of defendant’s no-fault examiner and mail room supervisor established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]) its verification requests and follow-up verification requests. Defendant demonstrated that it had not received all of the verification requested, and plaintiff did not show that such verification had been provided to defendant prior to the commencement of the action. Thus, the 30-day period within which defendant was required to pay or deny the claims did not begin to run (see 11 NYCRR 65-3.8 [a] [1]; 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]), and plaintiff’s action is premature. In light of the foregoing, plaintiff’s [*2]contention that its motion for summary judgment should have been granted is rendered moot. Plaintiff’s remaining contention is not properly before this court, as this argument is, on this record, being raised for the first time on appeal, and we decline to consider it (see Joe v Upper Room Ministries, Inc., 88 AD3d 963 [2011]; Gulf Ins. Co. v Kanen, 13 AD3d 579 [2004]). Consequently, the Civil Court properly denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

Accordingly, the order is affirmed.

Weston, J.P., Solomon and Elliot, JJ., concur.


Decision Date: March 26, 2015
Compas Med., P.C. v American Ind. Ins. Co. (2015 NY Slip Op 50481(U))

Reported in New York Official Reports at Compas Med., P.C. v American Ind. Ins. Co. (2015 NY Slip Op 50481(U))

Compas Med., P.C. v American Ind. Ins. Co. (2015 NY Slip Op 50481(U)) [*1]
Compas Med., P.C. v American Ind. Ins. Co.
2015 NY Slip Op 50481(U) [47 Misc 3d 134(A)]
Decided on March 26, 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 March 26, 2015

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


PRESENT: : WESTON, J.P., SOLOMON and ELLIOT, JJ.
2013-1551 Q C
Compas Medical, P.C. as Assignee of ASHLEY EMILIEN, Appellant, –

against

American Independent Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Larry L. Love, J.), entered May 29, 2013. The order granted defendant’s motion to dismiss 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 to dismiss the complaint, pursuant to CPLR 3211 (a) (8), on the ground that the Civil Court lacked personal jurisdiction over defendant. In several affidavits in support of the motion, two of defendant’s casualty managers as well as defendant’s claims casualty supervisor asserted that defendant is a Pennsylvania company, which is not licensed to do business in New York, maintains no offices in New York, has no bank accounts in New York, has no agents operating out of or representatives soliciting business in New York, does not “contact” [sic] or solicit business in New York, and does not own, use or possess any real property in New York. In opposition to the motion, plaintiff submitted only an affirmation in which plaintiff’s counsel conclusorily stated, among other things, that defendant was involved in the “transaction of business” (Insurance Law § 1213 [b] [1]; see also CCA 404 [a] [1]) in New York by “knowingly issuing policies to New York drivers” and by virtue of defendant’s alleged establishment of an ongoing attorney-client relationship with New York defense counsel, thereby subjecting defendant to jurisdiction in New York. By order entered May 29, 2013, the Civil Court granted defendant’s motion. On appeal, plaintiff’s sole contention is that the Civil Court should have denied defendant’s motion to dismiss and ordered jurisdictional discovery, pursuant to CPLR 3211 (d), because plaintiff could not properly oppose defendant’s motion without such discovery.

Plaintiff’s argument that “facts essential to justify opposition may exist but cannot then be stated” (CPLR 3211 [d]) is not properly before us, as this contention is raised by plaintiff for the first time on appeal (see Copp v Ramirez, 62 AD3d 23 [2009]). Even if the argument were before us, neither the unverified complaint nor the conclusory affirmation of plaintiff’s counsel in opposition to defendant’s motion constituted the “tangible evidence” (Mandel v Busch Entertainment Corp., 215 AD2d 455, 455 [1995]) necessary to substantiate plaintiff’s allegations that jurisdiction could exist, thereby demonstrating that plaintiff’s assertion of the existence of a jurisdictional predicate was not “frivolous” (Peterson v Spartan Indus., 33 NY2d 463, 467 [*2][1974]). Thus, plaintiff did not make a “sufficient start” (id.) by showing that essential jurisdictional facts might exist to warrant discovery on the issue of personal jurisdiction over defendant. Consequently, defendant’s motion to dismiss the complaint was properly granted.

Accordingly, the order is affirmed.

Weston, J.P., Solomon and Elliot, JJ., concur.


Decision Date: March 26, 2015
Edison Med. Servs., P.C. v Clarendon Natl. Ins. Co. (2015 NY Slip Op 50479(U))

Reported in New York Official Reports at Edison Med. Servs., P.C. v Clarendon Natl. Ins. Co. (2015 NY Slip Op 50479(U))

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

Edison Medical Services, P.C. as Assignee of JESUS DeLEON, FELIX ESPIRITU, CESAR PAZOS, GARRY PERKINS, JOSEFINA ROSARIO and DENISE THOMAS, Respondent, March 26, 2015

against

Clarendon National Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Carol Ruth Feinman, J.), entered March 15, 2013. The order denied defendant’s motion to vacate a default judgment and, upon vacatur, to dismiss the action pursuant to CPLR 3215 (c).

