Reported in New York Official Reports at EMC Health Prods., Inc. v Erie Ins. Co. of N.Y. (2016 NY Slip Op 51788(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Erie Insurance Company of New York, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Carol Ruth Feinman, J.), entered July 7, 2014. The order denied defendant’s motion to vacate a prior order of the same court (Wavny Toussaint, J.) entered September 24, 2013 which, upon defendant’s default in appearing for oral argument, granted plaintiff’s motion for summary judgment and denied defendant’s cross motion for summary judgment dismissing the complaint, and, upon vacatur of the September 24, 2013 order, for a finding that the complaint had been dismissed pursuant to a previously issued, self-executing conditional order or, in the alternative, for “permission to reargue” defendant’s cross motion and its opposition to plaintiff’s motion.
ORDERED that the order entered July 7, 2014 is modified by providing that the branch of defendant’s motion seeking to vacate the order entered September 24, 2013 is granted and the matter is remitted to the Civil Court for argument and determination of plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint; as so modified, the order entered July 7, 2014 is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court entered July 7, 2014 which denied its motion to vacate a prior order, entered September 24, 2013, which had granted plaintiff’s motion for summary judgment and denied defendant’s cross motion for summary judgment dismissing the complaint upon defendant’s default in appearing for oral argument, and, upon vacatur, to find that the complaint had been dismissed pursuant to a previously issued, self-executing conditional order or, in the alternative, for “permission to reargue” its cross motion and its opposition to plaintiff’s motion.
In order to be entitled to vacatur of the entire order entered September 24, 2013, which was issued upon defendant’s failure to appear for oral argument, defendant was required to establish, pursuant to CPLR 5015 (a) (1), a reasonable excuse for its default, a potentially meritorious defense to plaintiff’s motion and the potential merits of the cross motion (see 1158 Props., LLC v 1158 McDonald, LLC, 104 AD3d 658 [2013]; A.B. Med. Servs., PLLC v GLI Corporate Risk Solutions, Inc., 25 Misc 3d 137[A], 2009 NY Slip Op 52322[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Here, defendant’s attorney submitted an affirmation in which he explained that he had been late to the calendar call because there had been a major traffic jam due to a car accident, and that he had requested that plaintiff vacate the default upon [*2]his arrival. We find that defendant thereby established a reasonable excuse for its default (see Morales v Marma, 88 AD3d 722, 723 [2011]; Felsen v Stop & Shop Supermarket Co., LLC, 83 AD3d 656, 656-657 [2011]; Reices v Catholic Med. Ctr. of Brooklyn & Queens, 306 AD2d 394 [2003]). Furthermore, defendant demonstrated the existence of a potentially meritorious defense to plaintiff’s motion and the potential merits of the cross motion. Accordingly, the branch of defendant’s motion seeking to vacate the prior order should have been granted.
Defendant argues that the complaint had already been dismissed because plaintiff allegedly failed to comply with a conditional, self-executing order dated June 24, 2013. However, defendant has not given any indication that the June 24, 2013 order had been served on plaintiff. Therefore, defendant has not demonstrated that the order became binding (see CPLR 2220; All Boro Psychological Servs., P.C. v Travelers Prop. Cas. Co. of Am., 44 Misc 3d 48, 50 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]). Consequently, we cannot find, on this record, that the complaint had been dismissed.
In view of the foregoing, we remit the matter to the Civil Court for argument and determination of plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint.
Accordingly, the order entered July 7, 2014 is modified by providing that the branch of defendant’s motion seeking to vacate the order entered September 24, 2013 is granted, and the matter is remitted to the Civil Court for argument and determination of plaintiff’s motion for summary judgment and defendant’s cross motion for summary judgment dismissing the complaint.
Aliotta, J.P., Pesce and Solomon, JJ., concur.
Decision Date: December 07, 2016
Reported in New York Official Reports at A.C. Med., P.C. v Ameriprise Ins. Co. (2016 NY Slip Op 51787(U))
| A.C. Med., P.C. v Ameriprise Ins. Co. |
| 2016 NY Slip Op 51787(U) [54 Misc 3d 127(A)] |
| Decided on December 7, 2016 |
| 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 December 7, 2016
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : ALIOTTA, J.P., PESCE and SOLOMON, JJ.
