Westchester Med. Ctr. v Allstate Ins. Co. (2014 NY Slip Op 00655)

Reported in New York Official Reports at Westchester Med. Ctr. v Allstate Ins. Co. (2014 NY Slip Op 00655)

Westchester Med. Ctr. v Allstate Ins. Co. (2014 NY Slip Op 00655)
Westchester Med. Ctr. v Allstate Ins. Co.
2014 NY Slip Op 00655 [114 AD3d 672]
February 5, 2014
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, March 26, 2014
Westchester Medical Center, as Assignee of Christine Tachaud, Appellant,
v
Allstate Insurance Company, Respondent.

[*1] Joseph Henig, P.C., Bellmore, N.Y., for appellant.

McDonnell & Adels, PLLC, Garden City, N.Y. (Jannine A. Gordineer of counsel), for respondent.

In an action to recover no-fault benefits under a policy of automobile insurance, the plaintiff appeals from an order of the Supreme Court, Nassau County (Mahon, J.) dated September 6, 2012, which denied its motion for summary judgment on the complaint.

Ordered that the order is reversed, on the law, with costs, and the plaintiff’s motion for summary judgment on the complaint is granted.

The plaintiff made a prima facie showing of its entitlement to judgment as a matter of law by “demonstrating that the necessary billing documents were mailed to, and received by, [the defendant insurer] and that payment of no-fault benefits was overdue” (Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 106 AD3d 157, 164-165 [2013]; see Insurance Law § 5106 [a]; 11 NYCRR 65-3.8 [a] [1]; [c]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2d Dept 2013]), since “the prescribed statutory billing form had been mailed to and received by the defendant insurer, which failed either to pay or deny the claim within the requisite 30-day period” (Westchester Med. Ctr. v Hereford Ins. Co., 95 AD3d 1306, 1306 [2012]; see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]). Contrary to the defendant’s contention, the papers submitted in support of the plaintiff’s motion were in sufficient evidentiary form to warrant the granting of summary judgment in favor of the plaintiff (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]).

In opposition, the defendant failed to raise a triable issue of fact. The defendant acknowledged that it received the billing form on November 4, 2011. Neither the letter that the defendant describes as a request for a verification, dated December 6, 2011, nor its later denial of claim form dated December 20, 2011, was sent within the 30-day post-receipt-of-claim period (see id.; Sound Shore Med. Ctr. v New York Cent. Mut. Fire Ins. Co., 106 AD3d at 164; see also 11 NYCRR 65-3.5 [b]; Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294, 300-301 [2007]).

Accordingly, the Supreme Court should have granted the plaintiff’s motion for summary judgment on the complaint. Mastro, J.P., Dickerson, Chambers and Roman, JJ., concur.

Nyack Hosp. v Allstate Ins. Co. (2014 NY Slip Op 00641)

Reported in New York Official Reports at Nyack Hosp. v Allstate Ins. Co. (2014 NY Slip Op 00641)

Nyack Hosp. v Allstate Ins. Co. (2014 NY Slip Op 00641)
Nyack Hosp. v Allstate Ins. Co.
2014 NY Slip Op 00641 [114 AD3d 650]
February 5, 2014
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, March 26, 2014
Nyack Hospital, as Assignee of Christine M. Haskell, et al., Respondents,
v
Allstate Insurance Company, Appellant.

[*1] McDonnell & Adels, PLLC, Garden City, N.Y. (Jannine A. Gordineer of counsel), for appellant.

Joseph Henig, P.C., Bellmore, N.Y., for respondents.

In an action to recover no-fault benefits under three separate policies of automobile insurance, the defendant appeals from a judgment of the Supreme Court, Nassau County (Brandveen, J.), entered December 1, 2011, which, upon an order of the same court dated October 21, 2011, granting that branch of the plaintiffs’ motion which was for summary judgment on the second cause of action, is in favor of the plaintiff Richmond University Medical Center, as assignee of Arnold Sealey, and against it in the total sum of $6,698.56.

Ordered that the judgment is affirmed, with costs.

