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

Appeal from an order of the Civil Court of the City of New York, Queens County (Terrence C. O’Connor, J.), entered October 22, 2010, deemed from a judgment of the same court entered November 15, 2010 (see CPLR 5512 [a]; Neuman v Otto, 114 AD2d 791 [1985]). The judgment, entered pursuant to the October 22, 2010 order denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment, awarded plaintiff the principal sum of $5,349.47.

ORDERED that the judgment is reversed, without costs, so much of the order as denied the branches of defendant’s motion seeking summary judgment dismissing the first, second, fourth and fifth causes of action and granted plaintiff’s cross motion for summary judgment is vacated, the branches of defendant’s motion seeking summary judgment dismissing the first, second, fourth and fifth causes of action are granted, and plaintiff’s cross motion for summary judgment is denied.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order denying its motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment. A judgment was subsequently entered, [*2]from which we deem the appeal to have been taken (see CPLR 5512 [a]; Neuman v Otto, 114 AD2d 791 [1985]).

In support of its motion for summary judgment, defendant submitted an affidavit by an employee of National Claim Evaluations, Inc. (NCEI), an entity which had scheduled independent medical examinations (IMEs) of plaintiff’s assignor on behalf of defendant. The affidavit established that the IME scheduling letters had been timely mailed in accordance with NCEI’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]). Defendant also submitted an affidavit from its examining chiropractor/acupuncturist, who stated that plaintiff’s assignor had failed to appear for the scheduled IMEs. An affidavit executed by defendant’s litigation examiner demonstrated that denial of claim forms, which denied the claims at issue in the first, second, fourth and fifth causes of action based upon the failure of plaintiff’s assignor to appear for the IMEs, had been timely mailed (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; Delta Diagnostic Radiology, P.C., 17 Misc 3d 16). However, the affidavit did not address the claim at issue in the third cause of action. As a result, defendant established its prima facie entitlement to judgment as a matter of law as to the first, second, fourth and fifth causes of action (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). As plaintiff failed to raise a triable issue of fact, the branches of defendant’s motion seeking summary judgment dismissing the first, second, fourth and fifth causes of action should have been granted and the branches of plaintiff’s cross motion seeking summary judgment on those causes of action should have been denied.

The branch of plaintiff’s cross motion seeking summary judgment on the third cause of action should have been denied as well, as plaintiff failed to demonstrate that defendant’s denial of claim form, which was attached to plaintiff’s cross motion, was not timely mailed to plaintiff, or that it was conclusory, vague or without merit as a matter of law (see Insurance Law § 5106 [a]; 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]).

Accordingly, the judgment is reversed, so much of the order as denied the branches of defendant’s motion for summary judgment seeking to dismiss the first, second, fourth and fifth causes of action and granted plaintiff’s cross motion for summary judgment is vacated, the branches of defendant’s motion seeking summary judgment dismissing the first, second, fourth and fifth causes of action are granted, and plaintiff’s cross motion for summary judgment is denied.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: May 11, 2012

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

Appeal from an order of the Civil Court of the City of New York, Queens County (Anna Culley, J.), entered June 15, 2010, deemed from a judgment of the same court entered June 24, 2010 (see CPLR 5501 [c]). The judgment, entered pursuant to the June 15, 2010 order granting defendant’s motion for summary judgment, dismissed the complaint.

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

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court granting defendant’s motion for summary judgment dismissing the complaint. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

Defendant moved for summary judgment dismissing the complaint on the ground of lack of medical necessity. In opposition to the motion, plaintiff demonstrated that there was a triable [*2]issue of fact as to whether the supplies at issue were medically necessary (see generally Zuckerman v City of New York, 49 NY2d 557 [1980]). Accordingly, the judgment is reversed, the order granting defendant’s motion for summary judgment dismissing the complaint is vacated and the motion is denied.
Weston, J.P., Pesce and Rios, JJ., concur.
Decision Date: May 11, 2012

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

Appeal from an order of the Civil Court of the City of New York, Kings County (Margaret A. Pui Yee Chan, J.), entered October 23, 2009. The order, insofar as appealed from as limited by the brief, granted the branches of defendant’s motion seeking summary judgment dismissing the complaint as to services rendered to Natalia Agudelo from September 11, 2006 to November 16, 2006 and as to services rendered to Maria Salazar from November 11, 2006 to November 15, 2006.