2015-1171 K C
against
Ameriprise Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered April 24, 2015. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross 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, defendant moved for summary judgment dismissing the complaint on the ground that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). Plaintiff opposed the motion and cross-moved for summary judgment. By order entered April 24, 2015, the Civil Court denied defendant’s motion and granted plaintiff’s cross motion.
Contrary to defendant’s sole argument on appeal, that it was entitled to summary judgment dismissing the complaint based upon plaintiff’s nonappearance at duly scheduled EUOs, defendant failed to establish that it had timely (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and properly denied the claims. Pursuant to the no-fault regulations, “any additional verification required by the insurer to establish proof of claim shall be requested within 15 business days of receipt of the prescribed verification forms” (11 NYCRR 65-3.5 [b]). Since defendant received the claim in the amount of $403.58 on August 28, 2012 and mailed an EUO scheduling letter to plaintiff on September 26, 2012, defendant’s time to pay or deny that claim was reduced by the number of days that the EUO request was late (see 11 NYCRR 65-3.8 [l]). However, defendant did not timely deny that claim after plaintiff had failed to appear for the second scheduled EUO (see 11 NYCRR 65-3.8 [a] [1]). With respect to the remaining claims, because defendant did not mail its first EUO scheduling letter to plaintiff within 30 calendar days of receiving those claims, the scheduling letter was rendered a nullity by its untimeliness (see O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134[A], 2015 NY Slip Op 50476[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]) and did not toll defendant’s time to pay or deny those claims. Consequently, defendant failed to establish that it had timely denied the remaining claims and, thus, defendant is precluded from interposing its defense (see Nyack Hosp. v Encompass Ins. Co., 23 AD3d 535 [2005]; Points of Health Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133[A], 2010 NY Slip Op 51338[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2010]) that plaintiff had failed to comply with a condition precedent to coverage (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. [*2]Co., 35 AD3d 720 [2006]).
Accordingly, the order is affirmed.
Aliotta, J.P., Pesce and Solomon, JJ., concur.
Decision Date: December 07, 2016
Reported in New York Official Reports at Healthway Med. Care, P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51786(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
American Transit Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Terrence C. O’Connor, J.), entered March 26, 2015. 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.
Plaintiff commenced this action on November 1, 2013 to recover assigned first-party no-fault benefits for medical services provided to its assignor for injuries she had allegedly sustained in a motor vehicle accident on June 12, 2011. Plaintiff moved for summary judgment, and defendant opposed the motion on the ground that plaintiff failed to establish its prima facie case. Defendant cross-moved for summary judgment dismissing the complaint on the ground that the action is barred by the doctrine of res judicata. In support of its cross motion, defendant proffered an order, entered May 31, 2013, in a declaratory judgment action in the Supreme Court, New York County, that had been commenced against, among other parties, plaintiff herein and its assignor. The Supreme Court declared that the insurer is not required to pay any claims for no-fault benefits under the policy at issue with respect to an alleged accident on June 12, 2011. By order entered March 26, 2015, the Civil Court denied plaintiff’s motion and granted defendant’s cross motion on the basis of the order in the declaratory judgment action. On appeal, plaintiff argues that it established its prima facie entitlement to summary judgment and that defendant failed to demonstrate that the causes of action in the present matter arose out of the same transaction as the causes of action in the Supreme Court action.
Under the doctrine of res judicata, a disposition on the merits bars litigation between the same parties of a cause of action arising out of the same transaction or series of transactions as a cause of action that either was raised or could have been raised in the prior action (see Abraham v Hermitage Ins. Co., 47 AD3d 855 [2008]).
“The rationale underlying this principle is that a party who has been given a full and fair opportunity to litigate a claim should not be allowed to do so again” (Matter of Hunter, 4 NY3d 260, 269 [2005]). In the case at bar, the determination as to whether defendant was obligated to pay plaintiff’s claims “arises out of the same transaction, i.e., the subject accident” of June 12, 2011 (see SZ Med., P.C. v Erie Ins. Co., 24 Misc 3d 126[A], 2009 NY Slip Op 51221[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]), and involves the same insurer, medical [*2]provider and injured party as were involved in the Supreme Court declaratory judgment action. Thus, in light of the May 31, 2013 order of the Supreme Court, the instant action is barred under the doctrine of res judicata (see EBM Med. Health Care, P.C. v Republic W. Ins., 38 Misc 3d 1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]). A different result in the instant action would destroy or impair rights or interests established by the Supreme Court order (see Schuylkill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 [1929]). Consequently, the Civil Court properly granted defendant’s cross motion and denied plaintiff’s motion. In view of the foregoing, we do not reach plaintiff’s remaining contention.