ORDERED that the order is affirmed, without costs.

Plaintiff commenced this action to recover assigned first-party no-fault benefits, and the summons and complaint were personally served upon defendant’s authorized agent (see CPLR 311 [a] [1]) on March 13, 2007. It is undisputed that defendant did not answer the complaint and, thus, defaulted in the action on April 2, 2007 by failing to appear within 20 days after service of the summons (CCA 402 [a]). In November 2007, which was within one year of defendant’s default, plaintiff moved for leave to enter a default judgment. Defendant admitted receipt of the motion papers, which subsequently were rejected by the court. On April 17, 2008, plaintiff served a second motion for leave to enter a default judgment, and the Civil Court granted plaintiff’s motion on default. A default judgment awarding plaintiff the principal sum of $3,392.13 was entered on November 28, 2011. In April 2012, defendant moved to vacate the judgment and, upon vacatur, to dismiss the action, pursuant to CPLR 3215 (c), on the ground that plaintiff had failed to enter a default judgment within one year of defendant’s default. By order entered March 15, 2013, the Civil Court denied defendant’s motion, finding that defendant had failed to offer a reasonable excuse for not answering the complaint or a meritorious defense to the action.

CPLR 3215 (c) requires that a plaintiff commence proceedings for the entry of a default judgment within one year after the default. Where a plaintiff has made an application to the court for the entry of a default judgment within that period, the court may not later dismiss the complaint as abandoned pursuant to CPLR 3215 (c) (see U.S. Bank N.A. v Poku, 118 AD3d 980 [2014]; Jones v Fuentes, 103 AD3d 853 [2013]), even where, as here, the application was unsuccessful (see Brown v Rosedale Nurseries, 259 AD2d 256 [1999]). Furthermore, in the present case, as plaintiff filed the second motion for the entry of a default judgment, plaintiff demonstrated that it had not abandoned the action (see Jones, 103 AD3d 853; Brown, 259 AD2d [*2]256; see also Icon Equip. Distribs. v Gordon Envtl. & Mech. Corp., 272 AD2d 579 [2000]; Patterson v Patterson, 220 AD2d 731 [1995]). Consequently, defendant was not entitled to dismissal of the complaint.

With respect to the branch of defendant’s motion, pursuant to CPLR 5015 (a), to vacate the default judgment, which was entered upon an order that granted plaintiff’s unopposed motion, defendant was required to demonstrate both a reasonable excuse for the default and a potentially meritorious defense to the action (see CPLR 5015 [a] [1]; Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138 [1986]). Defendant’s sole excuse for failing to oppose plaintiff’s motion for entry of a default judgment was its denial of receipt of plaintiff’s motion, which excuse was insufficient to rebut the presumption of proper service that was raised by plaintiff’s affidavit of service (see Kihl v Pfeffer, 94 NY2d 118 [1999]; Engel v Lichterman, 62 NY2d 943 [1984]; Ortega v Trefz, 44 AD3d 916 [2007]; Oparaji v Citibank, N.A., 44 Misc 3d 25 [App Term, 2d, 11th & 13th Jud Dists 2014]). In addition, defendant did not explain its failure to appear or answer the complaint, or demonstrate the existence of a potentially meritorious defense to the action (see Giraldo v Weingarten, 81 AD3d 885 [2011]). We further note that defendant failed to proffer any excuse for its five-month delay in moving to vacate the default judgment (see Bethune v Prioleau, 82 AD3d 810 [2011]). Accordingly, the order is affirmed.

Weston, J.P., Solomon and Elliot, JJ., concur.


Decision Date: March 26, 2015
EMC Health Prods., Inc. v Travelers Ins. Co. (2015 NY Slip Op 50475(U))

Reported in New York Official Reports at EMC Health Prods., Inc. v Travelers Ins. Co. (2015 NY Slip Op 50475(U))

EMC Health Prods., Inc. v Travelers Ins. Co. (2015 NY Slip Op 50475(U)) [*1]
EMC Health Prods., Inc. v Travelers Ins. Co.
2015 NY Slip Op 50475(U) [47 Misc 3d 133(A)]
Decided on March 26, 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 March 26, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-1029 K C
EMC Health Products, INC. as Assignee of OMAYRA PEREZ, Appellant, March 26, 2015

against

Travelers Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Wavny Toussaint, J.), entered March 9, 2012. 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 defendant’s cross motion for summary judgment dismissing the complaint is 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 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.