ORDERED that the order, insofar as appealed from, is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court granted the branches of defendant’s motion seeking summary judgment dismissing the complaint as to services rendered to Natalia Agudelo from September 11, 2006 to November 16, 2006 and as to services rendered to Maria Salazar from November 11, 2006 to November 15, 2006, implicitly finding that defendant had timely denied these claims based upon the workers’ compensation fee schedule.

Plaintiff’s argument that defendant failed to demonstrate that it had fully paid plaintiff for [*2]the acupuncture services at issue in accordance with the workers’ compensation fee schedule lacks merit. Plaintiff’s remaining contention is, as plaintiff concedes, based upon material that is dehors the record, and will not be considered.

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

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: May 11, 2012

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

Appeal from an order of the Civil Court of the City of New York, Kings County (Wavny Toussaint, J.), entered August 14, 2009. The order, insofar as appealed from as limited by the brief, granted the branches of defendant’s cross motion seeking summary judgment dismissing the first, second, third and fifth causes of action.

ORDERED that the order, insofar as appealed from, is affirmed, without 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 the branches of defendant’s cross motion seeking summary judgment dismissing the first, second, third and fifth causes of action.

The affidavits submitted by defendant in support of its cross motion for summary judgment established that defendant had timely denied (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]) plaintiff’s claims on the ground that the unpaid portion exceeded the amount permitted by the workers’ compensation fee [*2]schedule. Moreover, defendant demonstrated that it had fully paid plaintiff for the services in accordance with the workers’ compensation fee schedule (see Great Wall Acupuncture, P.C. v GEICO Ins. Co., 26 Misc 3d 23 [App Term, 2d, 11th & 13th Jud Dists 2009]). Accordingly, the order, insofar as appealed from, is affirmed.

Weston, J.P., Pesce and Rios, JJ., concur.
Decision Date: May 11, 2012

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

Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered May 10, 2010. The order, insofar as appealed from, granted the branches of defendant’s motion seeking to compel disclosure and thereafter to produce plaintiff’s owner, Nikolai Lagoduke, for an examination before trial, and denied plaintiff’s cross motion for a protective order and for summary judgment.

ORDERED that the order, insofar as appealed from, is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from so much of an order of the Civil Court as granted the branches of defendant’s motion seeking to compel disclosure and thereafter to produce plaintiff’s owner, Nikolai Lagoduke, for an examination before trial, and denied plaintiff’s cross motion for a protective order and for summary judgment.

Notwithstanding defendant’s failure to assert in its answer a defense pursuant to State Farm Mut. Auto. Ins. Co. v Mallela (4 NY3d 313 [2005]), it was not precluded from seeking discovery related to that defense, since defendant made sufficient allegations in its moving papers that plaintiff, a professional service corporation, is ineligible to recover no-fault benefits because it fails to comply with applicable state or local licensing requirements (Lexington Acupuncture, P.C. v General Assur. Co., ___ Misc 3d ___, 2012 NY Slip Op 22047 [App Term, 2d, 11th & [*2]13th Jud Dists 2012]; Medical Polis, P.C. v Progressive Specialty Ins. Co., 34 Misc 3d 153[A], 2012 NY Slip Op 50342[U] [App Term, 2d, 11th & 13th Jud Dists 2012]). Consequently, the court did not improvidently exercise its discretion in granting the branches of defendant’s motion seeking to compel disclosure and thereafter to produce plaintiff’s owner, Nikolai Lagoduke, for an examination before trial. In light of the foregoing, the court properly denied plaintiff’s cross motion for a protective order and summary judgment (see CPLR 3212 [f]).

