Reported in New York Official Reports at Allstate Social Work & Psychological Servs., P.L.L.C. v Autoone Ins. Co. (2011 NY Slip Op 52295(U))
| Allstate Social Work & Psychological Servs., P.L.L.C. v Autoone Ins. Co. |
| 2011 NY Slip Op 52295(U) [34 Misc 3d 128(A)] |
| Decided on December 19, 2011 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : RIOS, J.P., WESTON and GOLIA, JJ
2010-1125 K C.
against
Autoone Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Robin D. Garson, J.), entered February 2, 2010. The order, insofar as appealed from as limited by the brief, granted the branch of defendant’s motion seeking to vacate the notice of trial, and granted the branch of defendant’s motion seeking to compel plaintiff to respond to defendant’s discovery demands to the extent of directing plaintiff to “respond to defendant’s written demands and provide management agreements, lease agreements, and the names/addresses of all landlords.”
ORDERED that the order, insofar as appealed from, is modified by providing that the branch of defendant’s motion seeking to compel plaintiff to respond to its discovery demands is granted to the extent of directing plaintiff to respond to defendant’s written demands, and to provide defendant with management agreements, lease agreements, and the names and addresses of all landlords, limited to the time period between January 1, 2002 and May 2, 2005; as so modified, 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 as granted the branch of defendant’s motion seeking to vacate the notice of trial, and granted the branch of defendant’s motion seeking to compel plaintiff to respond to defendant’s discovery demands to the extent of directing plaintiff to “respond to defendant’s written demands and provide management agreements, lease agreements, and the names/addresses of all landlords.”
Plaintiff contends on appeal that the Civil Court should not have granted the branch of defendant’s motion seeking to vacate the notice of trial. A review of the record, however, indicates that, in its affirmation in opposition to defendant’s motion, plaintiff failed to argue that the notice of trial should not be vacated. Consequently, this contention is unpreserved for appellate review. In any event, since defendant timely moved to vacate the notice of trial (see Uniform Rules of the New York City Civil Court [22 NYCRR] § 208.17 [c]), which notice contains the erroneous statement that discovery has been completed (see Savino v Lewittes, 160 AD2d 176 [1990]; Queens Chiropractic Mgt, P.C. v Country Wide Ins. Co., 23 Misc 3d 142[A], [*2]2009 NY Slip Op 51073[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; First Aid Occupational Therapy, PLLC v State Farm Mut. Auto. Ins. Co., 21 Misc 3d 128[A], 2008 NY Slip Op 51963[U] [App Term, 2d & 11th Jud Dists 2008]; Great Wall Acupuncture, P.C. v General Assur. Co., 21 Misc 3d 45 [App Term, 2d & 11th Jud Dists 2008]), the notice of trial was properly vacated (see Gregory v Ford Motor Credit Co., 298 AD2d 496, 497 [2002]).
Inasmuch as plaintiff failed to timely challenge the propriety of defendant’s discovery demands, it is obligated to produce the information sought except as to matters which are privileged or palpably improper (see Fausto v City of New York, 17 AD3d 520 [2005]; Marino v County of Nassau, 16 AD3d 628 [2005]; Midborough Acupuncture, P.C. v State Farm Ins. Co., 21 Misc 3d 10 [App Term, 2d & 11th Jud Dists 2008]; Great Wall Acupuncture v State Farm Mut. Auto. Ins. Co., 20 Misc 3d 136[A], 2008 NY Slip Op 51529[U] [App Term, 2d & 11th Jud Dists 2008]). Discovery demands concerning matters relating to defenses which a defendant is precluded from raising are palpably improper even where the plaintiff did not specifically object thereto (see Midborough Acupuncture, P.C., 21 Misc 3d 10; Great Wall Acupuncture, 20 Misc 3d 136[A], 2008 NY Slip Op 51529[U]; A.B. Med. Servs. PLLC v Utica Mut. Ins. Co., 11 Misc 3d 71 [App Term, 2d & 11th Jud Dists 2006]). An affirmative defense that a professional service corporation fails to comply with applicable state or local licensing laws and, thus, is ineligible to recover no-fault benefits (see State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]), is not precludable. In the instant case, plaintiff has failed to demonstrate that defendant is seeking to obtain discovery relating to precluded defenses.