Accordingly, the order is affirmed.
Aliotta, J.P., Pesce and Solomon, JJ., concur.
Decision Date: December 07, 2016
Reported in New York Official Reports at J.K.M. Med. Care, P.C. v Ameriprise Auto & Home Ins. Co. (2016 NY Slip Op 51773(U))
| J.K.M. Med. Care, P.C. v Ameriprise Auto & Home Ins. Co. |
| 2016 NY Slip Op 51773(U) [54 Misc 3d 126(A)] |
| Decided on December 7, 2016 |
| 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 December 7, 2016
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : SOLOMON, J.P., WESTON and ELLIOT, JJ.
2014-1232 K C
against
Ameriprise Auto & Home Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Carol Ruth Feinman, J.), entered May 1, 2014. The order granted defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.
Plaintiff commenced this action on May 6, 2013 to recover assigned first-party no-fault benefits for medical services that it had provided as a result of a motor vehicle accident that had occurred on May 5, 2011. The injured party, Tevin Jackson, signed an assignment of benefits to plaintiff on May 6, 2011. Defendant purported to schedule an examination under oath (EUO) of the assignor to be held on July 29, 2011, and, upon the assignor’s alleged nonappearance, a follow-up EUO on September 12, 2011.
On August 21, 2013, defendant moved for summary judgment dismissing the complaint on the ground that defendant is not obligated to pay assigned first-party no-fault benefits to plaintiff in light of a Supreme Court order and on the additional ground that the assignor had failed to appear for scheduled EUOs. Plaintiff opposed the motion. By order entered May 1, 2014, the Civil Court granted defendant’s motion.
For the reasons stated in J.K.M. Med. Care, P.C. as Assignee of Latoya Payne v Ameriprise Ins. Co. (___ Misc 3d ___, 2016 NY Slip Op _____ [appeal No. 2014-1219 K C], decided herewith), the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.
Solomon, J.P., Weston and Elliot, JJ., concur.
Decision Date: December 07, 2016
Reported in New York Official Reports at J.K.M. Med. Care, P.C. v Ameriprise Ins. Co. (2016 NY Slip Op 26424)
| J.K.M. Med. Care, P.C. v Ameriprise Ins. Co. |
| 2016 NY Slip Op 26424 [54 Misc 3d 54] |
| Accepted for Miscellaneous Reports Publication |
| Supreme Court, Appellate Term, Second Department, 2d, 11th and 13th Judicial Districts |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected through Wednesday, March 15, 2017 |
[*1]
| J.K.M. Medical Care, P.C., as Assignee of Latoya Payne, Appellant, v Ameriprise Insurance Company, Respondent. |
Supreme Court, Appellate Term, Second Department, 2d, 11th and 13th Judicial Districts, December 7, 2016
APPEARANCES OF COUNSEL
Law Offices of Melissa Betancourt, P.C., Brooklyn (Melissa Betancourt of counsel), for appellant.
Bruno, Gerbino & Soriano, LLP, Melville (Mitchell L. Kaufman of counsel), for respondent.
{**54 Misc 3d at 55} OPINION OF THE COURT
Ordered that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.
Plaintiff commenced this action on May 6, 2013 to recover assigned first-party no-fault benefits for medical services that it had provided as a result of a motor vehicle accident that had occurred on May 5, 2011. The injured party, Latoya Payne, signed an assignment of benefits to plaintiff on May 6, 2011. Defendant purported to schedule an examination under oath (EUO) of the assignor to be held on July 29, 2011, and, upon the assignor’s alleged nonappearance, a follow-up EUO on September 12, 2011. Subsequent to the assignment of benefits and the scheduling of the EUOs, defendant commenced a proceeding against Latoya Payne, Tevin Jackson and two other individuals in the Supreme Court, Kings County, to compel them to appear at EUOs, asserting in the petition that they had failed to appear for two scheduled examinations. Defendant’s petition also sought declaratory relief in the event of their nonappearances at a future EUO. Plaintiff was not named as a respondent in the proceeding. The Supreme Court granted defendant’s motion, and defendant then purported to schedule a third EUO to be held on April 27, 2012. Thereafter, defendant moved in the Supreme Court, pursuant to CPLR 3215 (a), for a default judgment against Latoya Payne, Tevin Jackson and the two other individuals, and argued that they had failed to appear for the third EUO. By order dated December 5, 2012, the Supreme Court granted defendant’s motion and declared that all first-party coverage for no-fault benefits was disclaimed as to Latoya Payne and the three other individuals, or any assignee under the subject policy with respect to the motor vehicle collision at issue.{**54 Misc 3d at 56}
On August 21, 2013, defendant moved in the Civil Court for summary judgment dismissing the complaint on the grounds that defendant is not obligated to pay assigned first-party no-fault benefits to plaintiff in light of the Supreme Court order and that the assignor had failed to appear for scheduled EUOs. Plaintiff opposed the motion, arguing, among other things, that it is not bound by the declaratory judgment rendered in the Supreme Court proceeding and that defendant failed to establish that it had timely and properly scheduled EUOs. By order entered May 1, 2014, the Civil Court granted defendant’s motion. We reverse.