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

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: May 11, 2012

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT

Defendant appeals from that portion of an order of the Civil Court of the City of New York, Bronx County (Fernando Tapia, J.), entered March 1, 2011, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Fernando Tapia, J.), entered March 1, 2011, insofar as appealed from, reversed, with $10 costs, motion granted and complaint dismissed. 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 Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 [2011], lv denied 17 NY3d 705 [2011]; cf. Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 [2006]). In opposition, plaintiff did not specifically deny the assignor’s nonappearance or otherwise raise a triable issue with respect thereto (see Unitrin at 560).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concur
Decision Date: May 10, 2012

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

Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered July 28, 2010. The order denied defendant’s motion to vacate an order entered December 8, 2009 which had granted, as unopposed, plaintiff’s motion for summary judgment and had refused to consider, on the ground of untimeliness, defendant’s cross motion for summary judgment dismissing the complaint, and, upon such vacatur, for a new determination of plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint. The appeal is deemed to be from a judgment of the same court entered August 16, 2010 dismissing the complaint (see CPLR 5512 [a]).

ORDERED that the judgment is reversed, without costs, the order entered July 28, 2010 is vacated, defendant’s motion to vacate the order entered December 8, 2009, which had granted, as unopposed, plaintiff’s motion for summary judgment and had refused to consider, on the ground of untimeliness, defendant’s cross motion for summary judgment dismissing the complaint, and, upon such vacatur, for a new determination of plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint is granted, and plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint are remitted to the Civil Court for a new determination.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff’s motion for summary judgment was granted on default inasmuch as the court refused to consider defendant’s opposing papers as well as its cross motion for summary judgment dismissing the complaint because, while the cross motion and opposing papers had been served 21 days before the return date of the motion, they were untimely pursuant to a briefing schedule set by the Civil Court. Defendant appeals from an order entered July 28, 2010 which denied its motion to vacate the default order entered December 8, 2009 and, upon vacatur, for a new determination of plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment.
We deem the appeal to be from the judgment which was subsequently entered (see CPLR 5512 [a]).

The Civil Court’s denial of defendant’s motion was premised upon the fact that the order which had granted plaintiff’s motion on default had already determined that defendant’s untimely [*2]papers should not be considered. However, where, as here, a defendant is seeking to vacate an order entered on default, relief may be granted upon a showing that there was a reasonable excuse for the default and that the defendant has a meritorious defense to the action (see CPLR 5015 [a] [1]; Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138, 141 [1986]; Codoner v Bobby’s Bus Co., Inc., 85 AD3d 843 [2011]; Lane v Smith, 84 AD3d 746 [2011]). In the instant case, defendant proffered a reasonable excuse for its failure to timely submit its opposing papers and cross motion, and also set forth a meritorious defense to the action. Accordingly, the judgment is reversed, the order entered July 28, 2010 is vacated, defendant’s motion to vacate the order entered December 8, 2009, which had granted, as unopposed, plaintiff’s motion for summary judgment and had refused to consider, on the ground of untimeliness, defendant’s cross motion for summary judgment dismissing the complaint, and, upon such vacatur, for a new determination of plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint is granted, and plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint are remitted to the Civil Court for a new determination.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: April 27, 2012

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

Appeals from orders of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered October 6, 2010 and December 20, 2010. The order entered October 6, 2010 granted plaintiff’s unopposed motion for summary judgment. The order entered December 20, 2010 denied defendant’s motion to vacate the order entered October 6, 2010 and, upon such vacatur, to deny plaintiff’s motion for summary judgment. The appeal from the order entered December 20, 2010 is deemed to be from a judgment of the same court entered January 4, 2011 awarding plaintiff the principal sum of $9,697.56 (see CPLR 5512 [a]).

ORDERED that the appeal from the order entered October 6, 2010 is dismissed on the ground that no appeal lies from an order entered upon the default of the appealing party (see CPLR 5511); and it is further,

ORDERED that the judgment is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from, among other things, an order of the Civil Court entered December 20, 2010 which denied defendant’s motion to vacate a prior order entered October 6, 2010 granting plaintiff’s unopposed motion for summary judgment and, upon such vacatur, to deny plaintiff’s motion for summary judgment. We deem the appeal from the order entered December 20, 2010 to be from the judgment which was subsequently entered (see CPLR 5512 [a]).