In view of the fact that defendant’s interrogatories sought information for the time period of January 1, 2002 until the date of the interrogatories, May 2, 2005, the order is modified by providing that the branch of defendant’s motion seeking to compel plaintiff to respond to its discovery demands is granted to the extent of directing plaintiff to respond to defendant’s written demands, and to provide defendant with management agreements, lease agreements, and the names and addresses of all landlords, limited to the time period between January 1, 2002 and May 2, 2005. Plaintiff’s remaining contentions lack merit.
Rios, J.P., Weston and Golia, JJ., concur.
Decision Date: December 19, 2011
Reported in New York Official Reports at Crossbridge Diagnostic Radiology v Progressive Northeastern Ins. Co. (2011 NY Slip Op 52294(U))
| Crossbridge Diagnostic Radiology v Progressive Northeastern Ins. Co. |
| 2011 NY Slip Op 52294(U) [34 Misc 3d 128(A)] |
| Decided on December 19, 2011 |
| 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. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : RIOS, J.P., WESTON and GOLIA, JJ
2010-1108 K C.
against
Progressive Northeastern Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered March 11, 2010. The order denied plaintiff’s motion to vacate a prior order granting defendant’s unopposed motion for summary judgment.
ORDERED that the order is affirmed, without costs.
In this action by a provider to recover assigned first party no-fault benefits, the Civil Court did not improvidently exercise its discretion in denying plaintiff’s motion to vacate a prior order granting defendant’s unopposed motion for summary judgment, since plaintiff failed to demonstrate a reasonable excuse for its failure to submit written opposition to defendant’s motion (see CPLR 5015 [a] [1]; Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138, 141 [1986]). Accordingly, the order is affirmed.
Rios, J.P., Weston and Golia, JJ., concur.
Decision Date: December 19, 2011
Reported in New York Official Reports at Great Wall Acupuncture, P.C. v Interboro Mut. Indem. Ins. (2011 NY Slip Op 52293(U))
| Great Wall Acupuncture, P.C. v Interboro Mut. Indem. Ins. |
| 2011 NY Slip Op 52293(U) [34 Misc 3d 128(A)] |
| Decided on December 19, 2011 |
| 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. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : RIOS, J.P., WESTON and GOLIA, JJ
2010-1106 K C.
against
Interboro Mutual Indemnity Ins., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Wavny Toussaint J.), entered October 6, 2009. The order denied plaintiff’s motion for leave to enter judgment.
ORDERED that the order is affirmed, without costs.
Plaintiff commenced this action to recover the sum of $3,854.30 in assigned first-party no-fault benefits. In April 2006, the attorneys for plaintiff and defendant entered into a “Stipulation of Settlement,” settling plaintiff’s claim for the sum of $1,387.55, which amount had to be received by plaintiff’s attorney within 30 days. The stipulation provided that, pursuant to CPLR 3215 (i) (1), defendant’s failure to comply with its terms would result in the entry of judgment in the sum of $1,387.55, plus interest. The parties also executed a “Stipulation Discontinuing Action After Settlement,” dated April 2006, which provided, among other things, that:
“This stipulation may be filed with the Clerk of the Court without further notice to either party.”
Both parties agree that the stipulation of settlement did not become effective until August 8, 2007.
Thereafter, defendant sent plaintiff two checks, each dated September 7, 2007, totalling the
sum of $1,387.55. Plaintiff’s attorney stated that he did not receive any payment within 30 days
as required by the terms of the stipulation of settlement and, therefore, negotiated a second
stipulation with defendant which settled the claim for the sum of $3,250. Defendant signed and
returned the second stipulation to plaintiff’s attorney in October 2007. In the interim, plaintiff
received defendant’s two checks totaling $1,387.55, which plaintiff deposited on September 24,
2007. After defendant failed to pay the additional amount owed pursuant to the second [*2]stipulation, plaintiff attempted to enter judgment but, since
defendant had already filed the April 2006 stipulation of discontinuance, the clerk would not
enter judgment. Plaintiff subsequently moved for leave to enter judgment, which motion the
Civil Court denied “based upon a
review of all papers which indicate a settlement was entered into, payment was made upon
it and checks were cashed without a reservation of rights.”