[*2]Plaintiff herein was neither named nor served in the Supreme Court proceeding, nor, at the time, was plaintiff in privity with its assignor, who was a named party in that proceeding, as the assignment of benefits had been executed before defendant had commenced the Supreme Court proceeding to compel the assignor’s appearance at an EUO or for declaratory relief upon the assignor’s failure to appear. As plaintiff had no full and fair opportunity to appear and defend its interests in the Supreme Court proceeding, the present action in the Civil Court is not subject to summary judgment dismissing the complaint by virtue of the Supreme Court declaration (see Gramatan Home Invs. Corp. v Lopez, 46 NY2d 481 [1979]; Smooth Dental, P.L.L.C. v Preferred Mut. Ins. Co., 37 Misc 3d 67 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]; Magic Recovery Med. & Surgical Supply Inc. v State Farm Mut. Auto. Ins. Co., 27 Misc 3d 67 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2010]).
Defendant argues that, even in the absence of a judicial declaration, the order granting defendant’s motion for summary judgment dismissing the complaint should be affirmed on the alternative ground that plaintiff’s assignor had failed to appear for duly scheduled EUOs. However, contrary to defendant’s assertion, defendant failed to establish that it had timely and properly mailed its EUO scheduling letters (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Furthermore, plaintiff properly argues that the scheduling letters failed to advise the assignor, in accordance with 11 NYCRR 65-3.5 (e), that she would be reimbursed for any loss of earnings and reasonable transportation costs incurred in complying with the request for an EUO. Thus, defendant failed to demonstrate entitlement to summary judgment dismissing the complaint on either ground.{**54 Misc 3d at 57}
Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is denied.
Solomon, J.P., Weston and Elliot, JJ., concur.
Reported in New York Official Reports at Matter of Liberty Mut. Fire Ins. Co. v Global Liberty Ins. Co. of N.Y. (2016 NY Slip Op 08078)
| Matter of Liberty Mut. Fire Ins. Co. v Global Liberty Ins. Co. of N.Y. |
| 2016 NY Slip Op 08078 [144 AD3d 1160] |
| November 30, 2016 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| In the Matter of Liberty Mutual Fire Insurance
Company, as Subrogee of Mohan Singh, Respondent, v Global Liberty Insurance Co. of N.Y., Appellant. |
The Law Office of Jason Tenenbaum, P.C., Garden City, NY, for appellant.
Sim & Record, LLP, Bayside, NY (Sang J. Sim of counsel), for respondent.
In a proceeding pursuant to CPLR 7511 to vacate an arbitration award dated March 24, 2014, in which Global Liberty Insurance Co. of N.Y. cross-petitioned to confirm the award, Global Liberty Insurance Co. of N.Y. appeals from an order of the Supreme Court, Suffolk County (Asher, J.), dated March 25, 2015, which granted the petition and denied the cross petition.
Ordered that the order is affirmed, with costs.
The petitioner, Liberty Mutual Fire Insurance Company, as subrogee of Mohan Singh (hereinafter Liberty Mutual), paid no-fault benefits on behalf of its insured for the medical treatment of a third party who was injured in a motor vehicle collision with a livery vehicle insured by Global Liberty Insurance Co. of N.Y. (hereinafter Global). Liberty Mutual thereafter sought to recover payments of $11,398.38 from Global in compulsory arbitration pursuant to Insurance Law § 5105. Despite finding that the livery vehicle insured by Global was 100% at fault in the happening of the accident, and notwithstanding Liberty Mutual’s submission of a payment ledger detailing the payments it made for various medical services, the arbitrator determined that Liberty Mutual did not properly manage the medical claims and awarded it only $5,699.19, or 50% of the amount sought. Liberty Mutual thereafter commenced this proceeding pursuant to CPLR 7511 to vacate the arbitration award, contending that the arbitrator erred in awarding it damages of only $5,699.19, rather than the full amount of $11,398.38, and Global cross-petitioned to confirm the award. The Supreme Court granted Liberty Mutual’s petition and denied Global’s cross petition, determining that there was no evidence to support the arbitrator’s findings. We affirm.