By failing to timely contest, at the claims stage, the adequacy of the claim forms used by the plaintiff Richmond University Medical Center, as assignee of Arnold Sealey, to establish proof of claim, the defendant waived its right to rely on any deficiencies in those forms at the litigation stage (see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 318 [2007]; Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556, 563 [2008]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2nd Dept 2013]; Westchester Med. Ctr. v Safeco Ins. Co. of Am., 40 AD3d 984, 984 [2007]). Accordingly, by submitting evidence in admissible form that the prescribed statutory billing form had been mailed to and received by the defendant insurer, which failed to either pay or deny the claim within the requisite 30-day period, the plaintiffs established their prima facie entitlement to judgment as a matter of law on the second cause of action (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]; Westchester Med. Ctr. v Hereford Ins. Co., 95 AD3d 1306, 1306-1307 [2012]).

We note that the defendant does not contend on appeal that it raised a triable issue of fact in opposition to the plaintiffs’ prima facie showing, but only that the plaintiffs failed to meet their prima facie burden. Therefore, we do not address the issue of whether the defendant raised a triable issue of fact in opposition.

Accordingly, we affirm the judgment appealed from. Dillon, J.P., Balkin and Chambers, JJ., concur.

Miller, J., concurs in the result on constraint of this Court’s opinion and order in Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co. (114 AD3d 33 [2d Dept 2013]).

New York Hosp. Med. Ctr. of Queens v Allstate Ins. Co. (2014 NY Slip Op 00640)

Reported in New York Official Reports at New York Hosp. Med. Ctr. of Queens v Allstate Ins. Co. (2014 NY Slip Op 00640)

New York Hosp. Med. Ctr. of Queens v Allstate Ins. Co. (2014 NY Slip Op 00640)
New York Hosp. Med. Ctr. of Queens v Allstate Ins. Co.
2014 NY Slip Op 00640 [114 AD3d 650]
February 5, 2014
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, March 26, 2014
New York Hospital Medical Center of Queens, as Assignee of Luis Robles, et al., Respondents,
v
Allstate Insurance Company, Appellant.

[*1] McDonnell & Adels, PLLC, Garden City, N.Y. (Jannine A. Gordineer of counsel), for appellant.

Joseph Henig, P.C., Bellmore, N.Y. (Mark A. Green of counsel), for respondents.

In an action to recover no-fault benefits under a policy of automobile insurance, the defendant appeals, as limited by its brief, from so much of an order of the Supreme Court, Nassau County (Parga, J.), entered February 10, 2012, as granted the plaintiffs’ motion for summary judgment on the first cause of action.

Ordered that the order is affirmed insofar as appealed from, with costs.

The plaintiffs’ submissions included a postal receipt indicating that the prescribed NF-5 statutory billing form corresponding to the no-fault claim at issue, and related documents, were received by the defendant on May 26, 2011. The person who mailed the NF-5 form averred, in support of the plaintiffs’ motion, that the defendant neither paid nor properly denied the claim within 30 days. This initial showing was sufficient to demonstrate the plaintiffs’ prima facie entitlement to judgment as a matter of law on the first cause of action (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.8 [c]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]). In opposition, the defendant failed to raise a triable issue of fact as to whether it timely paid or denied the claim, or requested additional verification within the time frame set forth in the no fault regulations (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]).

Accordingly, the Supreme Court properly granted the plaintiffs’ motion for summary judgment on the first cause of action. Mastro, J.P., Chambers, Hall and Lott, JJ., concur. [Prior Case History: 2012 NY Slip Op 30418(U).]

New York Hosp. Med. Ctr. of Queens v QBE Ins. Corp. (2014 NY Slip Op 00639)

Reported in New York Official Reports at New York Hosp. Med. Ctr. of Queens v QBE Ins. Corp. (2014 NY Slip Op 00639)

New York Hosp. Med. Ctr. of Queens v QBE Ins. Corp. (2014 NY Slip Op 00639)
New York Hosp. Med. Ctr. of Queens v QBE Ins. Corp.
2014 NY Slip Op 00639 [114 AD3d 648]
February 5, 2014
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, March 26, 2014
New York Hospital Medical Center of Queens, as Assignee of Khushi Robinson, et al., Respondents,
v
QBE Insurance Corporation, Appellant.