It is uncontroverted that plaintiff signed a stipulation of discontinuance, with prejudice, which was filed in the Civil Court prior to plaintiff’s attempt to enter judgment on the second stipulation. Since the instant action was terminated with the filing of the binding stipulation of discontinuance (see CPLR 2104), the relief requested by plaintiff was no longer available by motion in this action but, rather, plaintiff was required to commence a plenary action (see Teitelbaum Holdings v Gold, 48 NY2d 51 [1979]; Matter of Serpico, 62 AD3d 887 [2009]; Zeer v Azulay, 50 AD3d 781, 785 [2008]).
Accordingly, the order is affirmed, albeit on other grounds. We pass on no other issue.
Rios, J.P., Weston and Golia, JJ., concur.
Decision Date: December 19, 2011
Reported in New York Official Reports at All Points Med. Supply, Inc. v Clarendon Ins. Co. (2011 NY Slip Op 52292(U))
| All Points Med. Supply, Inc. v Clarendon Ins. Co. |
| 2011 NY Slip Op 52292(U) [34 Misc 3d 128(A)] |
| Decided on December 19, 2011 |
| 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. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON and RIOS, JJ
2010-1093 Q C.
against
Clarendon Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered February 24, 2010. The order, insofar as appealed from as limited by the brief, denied the branches of defendant’s motion for summary judgment seeking the dismissal of the first through fourth causes of action.
ORDERED that the order, insofar as appealed from, is reversed, without costs, and the branches of defendant’s motion for summary judgment seeking the dismissal of the first through fourth causes of action are granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much of an order as denied the branches of its motion for summary judgment seeking the dismissal of the first through fourth causes of action.
In support of its motion, defendant submitted, among other things, affirmed peer review reports which set forth the factual basis and medical rationale for the doctor’s determination that there was a lack of medical necessity for the supplies at issue. Defendant’s showing that the supplies were not medically necessary was not rebutted by plaintiff. As plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, the branches of defendant’s motion for summary judgment seeking the dismissal of plaintiff’s first through fourth causes of action are granted (see Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]; A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).
Accordingly, the order, insofar as appealed from, is reversed and the branches of defendant’s motion for summary judgment seeking the dismissal of the first through fourth causes of action are granted.
Pesce, P.J., Weston and Rios, JJ., concur.
Decision Date: December 19, 2011
Reported in New York Official Reports at Vega Chiropractic, P.C. v Kemper Independence Ins. Co. (2011 NY Slip Op 52291(U))
| Vega Chiropractic, P.C. v Kemper Independence Ins. Co. |
| 2011 NY Slip Op 52291(U) [34 Misc 3d 128(A)] |
| Decided on December 19, 2011 |
| 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. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : RIOS, J.P., WESTON and GOLIA, JJ
2010-1059 Q C.
against
Kemper Independence Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered March 3, 2010. The order, insofar as appealed from as limited by the brief, granted defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is modified by striking so much of
the order as granted the branches of defendant’s motion for summary judgment seeking to dismiss
plaintiff’s $155.84 claim for services rendered September 18, 2007 through September 27, 2007
and plaintiff’s $134.80 claim for services rendered October 2, 2007 through October 11, 2007; as
so modified, the order, insofar
as appealed from, is affirmed, without costs, and the matter is remitted to the Civil Court
for a new determination of the aforesaid branches of defendant’s motion in accordance with the
decision herein.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff, as limited by its brief, appeals from so much of an order of the Civil Court as granted defendant’s motion for summary judgment dismissing the complaint.