While judicial review of arbitration awards is limited to the grounds set forth in CPLR 7511, an award that is the product of compulsory arbitration, such as the one at issue in this case, “must satisfy an additional layer of judicial scrutiny—it ‘must have evidentiary support and cannot be arbitrary and capricious’ ” (City School Dist. of the City of N.Y. v McGraham, 17 NY3d 917, 919 [2011], quoting Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d 214, 223 [1996]; see Matter of Fiduciary Ins. Co. v American Bankers Ins. Co. of Florida, 132 AD3d 40, 46 [2015]; Matter of Travelers Indem. Co. v United Diagnostic Imaging, P.C., 70 AD3d 1043 [2010]; Matter of Mercury Cas. [*2]Co. v Healthmakers Med. Group, P.C., 67 AD3d 1017 [2009]).
Here, in response to Liberty Mutual’s submission of evidence establishing the medical payments for which it sought reimbursement, Global failed to produce any evidence that any of the medical claims were improperly paid (see generally State Farm Mut. Auto. Ins. Co. v Stack, 55 AD3d 594, 595 [2008]). Accordingly, the arbitrator’s determination that Liberty Mutual was not entitled to full reimbursement was not supported by evidence in the record and was arbitrary and capricious (see generally Matter of Progressive Cas. Ins. Co. v New York State Ins. Fund, 47 AD3d 633, 634 [2008]). Under these circumstances, the Supreme Court properly granted Liberty Mutual’s petition and denied Global’s cross petition. Chambers, J.P., Dickerson, Miller and Brathwaite Nelson, JJ., concur.
Reported in New York Official Reports at Queens Med. Supply, Inc. v Hereford Ins. Co. (2016 NY Slip Op 51706(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Hereford Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered July 14, 2014. The order granted defendant’s motion to vacate a default judgment and a marshal’s notice.
ORDERED that the order is reversed, without costs, and defendant’s motion to vacate the default judgment and the marshal’s notice is denied.
In June 2009, plaintiff commenced this action to recover assigned first-party no-fault benefits. Defendant failed to appear or answer, and a $6,288.40 default judgment was entered against defendant on December 8, 2009. On May 9, 2013, a marshal’s “notice of levy and sale” was issued which stated that $12,102.79 would be levied against defendant’s bank account. In September 2013, after its account had been levied, defendant moved to vacate the default judgment and the marshal’s notice. By order entered July 14, 2014, the Civil Court granted defendant’s motion.
On appeal, plaintiff contends, among other things, that defendant’s motion to vacate was untimely, and that defendant failed to show both a reasonable excuse for its default and a meritorious defense to the action.
It is well settled that, within one year after service of a default judgment with notice of entry, a defendant seeking to vacate the judgment pursuant to CPLR 5015 (a) (1) must demonstrate both a reasonable excuse for the default and the existence of a meritorious defense (see Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138, 141 [1986]; Sound Shore Med. Ctr. v Lumbermens Mut. Cas. Co., 31 AD3d 743 [2006]). Defendant asserts that, when the summons and complaint were served in June 2009, its employee erroneously returned the documents to plaintiff, instead of forwarding them to defendant’s attorney. Defendant argues that it timely moved to vacate the default judgment in September 2013, after it had received the marshal’s notice in May 2013. In opposition, plaintiff, among other things, submitted the affidavit of service of its mailing of the December 8, 2009 default judgment, with notice of entry, which stated that these documents were mailed to defendant on December 22, 2009. The affidavit of service created a presumption that defendant had received the default judgment with notice of entry (see Engel v Lichterman, 62 NY2d 943, 944-945 [1984]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]).