[*1] Jaffe & Koumourdas, LLP, New York, N.Y. (Jean H. Kang of counsel), for appellant.

Joseph Henig, P.C., Bellmore, N.Y., for respondents.

In an action to recover no-fault benefits under two separate policies of automobile insurance, the defendant appeals from a judgment of the Supreme Court, Nassau County (Winslow, J.), entered October 13, 2011, which, upon an order of the same court entered August 2, 2011, granting the plaintiffs’ motion for summary judgment on the complaint and denying its cross motion, inter alia, for summary judgment dismissing the complaint, is in favor of the plaintiffs and against it in the sum of $66,682.29.

Ordered that the judgment is modified, on the law, by deleting the provision thereof, in effect, awarding the plaintiffs damages in the sum of $7,354.28 on the first cause of action and substituting therefor a provision dismissing that cause of action; as so modified, the judgment is affirmed, without costs or disbursements, that branch of the plaintiffs’ motion which was for summary judgment on the first cause of action is denied, that branch of the defendant’s cross motion which was for summary judgment dismissing that cause of action is granted, the order entered August 2, 2011, is modified accordingly, and the matter is remitted to the Supreme Court, Nassau County, for the entry of an appropriate amended judgment.

The plaintiffs made a prima facie showing of entitlement to judgment as a matter of law on the second cause of action, which related to the claim submitted by Westchester Medical Center in connection with the injuries allegedly sustained by its assignor, Robert de los Santos, by submitting evidence that the prescribed statutory billing form had been mailed to and received by the defendant insurer, which failed to either pay or deny the claims within the requisite 30-day period (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33, 2013 NY Slip Op 08430 [2d Dept 2013]; Westchester Med. Ctr. v Hereford Ins. Co., 95 AD3d 1306, 1306-1307 [2012]; Westchester Med. Ctr. v Lancer Ins. Co., 94 AD3d 984, 984 [2012]; Westchester Med. Ctr. v Progressive Cas. Ins. Co., 89 AD3d 1081, 1082 [2011]). A medical provider is not required, as part of its prima facie showing, to demonstrate the admissibility of its billing records or to prove the truth of their content under the business records exception to the hearsay rule (see CPLR 4518 [a]; Viviane [*2]Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33, 45 [2013]). In opposition to the plaintiffs’ showing in connection with the second cause of action, the defendant failed to raise a triable issue of fact as to whether it properly requested further verification of that claim (see Westchester Med. Ctr. v Progressive Cas. Ins. Co., 89 AD3d at 1083; Mount Sinai Hosp. v Triboro Coach, 263 AD2d 11 [1999]). By failing to timely contest, at the claims stage, the adequacy of the claim forms employed by Westchester Medical Center to establish proof of the claim it submitted on behalf of de los Santos, the defendant waived its right to rely on any deficiencies in those forms at the litigation stage (see Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556, 563 [2008]; Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 318 [2007]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33, 46 [2013]). Similarly, on its cross motion for summary judgment, the defendant failed to establish, prima facie, that it properly requested verification of that claim (see Westchester Med. Ctr. v Countrywide Ins. Co., 45 AD3d 676, 676 [2007]). Accordingly, the Supreme Court properly granted that branch of the plaintiffs’ motion which was for summary judgment on the second cause of action and properly denied that branch of the defendant’s cross motion which was for summary judgment dismissing the second cause of action (see Westchester Med. Ctr. v State Farm Mut. Auto. Ins. Co., 44 AD3d 750, 754 [2007]).