We note, at the outset, that defendant denied all of the claims, except for claims in the sums of $155.84 and $134.80 for services rendered September 18, 2007 through October 11, 2007, on the ground that plaintiff’s assignor had failed to appear at any of three independent medical examinations (IMEs). The Civil Court found that defendant’s motion papers established the assignor’s failure to appear for the IMEs and granted defendant’s motion for summary judgment dismissing the complaint. Plaintiff contends on appeal that the scheduling of the examinations was unreasonable. However, since plaintiff failed to submit sufficient evidence to raise an issue of fact as to the reasonableness of the scheduling of the IMEs, we leave undisturbed so much of the order as granted defendant summary judgment dismissing the complaint with respect to all of the claims, other than the claims for $155.84 and $134.80 (see e.g. All Borough Group Med. Supply, Inc. v Utica Mut. Ins. Co., 31 Misc 3d 146[A], 2011 NY Slip Op 50949[U] [App Term, 2d, 11th & 13th Jud Dists 2011]). [*2]
With respect to plaintiff’s claims for $155.84 and $134.80, defendant, in its brief, in effect concedes that it is not entitled to summary judgment dismissing these claims on the ground relied upon by the Civil Court. Defendant requests that these claims be “returned to the lower court for a determination as to the merits of defendant’s summary judgment motion” based upon the grounds set forth in its motion papers. As the record indicates that the Civil Court apparently did not consider the grounds upon which defendant sought summary judgment with respect to the claims for $155.84 and $134.80, so much of the Civil Court’s order as granted the branches of defendant’s motion for summary judgment seeking to dismiss these claims is stricken, and the matter is remitted to the Civil Court for a new determination with respect to these two claims.
Rios, J.P., Weston and Golia, JJ., concur.
Decision Date: December 19, 2011
Reported in New York Official Reports at Jesa Med. Supply, Inc. v Progressive Ins. Co. (2011 NY Slip Op 52290(U))
| Jesa Med. Supply, Inc. v Progressive Ins. Co. |
| 2011 NY Slip Op 52290(U) [34 Misc 3d 128(A)] |
| Decided on December 19, 2011 |
| 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. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., RIOS and STEINHARDT, JJ
.
against
Progressive Insurance Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Alice Fisher Rubin, J.), entered February 5, 2010. 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, without 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. The Civil Court found that plaintiff had established its prima facie case, that defendant had demonstrated that it had timely denied plaintiff’s claims and that the sole issue for trial was the medical necessity of the supplies provided to plaintiff’s assignor. Defendant appeals from so much of the order as denied its cross motion for summary judgment dismissing the complaint.
In support of its cross motion, defendant submitted, among other things, an affirmed peer review report which set forth a factual basis and medical rationale for the doctor’s determination that there was a lack of medical necessity for the supplies at issue. Defendant’s showing that the supplies were not medically necessary was unrebutted by plaintiff.
As plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, defendant’s cross motion for summary judgment dismissing the complaint is granted (see Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]; A. KhodadadiRadiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).
Pesce, P.J., Rios and Steinhardt, JJ., concur.
[*2]
Decision Date: December 19, 2011
Reported in New York Official Reports at Comfort Supply, Inc. v Progressive Northeastern Ins. Co. (2011 NY Slip Op 52289(U))
| Comfort Supply, Inc. v Progressive Northeastern Ins. Co. |
| 2011 NY Slip Op 52289(U) [34 Misc 3d 128(A)] |
| Decided on December 19, 2011 |
| 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. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : WESTON, J.P., GOLIA and RIOS, JJ
2010-748 K C.
against
Progressive Northeastern Insurance Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Margaret A. Pui Yee Chan, J.), entered October 22, 2009. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.
ORDERED that 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 granting defendant’s motion for summary judgment dismissing the complaint and denying plaintiff’s cross motion for summary judgment.