While defendant’s September 2013 motion to vacate was not made within one year after [*2]the December 2009 service upon defendant of a copy of the default judgment with notice of entry (see CPLR 5015 [a] [1]; Yung Chong Ho v Uppal, 130 AD3d 811, 812 [2015]; U.S. Bank N.A. v Bien-Aime, 123 AD3d 696, 697 [2014]), even after the expiration of the one-year period set forth in CPLR 5015, “a court may vacate its own judgment for sufficient reason and in the interests of substantial justice” (Woodson v Mendon Leasing Corp., 100 NY2d 62, 68 [2003]; see also Yung Chong Ho v Uppal, 130 AD3d at 812). Nevertheless, in the case at bar, the vacatur of the default judgment upon the exercise of the Civil Court’s inherent power was not warranted, inasmuch as defendant failed to address, in its reply papers, the affidavit of service that plaintiff had submitted in opposition to defendant’s motion which created a presumption that defendant had received the default judgment with notice of entry in 2009. Even if defendant’s employee had erroneously returned the summons and complaint to plaintiff in June 2009, defendant has not proffered any excuse for its failure to move within a reasonable period of time after its receipt of the default judgment with notice of entry (see Matter of Liberty Mut. Ins. Co. v Fiduciary Ins. Co. of Am., 111 AD3d 731, 732 [2013]; Johnson v Nello Homes, 159 AD2d 562 [1990]).
Accordingly, the order is reversed and defendant’s motion is denied.
Solomon, J.P., Weston and Elliot, JJ., concur.
Decision Date: November 25, 2016
Reported in New York Official Reports at Neptune Med. Care, P.C. v Dairyland Ins. Co. (2016 NY Slip Op 51705(U))
| Neptune Med. Care, P.C. v Dairyland Ins. Co. |
| 2016 NY Slip Op 51705(U) [53 Misc 3d 152(A)] |
| Decided on November 25, 2016 |
| 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 25, 2016
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : SOLOMON, J.P., WESTON and ELLIOT, JJ.
2015-283 K C
against
Dairyland Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Pamela L. Fisher, J.), entered January 8, 2015. 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 in the principal sum of $2,279.17, plaintiff appeals from an order which denied its motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint. Plaintiff moved for summary judgment as assignee of Mercedes Sinclair. The affidavit submitted by plaintiff’s employee in support of the motion was sufficient to establish plaintiff’s prima facie entitlement to summary judgment with respect to the services at issue (see Insurance Law § 5106 [a]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]). Defendant opposed the motion, and cross-moved for summary judgment, on the ground that defendant had paid the claim at issue. While plaintiff argues that defendant’s cross motion should have been denied because of procedural defects, plaintiff failed to assert, let alone demonstrate, prejudice in support of its contentions that the substitution of defense counsel had not been performed in accordance with CPLR 321 (b) (1) (see EIFS, Inc. v Morie Co., 298 AD2d 548, 550 [2002]); that defendant’s cross motion was untimely (see Lawrence v Celtic Holding, LLC, 85 AD3d 874, 875 [2011]; Kavakis v Total Care Sys., 209 AD2d 480 [1994]); and that defendant had failed to annex a copy of the pleadings to its cross motion (see CPLR 2001). In any event, plaintiff submitted the pleadings in support of its motion, and, thus, the record is “sufficiently complete” (Long Is. Pine Barrens Socy., Inc. v County of Suffolk, 122 AD3d 688, 691 [2014]).
Defendant acknowledges its receipt of the disputed claim in the amount of $2,279.17. While defendant contends that it issued a check to plaintiff in the amount at issue, and defendant proffered a copy of the canceled check, defendant failed to establish that a check had been mailed within the 30-day period to pay or deny the claim. Consequently, an issue of fact exists as to whether defendant timely paid the claim at issue, and, thus, neither party is entitled to summary judgment.
Accordingly, the order is modified by providing that defendant’s cross motion for summary judgment dismissing the complaint is denied.
Solomon, J.P., Weston and Elliot, JJ., concur.
Decision Date: November 25, 2016
Reported in New York Official Reports at Golden Earth Chiropractic & Acupuncture, PLLC v Global Liberty Ins. Co. of N.Y. (2016 NY Slip Op 26395)
| Golden Earth Chiropractic & Acupuncture, PLLC v Global Liberty Ins. Co. of N.Y. |
| 2016 NY Slip Op 26395 [54 Misc 3d 31] |
| Accepted for Miscellaneous Reports Publication |
| Supreme Court, Appellate Term, Second Department, 9th and 10th Judicial Districts |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected through Wednesday, February 8, 2017 |
[*1]
| Golden Earth Chiropractic & Acupuncture, PLLC, as Assignee of Segundo Campoverde, Respondent, v Global Liberty Insurance Company of New York, Appellant. |
Supreme Court, Appellate Term, Second Department, 9th and 10th Judicial Districts, November 25, 2016
APPEARANCES OF COUNSEL
The Law Office of Jason Tenenbaum, P.C., Garden City (Jason Tenenbaum of counsel), for appellant.