In connection with that branch of its cross motion which was for summary judgment dismissing the first cause of action, however, the defendant established, prima facie, that payment on the claim made by the plaintiff New York Hospital Medical Center of Queens on behalf of its assignor, Khushi Robinson, was not overdue since there were verification requests that remained outstanding with respect to that claim (see New York & Presbyt. Hosp. v Allstate Ins. Co., 30 AD3d 492, 493 [2006]). In opposition, the plaintiffs failed to raise a triable issue of fact (see id.). Specifically, the defendant submitted evidence that it timely and properly requested further verification of that claim and timely and properly followed up on that request, but that New York Hospital Medical Center of Queens did not respond (see Westchester Med. Ctr. v Country Wide Ins. Co., 84 AD3d 790, 791 [2011]; St. Barnabas Hosp. v American Tr. Ins. Co., 57 AD3d 517, 518 [2008]; New York & Presbyt. Hosp. v Countrywide Ins. Co., 44 AD3d 729, 730 [2007]). Accordingly, the Supreme Court should have denied that branch of the plaintiffs’ motion which was for summary judgment on the first cause of action, and granted that branch of the defendant’s cross motion which was for summary judgment dismissing that cause of action. Balkin, J.P., Roman, Sgroi and Cohen, JJ., concur.

Westchester Med. Ctr. v Government Empls. Ins. Co. (2014 NY Slip Op 00500)

Reported in New York Official Reports at Westchester Med. Ctr. v Government Empls. Ins. Co. (2014 NY Slip Op 00500)

Westchester Med. Ctr. v Government Empls. Ins. Co. (2014 NY Slip Op 00500)
Westchester Med. Ctr. v Government Empls. Ins. Co.
2014 NY Slip Op 00500 [113 AD3d 842]
January 29, 2014
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, March 5, 2014
Westchester Medical Center, as Assignee of Arianna Thrasher, Appellant, et al., Plaintiffs,
v
Government Employees Insurance Company, Respondent.

[*1] Joseph Henig, P.C., Bellmore, N.Y., for appellant.

Spina, Korshin & Welden, Woodbury, N.Y. (Jeanne M. Ortega and P. Stephanie Estevez of counsel), for respondent.

In an action to recover no-fault benefits under a policy of automobile insurance, the plaintiff Westchester Medical Center, as assignee of Arianna Thrasher, appeals from so much of an order of the Supreme Court, Nassau County (Cozzens, Jr., J.), entered January 23, 2012, as denied that branch of its motion which was for summary judgment on its first cause of action.

Ordered that the order is reversed insofar as appealed from, on the law, with costs, and that branch of the motion of the plaintiff Westchester Medical Center, as assignee of Arianna Thrasher, which was for summary judgment on its first cause of action is granted.

The plaintiff Westchester Medical Center, as assignee of Arianna Thrasher (hereinafter the appellant), made a prima facie showing of entitlement to judgment as a matter of law by submitting evidence in admissible form that the prescribed statutory billing form had been mailed to and received by the respondent insurer, which failed to either pay or deny the claim within the requisite 30-day period (see Insurance Law § 5106 [a]; 11 NYCRR 65-3.8 [c]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33 [2013]; Westchester Med. Ctr. v Hereford Ins. Co., 95 AD3d 1306, 1306-1307 [2012]; Westchester Med. Ctr. v Lancer Ins. Co., 94 AD3d 984, 984 [2012]; NYU-Hosp. for Joint Diseases v American Intl. Group, Inc., 89 AD3d 702, 703 [2011]; Mount Sinai Hosp. v Country Wide Ins. Co., 85 AD3d 1136, 1137 [2011]; Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045, 1045-1046 [2009]).

Contrary to the Supreme Court’s determination, the respondent, in opposition to the appellant’s prima facie showing, failed to raise a triable issue of fact.

The respondent’s contention that there was a complete absence of coverage that could be asserted as a basis for disclaimer notwithstanding its failure to comply with the 30-day rule set forth in Insurance Law § 5106 (a) and 11 NYCRR 65-3.8 (c) (see generally Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556 [2008]; Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., 90 NY2d 274 [1997]; Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195 [1997]; Zappone v Home [*2]Ins. Co., 55 NY2d 131 [1982]), is improperly raised for the first time on appeal, and, therefore, is not properly before this Court.

In light of our determination, we need not reach the plaintiff’s remaining contentions. Mastro, J.P., Dickerson, Sgroi and Hinds-Radix, JJ., concur.

Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 50134(U))

Reported in New York Official Reports at Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 50134(U))

Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2014 NY Slip Op 50134(U)) [*1]
Natural Therapy Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co.
2014 NY Slip Op 50134(U) [42 Misc 3d 137 (A)]
Decided on January 28, 2014
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 January 28, 2014

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2012-1452 K C.
Natural Therapy Acupuncture, P.C. as Assignee of KENETTA ALLEN-HALL, Appellant,

against

State Farm Mutual Automobile Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered May 17, 2012. The order granted defendant’s motion for summary judgment dismissing the complaint.

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

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint. The Civil Court found that defendant had timely and properly denied the claims at issue on the ground that plaintiff had failed to comply with a condition precedent to coverage in that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). On appeal, plaintiff argues that defendant failed to prove that it had mailed its EUO scheduling letters and denial of claim forms, that defendant lacked justification for its EUO requests, and that defendant’s motion should have been denied pursuant to CPLR 3212 (f), as plaintiff had not received discovery regarding the reasonableness of defendant’s EUO requests.

Contrary to plaintiff’s argument, the affidavits submitted by defendant established that the EUO scheduling letters and the denial of claim forms had been timely mailed in accordance with its 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]). Furthermore, since plaintiff does not claim to have responded in any way to the EUO requests, its objections regarding the EUO requests will not now be heard (see Viviane Etienne Med. Care, P.C. v State Farm Mut. Auto. Ins. Co., 35 Misc 3d 127[A], 2012 NY Slip Op 50579[U] [App Term, 2d, 11th & 13th Jud Dists 2012] Crescent Radiology, PLLC v American Tr. Ins. Co., 31 Misc 3d 134[A], 2011 NY Slip Op 50622[U] [App Term, 9th & 10th Jud Dists 2011]). Consequently, discovery relevant to the reasonableness of the EUO requests was not necessary for plaintiff to oppose defendant’s motion (see CPLR 3212 [f]). Finally, contrary to plaintiff’s argument on appeal, the affirmation submitted by defendant’s attorney, who was present in his office to conduct plaintiff’s EUO on the scheduled dates, was sufficient to establish that plaintiff had failed to appear.

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: January 28, 2014

Alev Med. Supply, Inc. v Government Employees Ins. Co. (2014 NY Slip Op 50130(U))

Reported in New York Official Reports at Alev Med. Supply, Inc. v Government Employees Ins. Co. (2014 NY Slip Op 50130(U))

Alev Med. Supply, Inc. v Government Employees Ins. Co. (2014 NY Slip Op 50130(U)) [*1]
Alev Med. Supply, Inc. v Government Employees Ins. Co.
2014 NY Slip Op 50130(U) [42 Misc 3d 137(A)]
Decided on January 28, 2014
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 January 28, 2014

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


PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ
2011-1024 Q C.
Alev Medical Supply, Inc. as Assignee of KECIA DANIELY, Appellant,

against

Government Employees Insurance Company, Respondent.

Appeal from a judgment of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered February 7, 2011. The judgment, entered pursuant to a decision of the same court dated October 14, 2010, insofar as appealed from, after a nonjury trial, dismissed the complaint except for so much thereof as sought to recover the principal sum of $330 for a massager and a Thermophore.

ORDERED that, on the court’s own motion, the notice of appeal from the decision dated October 14, 2010 is deemed a premature notice of appeal from the judgment entered February 7, 2011 (see CPLR 5520 [c]); and it is further,

ORDERED that the judgment, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, a nonjury trial was held, limited to defendant’s defense of lack of medical necessity. Following the trial, the Civil Court found in favor of defendant on most of plaintiff’s claims, and a judgment was entered dismissing the complaint except for so muchthereof as sought to recover the principal sum of $330 for a massager and a Thermophore.

On appeal, plaintiff does not challenge the substance of defendant’s expert witness’s testimony. Instead, plaintiff raises only evidentiary objections.

Contrary to plaintiff’s arguments, the Civil Court properly overruled plaintiff’s hearsay objection to defendant’s doctor’s testimony as to the issue of medical necessity (see Park Slope Med. & Surg. Supply, Inc. v Travelers, 37 Misc 3d 19 [App Term, 2d, 11th & 13th Jud Dists 2012] Alrof, Inc. v Progressive Ins. Co., 34 Misc 3d 29 [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]). Plaintiff’s remaining contentions lack merit (see A-Quality Med. Supply v GEICO Gen. Ins. Co., 39 Misc 3d 24 [App Term, 2d, 11th & 13th Jud Dists 2013] see also Eagle Surgical Supply, Inc. v GEICO Ins. Co., 39 Misc 3d 146[A], 2013 NY Slip Op 50854[U] [App Term, 2d, 11th & 13th Jud Dists 2013]).