In support of its motion, defendant submitted an affidavit of its litigation representative which was sufficient to establish that the denial of claim forms, which had denied the claims at issue on the ground of lack of medical necessity, 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]). Defendant also submitted an affirmed peer review report which set forth a factual basis and medical rationale for the doctor’s determination that there was a lack of medical necessity for the equipment provided to plaintiff’s assignor (see Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]). Contrary to plaintiff’s assertion, the fact that defendant did not annex the underlying medical records which the peer reviewer considered in formulating his opinion did not render the peer review report inadmissible (see Neomy Med., P.C. v GEICO Ins. Co., 32 Misc 3d 137[A], 2011 NY Slip Op 51532[U] [App Term, 2d, 11th & 13th Jud Dists 2011]; Urban Radiology, P.C. v Tri-State Consumer Ins. Co., 27 Misc 3d 140[A], 2010 NY Slip Op 50987[U] [App Term, 2d, 11th & 13th Jud Dists 2010]). Since defendant [*2]established, prima facie, a lack of medical necessity for the equipment in question, the burden shifted to plaintiff to rebut defendant’s prima facie showing (see Alur Med. Supply, Inc. v Clarendon Natl. Ins. Co., 27 Misc 3d 132[A], 2010 NY Slip Op 50700[U] [App Term, 2d, 11th & 13th Jud Dists 2010]; Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]), but plaintiff failed to do so.
As plaintiff’s remaining contentions are either unpreserved or lack merit (see e.g. Quality Health Prods., Inc. v NY Cent. Mut. Fire Ins. Co., 27 Misc 3d 141[A], 2010 NY Slip Op 50990[U] [App Term, 2d, 11th & 13th Jud Dists 2010]), the order is affirmed (see A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).
Weston, J.P., Golia and Rios, JJ., concur.
Decision Date: December 19, 2011
Reported in New York Official Reports at WJJ Acupuncture, P.C. v Nationwide Mut. Ins. Co. (2011 NY Slip Op 52288(U))
| WJJ Acupuncture, P.C. vNationwide Mut. Ins. Co. |
| 2011 NY Slip Op 52288(U) [34 Misc 3d 127(A)] |
| Decided on December 19, 2011 |
| 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. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : STEINHARDT, J.P., PESCE and WESTON, JJ
2010-530 K C.
against
Nationwide Mutual Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Margaret A. Pui Yee Chan, J.), dated October 23, 2009. The order, insofar as appealed from as limited by the brief, granted defendant’s motion for summary judgment dismissing the complaint. ORDERED that the order, insofar as appealed from, is reversed, without 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, plaintiff appeals, as limited by its brief, from so much of an order of the Civil Court as granted defendant’s motion for summary judgment dismissing the complaint.
In support of its motion for summary judgment, defendant submitted an affidavit of its claims representative which established neither that the denial of claim forms, which denied the claims at issue on the ground that the fees sought exceeded the amount permitted by the workers’ compensation fee schedule, had actually been timely mailed nor that they had been timely mailed in accordance with defendant’s standard office practices and procedures so as to give rise to the presumption of mailing (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]). Thus, defendant’s motion for summary judgment should have been denied.
In view of the foregoing, we reach no other issue. Accordingly, the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment is denied.
Steinhardt, J.P., Pesce and Weston, JJ., concur.
Decision Date: December 19, 2011
Reported in New York Official Reports at New Millennium Psychological Servs., P.C. v Commerce Ins. Co. (2011 NY Slip Op 52286(U))
| New Millennium Psychological Servs., P.C. v Commerce Ins. Co. |
| 2011 NY Slip Op 52286(U) [34 Misc 3d 127(A)] |
| Decided on December 16, 2011 |
| 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. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : WESTON, J.P., GOLIA and RIOS, JJ
2010-2229 Q C.
against
Commerce Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered April 29, 2010, deemed from a judgment of the same court entered August 11, 2010 (see CPLR 5501 [c]). The judgment, entered pursuant to the April 29, 2010 order granting defendant’s motion for summary judgment, dismissed the complaint.
ORDERED that the judgment is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground of fraudulent procurement of the insurance policy by virtue of the assignor misrepresenting his state of residence in connection with the issuance of the insurance policy in question. The Civil Court granted defendant’s motion for summary judgment and dismissed the complaint. This appeal by plaintiff ensued. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).