The Law Office of Thomas Tona, P.C., St. James (Alison Berdnik of counsel), for respondent.
{**54 Misc 3d at 32} OPINION OF THE COURT
Ordered that the order, insofar as appealed from, is reversed, with $30 costs, the petition to vacate the master arbitrator’s award is denied and so much of the cross petition as sought to confirm the master arbitrator’s award is granted.
After the provider’s claim for assigned first-party no-fault benefits had been denied by the insurer due to the assignor’s failure to appear at duly scheduled independent medical examinations (IMEs), the provider submitted the claim to arbitration, pursuant to Insurance Law § 5106 (b). The IME scheduling letters that had been sent to the assignor stated that he would be reimbursed for any proven loss of earnings and reasonable transportation expenses incurred in complying with the IME request.[FN*] The arbitrator determined that the IME scheduling letters were defective because they called for “proven” loss of earnings and did not track the language of the regulation, and found that, as a result, proper notice was not effectuated. The arbitrator awarded the provider the principal sum of $520.20. The insurer appealed the adverse decision to a master arbitrator, who vacated the arbitrator’s award in favor of the provider, upon a determination that the award “was not supported by sufficient evidence and was irrational, arbitrary and capricious and incorrect as a matter of law,” thereby, in effect, finding for the insurer.
{**54 Misc 3d at 33}The provider then commenced this proceeding to vacate the master arbitrator’s award, contending that the master arbitrator had exceeded his power, within the meaning of CPLR 7511 (b) (1) (iii), because he had performed an independent review of the evidence, assessed its [*2]credibility and made his own factual determinations. The insurer, by cross petition, sought to confirm the master arbitrator’s award. By order dated April 22, 2015, from which the insurer appeals, the District Court granted the provider’s petition and denied so much of the insurer’s cross petition as sought to confirm the master arbitrator’s award, finding that the master arbitrator had exceeded his authority by reviewing factual issues which had already been decided by the arbitrator and had impermissibly substituted his own factual determination for that of the arbitrator. We reverse.
Judicial review of a master arbitrator’s authority to vacate an award under Insurance Law § 5106 derives from CPLR 7511 (b) (1) (iii) and involves the question of whether the master arbitrator has exceeded his or her power (see Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d 207, 210 [1981]; see also Matter of Smith [Firemen’s Ins. Co.], 55 NY2d 224, 231 [1982]). A master arbitrator is empowered to vacate an arbitration award based upon most grounds set forth in CPLR 7511 (see Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d at 210; see also 11 NYCRR 65-4.10 [a] [1]) or based upon the ground that the arbitration award “was incorrect as a matter of law (procedural or factual errors committed in the arbitration below are not encompassed within this ground)” (11 NYCRR 65-4.10 [a] [4]; see Matter of Smith [Firemen’s Ins. Co.], 55 NY2d at 231; Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d at 211). The power of a master arbitrator to review factual and procedural issues (unlike substantive law issues) is limited to “whether the arbitrator acted in a manner that was arbitrary and capricious, irrational or without a plausible basis” (Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d at 211). A master arbitrator “exceeds his statutory power by making his own factual determination, by reviewing factual and procedural errors committed during the course of the arbitration, by weighing the evidence, or by resolving issues such as the credibility of the witnesses” (Matter of Allstate Ins. Co. v Keegan, 201 AD2d 724, 725 [1994]; see also Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d 207 [1981]). If, however, the master arbitrator vacates the arbitrator’s award based upon an alleged error of a rule of{**54 Misc 3d at 34} substantive law, the determination of the master arbitrator must be upheld unless it is irrational (see Matter of Smith [Firemen’s Ins. Co.], 55 NY2d at 232; Matter of Liberty Mut. Ins. Co. v Spine Americare Med., 294 AD2d 574, 576 [2002]).