A defendant seeking to vacate an order entered on default pursuant to CPLR 5015 (a) (1) must demonstrate a reasonable excuse for the default and a meritorious defense to the action (see Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138, 141 [1986]; Hodges v Sidial, 48 AD3d 633, 634 [2008]; Hageman v Home Depot U.S.A., Inc., 25 AD3d 760 [2006]). In the instant case, defendant’s moving papers failed to proffer, let alone establish, a reasonable excuse for the default. Accordingly, the judgment is affirmed.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: April 27, 2012

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

Appeals from orders of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered October 7, 2010 and December 20, 2010. The order entered October 7, 2010 granted plaintiff’s unopposed motion for summary judgment. The order entered December 20, 2010 denied defendant’s motion to vacate the order entered October 7, 2010 and, upon such vacatur, to deny plaintiff’s motion for summary judgment. The appeal from the order entered December 20, 2010 is deemed to be from a judgment of the same court entered January 4, 2011 awarding plaintiff the principal sum of $3,787.20 (see CPLR 5512 [a]).

ORDERED that the appeal from the order entered October 7, 2010 is dismissed on the ground that no appeal lies from an order entered upon the default of the appealing party (see CPLR 5511); and it is further,

ORDERED that the judgment is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from, among other things, an order of the Civil Court entered December 20, 2010 which denied defendant’s motion to vacate a prior order entered October 7, 2010 granting plaintiff’s unopposed motion for summary judgment and, upon such vacatur, to deny plaintiff’s motion for summary judgment. We deem the appeal from the order entered December 20, 2010 to be from the judgment which was subsequently entered (see CPLR 5512 [a]).

A defendant seeking to vacate an order entered on default pursuant to CPLR 5015 (a) (1) must demonstrate a reasonable excuse for the default and a meritorious defense to the action (see Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138, 141 [1986]; Hodges v Sidial, 48 AD3d 633, 634 [2008]; Hageman v Home Depot U.S.A., Inc., 25 AD3d 760 [2006]). In the instant case, defendant’s moving papers failed to proffer, let alone establish, a reasonable excuse for the default. Accordingly, the judgment is affirmed.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: April 27, 2012

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

Appeals from orders of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered October 7, 2010 and December 20, 2010. The order entered October 7, 2010 granted plaintiff’s unopposed motion for summary judgment. The order entered December 20, 2010 denied defendant’s motion to vacate the order entered October 7, 2010 and, upon such vacatur, to deny plaintiff’s motion for summary judgment. The appeal from the order entered December 20, 2010 is deemed to be from a judgment of the same court entered January 4, 2011 awarding plaintiff the principal sum of $3,780.82 (see CPLR 5512 [a]).

ORDERED that the appeal from the order entered October 7, 2010 is dismissed on the ground that no appeal lies from an order entered upon the default of the appealing party (see CPLR 5511); and it is further,

ORDERED that the judgment is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from, among other things, an order of the Civil Court entered December 20, 2010 which denied defendant’s motion to vacate a prior order entered October 7, 2010 granting plaintiff’s unopposed motion for summary judgment and, upon such vacatur, to deny plaintiff’s motion for summary judgment. We deem the appeal from the order entered December 20, 2010 to be from the judgment which was subsequently entered (see CPLR 5512 [a]).

A defendant seeking to vacate an order entered on default pursuant to CPLR 5015 (a) (1) must demonstrate a reasonable excuse for the default and a meritorious defense to the action (see Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138, 141 [1986]; Hodges v Sidial, 48 AD3d 633, 634 [2008]; Hageman v Home Depot U.S.A., Inc., 25 AD3d 760 [2006]). In the instant case, defendant’s moving papers failed to proffer, let alone establish, a reasonable excuse for the default. Accordingly, the judgment is affirmed.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: April 27, 2012