Plaintiff failed to demonstrate its prima facie entitlement to summary judgment, as the affidavit submitted in support of its motion failed to establish that the claim at issue had not been timely denied or that defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]; 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]; see also Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]). Consequently, plaintiff’s motion for summary judgment was properly denied. However, defendant’s cross motion should also have been denied, as defendant failed to establish, as a matter of law, its defense that plaintiff had failed to appear for properly scheduled examinations under oath (see e.g. Alrof, Inc. v Safeco Natl. Ins. Co., 39 Misc 3d 130[A], 2013 NY Slip Op 50458[U] [App Term, 2d, 11th & 13th Jud Dists 2013]; 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]).

Accordingly, the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.

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


Decision Date: March 26, 2015
EMA Acupuncture P.C. v Allstate Ins. Co. (2015 NY Slip Op 50348(U))

Reported in New York Official Reports at EMA Acupuncture P.C. v Allstate Ins. Co. (2015 NY Slip Op 50348(U))

EMA Acupuncture P.C. v Allstate Ins. Co. (2015 NY Slip Op 50348(U)) [*1]
EMA Acupuncture P.C. v Allstate Ins. Co.
2015 NY Slip Op 50348(U) [47 Misc 3d 126(A)]
Decided on March 23, 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 March 23, 2015

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT
PRESENT: Schoenfeld, J.P., Hunter, Jr., Ling-Cohan, JJ.
570852/14
EMA Acupuncture P.C. a/a/o Nicole Flynn, Plaintiff-Appellant, –

against

Allstate Insurance Company, Defendant-Respondent.

Plaintiff appeals from an order of the Civil Court of the City of New York, New York County (Margaret A. Chan, J.), entered December 17, 2012, which granted defendant’s motion to consolidate four related actions and to limit any potential recovery of attorneys’ fees in the consolidated action to $850.

Per Curiam.

Order (Margaret A. Chan, J.), entered December 17, 2012, insofar as appealable, affirmed, with $10 costs.

We sustain so much of the order under review as limited the amount of any recovery of attorneys’ fees to the sum of $850, the maximum allowable pursuant to Insurance Department Regulations [11 NYCRR] § 65-4.6(e). Since this provision provides that attorneys’ fees in a no-fault action are to be calculated based on the “aggregate of all bills for each insured” disputed in any action, up to a maximum of $850 (LMK Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co., 12 NY3d 217 [2009]), the $850 limit was properly applied to the claims at issue in this consolidated action, all of which involve the same parties and assignor, and arise from the same accident.

Plaintiff’s appeal from that portion of the order granting consolidation must be dismissed, inasmuch as plaintiff expressly “agree[d] to consolidation.” No appeal lies from an order entered on consent of the appealing party (see CPLR 5511; Shteierman v Shteierman, 29 AD3d 810 [2006]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.


I concur I concur I concur
Decision Date: March 23, 2015
New Way Med. Supply Corp. v American Tr. Ins. Co. (2015 NY Slip Op 50422(U))

Reported in New York Official Reports at New Way Med. Supply Corp. v American Tr. Ins. Co. (2015 NY Slip Op 50422(U))

New Way Med. Supply Corp. v American Tr. Ins. Co. (2015 NY Slip Op 50422(U)) [*1]
New Way Med. Supply Corp. v American Tr. Ins. Co.
2015 NY Slip Op 50422(U) [47 Misc 3d 132(A)]
Decided on March 17, 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 March 17, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-1576 K C
New Way Medical Supply Corp. as Assignee of JONATHAN TREVINO, Appellant,

against

American Transit Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered April 17, 2013. The order denied plaintiff’s motion for summary judgment.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which denied plaintiff’s motion for summary judgment.

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., 114 AD3d 33 [2013]), 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. Accordingly, the order is affirmed.

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


Decision Date: March 17, 2015
T & J Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50406(U))

Reported in New York Official Reports at T & J Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50406(U))

T & J Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co. (2015 NY Slip Op 50406(U)) [*1]
T & J Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co.
2015 NY Slip Op 50406(U) [47 Misc 3d 130(A)]
Decided on March 17, 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 March 17, 2015

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-2350 K C
T & J Chiropractic, P.C. as Assignee of DIONICIO PEREZ, 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 (Wavny Toussaint, J.), entered August 23, 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. 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; and 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.

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]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]), and the affirmation submitted by defendant’s attorney, who was present in his office to conduct plaintiff’s EUO on the scheduled dates, was sufficient to establish that plaintiff had failed to appear. Furthermore, since plaintiff does not claim to have responded in any way to the EUO requests, its objections regarding the EUO requests will not now be heard (see 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, 11th & 13th Jud Dists 2012]; Crescent Radiology, PLLC v American Tr. Ins. Co., 31 Misc 3d 134[A], 2011 NY Slip Op 50622[U] [App Term, 9th & 10th Jud Dists 2011]). Consequently, discovery relevant to the reasonableness of the EUO requests was not necessary for plaintiff to oppose defendant’s motion (see CPLR 3212 [f]).

Accordingly, the order is affirmed.


Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: March 17, 2015