Contrary to the provider’s contention, we find that the master arbitrator did not exceed the scope of his authority, as he did not weigh or independently evaluate issues of credibility or engage in any factual analysis. Rather, his legal analysis of the arbitrator’s determination was well within the scope of his authority to review and correct an error of law made by the arbitrator (see Matter of Smith [Firemen’s Ins. Co.], 55 NY2d at 231; Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d at 211). Moreover, “applying the law to a given set of facts is well within the province of a master arbitrator, even if his conclusion differs from that of the arbitrator” (Martinez v Metropolitan Prop. & Liab. Ins. Co., 146 AD2d 610, 611 [1989]). Here, the master arbitrator determined that the use of the word “proven” in the IME scheduling letters did not render such letters ineffective, notwithstanding the fact that the word “proven” does not appear in 11 NYCRR 65-3.5 (e), and that proper notice of the scheduled IMEs was, therefore, effectuated. As the master arbitrator’s determination was not irrational (see Matter of Smith [Firemen’s Ins. Co.], 55 NY2d at 232), the District Court erred in granting the provider’s petition to vacate the master arbitrator’s award and in denying the insurer’s cross petition to confirm the master arbitrator’s award.
Accordingly, the order, insofar as appealed from, is reversed, the petition to vacate the master arbitrator’s award is denied and so much of the cross petition as sought to confirm the master arbitrator’s award is granted.
We incidentally note that a proceeding to confirm or vacate an arbitration award is a special proceeding brought pursuant to CPLR article 4, and must terminate in a judgment rather than an order (see CPLR 411).
Iannacci, J.P., Tolbert and Garguilo, JJ., concur.
Footnotes
Footnote *:11 NYCRR 65-3.5 (e) provides: “The insurer shall inform the applicant at the time the examination is scheduled that the applicant will be reimbursed for any loss of earnings and reasonable transportation expenses incurred in complying with the request.”
Reported in New York Official Reports at Hu-Nam-Nam v Infinity Ins. Co. (2016 NY Slip Op 51702(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Infinity Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered September 29, 2014. The order denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order is reversed, with $30 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 the automobile insurance policy in question had been issued in Florida, and that, based upon a conflict-of-law analysis, Florida law applied, pursuant to which there was a lack of coverage due to the valid rescission of the automobile insurance policy. By order entered September 29, 2014, the Civil Court denied defendant’s motion.
On appeal, defendant contends that it made a prima facie showing of its defense of rescission of the underlying insurance policy in accordance with Florida law and that its motion for summary judgment dismissing the complaint should have been granted. We agree.
It is undisputed that the vehicle in question was insured by defendant under a Florida automobile insurance policy. At the time of the accident at issue, which occurred in New York, the vehicle was being driven by the policyholder, and plaintiff’s assignor was a passenger in the vehicle. After defendant’s investigation revealed that, at the time the insured applied for automobile insurance, she did not reside at the Florida address listed on the insurance application and that the vehicle was not garaged at that Florida address, defendant rescinded the policy, ab initio, pursuant to Florida Statutes Annotated, title 37, § 627.409, which permits the retroactive cancellation of an insurance contract if there has been a material misrepresentation in an application for insurance.
In order to show that it properly voided a motor vehicle insurance policy ab initio, in accordance with Florida law, an insurer must demonstrate that it gave notice of the rescission to the insured and that it returned or tendered all premiums paid within a reasonable time after the discovery of the grounds for avoiding the policy (see W.H.O. Acupuncture, P.C. v Infinity Prop. & Cas. Co., 36 Misc 3d 4, 6-7 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012], citing Leonardo v State Farm Fire and Cas. Co., 675 So 2d 176, 179 [Fla Dist Ct App, 4th Dist 1996]; [*2]see also Hu-Nam-Nam, M.D. v Infinity Ins. Co., 51 Misc 3d 130[A], 2016 NY Slip Op 50391[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]). Inasmuch as defendant demonstrated, through the supporting affidavit of its litigation specialist and accompanying documents, that it had complied with the foregoing requirements, defendant’s prima facie entitlement to summary judgment was established (see Hu-Nam-Nam, M.D. v Infinity Ins. Co., 51 Misc 3d 130[A], 2016 NY Slip Op 50391[U], *1; W.H.O. Acupuncture, P.C. v Infinity Prop. & Cas. Co., 36 Misc 3d at 7). In opposition to defendant’s prima facie showing, plaintiff failed to raise a triable issue of fact as to the validity of the retroactive rescission of the policy in accordance with Florida law.
Accordingly, the order is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
Pesce, P.J., Weston and Aliotta, JJ., concur.
Decision Date: November 21, 2016