The sole argument raised on appeal is whether defendant proffered admissible evidence of a fraudulently procured insurance policy. Upon our review of the record, we find that the affidavits and investigative reports annexed to defendant’s motion papers sufficiently established that the assignor, who was also the insured under the subject insurance policy, had misrepresented his state of residence. Furthermore, the evidence submitted by defendant established that this misrepresentation was material since defendant would not have issued the policy had it known that the assignor resided in the State of New York, as defendant was not licensed to insure vehicles in New York at the time of this loss, and would not have issued the subject policy to him. Thus, the assignor was ineligible to receive first-party no-fault benefits under the insurance policy in question (see Matter of Insurance Co. of N. Am. v Kaplun, 274 AD2d 293 [2000]; Central Radiology Servs., P.C. v Commerce Ins. Co., 31 Misc 3d 146[A], 2011 NY Slip Op 50948[U] [App Term, 2d, 11th & 13th Jud Dists 2011]; A.B. Med. Servs. PLLC v Commercial Mut. Ins. Co., 12 Misc 3d 8 [App Term, 2d & 11th Jud Dists 2006]). In opposition, plaintiff, as assignee standing in the shoes of its assignor (see New York & Presbyt. [*2]Hosp. v Country Wide Ins. Co., NY3d , 2011 NY Slip Op 07149 [2011]), failed to submit any evidence sufficient to defeat defendant’s motion for summary judgment. Accordingly, the judgment is affirmed.
Weston, J.P., Golia and Rios, JJ., concur.
Decision Date: December 16, 2011
Reported in New York Official Reports at Queens Med. Supply, Inc. v Geico Gen. Ins. Co. (2011 NY Slip Op 52284(U))
| Queens Med. Supply, Inc. v Geico Gen. Ins. Co. |
| 2011 NY Slip Op 52284(U) [34 Misc 3d 127(A)] |
| Decided on December 16, 2011 |
| 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. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., RIOS and STEINHARDT, JJ
2010-2198 K C.
against
Geico General Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Lisa S. Ottley, J.), entered April 27, 2010. 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, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order denying its motion for summary judgment and granting defendant’s cross motion for summary judgment dismissing the complaint.
The affidavit submitted by defendant in support of its cross motion for summary judgment established that defendant had timely denied the claim at issue, on the ground of lack of medical necessity, 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]). Moreover, defendant annexed to its motion papers an affirmed peer review report which set forth a factual basis and medical rationale for the peer reviewer’s determination that there was a lack of medical necessity for the supplies provided (see e.g. Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]; A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).
In opposition to defendant’s cross motion for summary judgment, plaintiff failed to raise a triable issue of fact, since it did not submit an affirmation from a doctor rebutting the conclusions set forth in the peer review report (see Innovative Chiropractic, P.C. v Mercury Ins. Co., 25 Misc 3d 137[A], 2009 NY Slip Op 52321[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). While plaintiff asserted that the peer review report [*2]contained an electronic stamped facsimile of the peer reviewer’s signature and, as a result, the report was inadmissible, the record indicates that the facsimile signature was placed on the report by the doctor who had performed the peer review or at his direction (see Eden Med., P.C. v Eveready Ins. Co., 26 Misc 3d 140[A], 2010 NY Slip Op 50265[U] [App Term, 2d, 11th & 13th Jud Dists 2010]; cf. Orthotic Surgical & Med. Supply, Inc. v GEICO Ins. Co., 20 Misc 3d 137[A], 2008 NY Slip Op 51540[U] [App Term, 2d & 11th Jud Dists 2008]; Radiology Today, P.C. v GEICO Ins. Co., 20 Misc 3d 70 [App Term, 2d & 11th Jud Dists 2008]). Thus, the Civil Court properly granted defendant’s cross motion for summary judgment dismissing the complaint and denied plaintiff’s motion for summary judgment.
Accordingly, the order is affirmed.
Pesce, P.J., Rios and Steinhardt, JJ., concur.
Decision Date: December 16, 2011