Accordingly, the judgment is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: January 28, 2014

Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50128(U))

Reported in New York Official Reports at Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50128(U))

Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50128(U)) [*1]
Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co.
2014 NY Slip Op 50128(U) [42 Misc 3d 137(A)]
Decided on January 27, 2014
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 January 27, 2014

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


PRESENT: : LaSALLE, J.P., NICOLAI and IANNACCI, JJ
2012-2768 S C.
Comprehensive MRI of New York, P.C. as Assignee of GENEVIEVE A. BARTLEY, Respondent,

against

New York Central Mutual Fire Insurance Company, Appellant.

Appeal from an order of the District Court of Suffolk County, Third District (C. Stephen Hackeling, J.), dated November 13, 2012. The order, insofar as appealed from as limited by the brief, denied defendant’s motion for summary judgment dismissing the complaint.

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, defendant appeals from so much of an order of the District Court as denied defendant’s motion for summary judgment dismissing the complaint.

Contrary to the determination of the District Court, the affidavit submitted by defendant in support of its motion for summary judgment established that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) its denial of claim forms, which denied the two claims at issue on the ground of lack of medical necessity. The conflicting medical expert opinions proffered by the parties were sufficient to demonstrate the existence of a triable issue of fact as to whether there was a lack of medical necessity for the services provided (see Zuckerman v City of New York, 49 NY2d 557 [1980] Dynamic Med. Imaging, P.C. v New York Cent. Mut. Fire Ins. Co., 29 Misc 3d 139[A], 2010 NY Slip Op 52062[U] [App Term, 9th & 10th Jud Dists 2010]). Defendant’s remaining contention lacks merit.

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

LaSalle, J.P., Nicolai and Iannacci, JJ., concur.
Decision Date: January 27, 2014

Flushing Traditional Acupuncture, P.C. v Kemper Ins. Co. (2014 NY Slip Op 50052(U))

Reported in New York Official Reports at Flushing Traditional Acupuncture, P.C. v Kemper Ins. Co. (2014 NY Slip Op 50052(U))

Flushing Traditional Acupuncture, P.C. v Kemper Ins. Co. (2014 NY Slip Op 50052(U)) [*1]
Flushing Traditional Acupuncture, P.C. v Kemper Ins. Co.
2014 NY Slip Op 50052(U) [42 Misc 3d 133(A)]
Decided on January 10, 2014
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 January 10, 2014

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


PRESENT: : ALIOTTA, J.P., PESCE and SOLOMON, JJ
2012-932 K C.
Flushing Traditional Acupuncture, P.C. as Assignee of DWAYNE GRIFFITHS, Appellant,

against

Kemper Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered February 6, 2012. The order granted defendant’s motion to dismiss the complaint.

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

In this action by a provider to recover assigned first-party no-fault benefits, the record indicates that, subsequent to the provision of acupuncture services by plaintiff to its assignor, defendant Kemper Insurance Company (Kemper) commenced a declaratory judgment action in the Supreme Court, New York County, against plaintiff, 12 other providers and the injured assignor, alleging that the providers had breached the terms of the insurance policy by failing to appear for scheduled examinations under oath. On September 4, 2009, several months after the declaratory judgment action had been filed, plaintiff commenced the present action in the Civil Court. In a judgment entered on default on June 22, 2010, the Supreme Court declared that plaintiff and the other named providers were not entitled to recover no-fault benefits arising out of the accident in question. Kemper thereafter moved in the Civil Court to dismiss plaintiff’s complaint, contending that the instant action is barred by virtue of the declaratory judgment. Plaintiff appeals from an order of the Civil Court which granted Kemper’s motion and dismissed the action.

In light of the declaratory judgment, the present 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, 11th & 13th Jud Dists 2012] Ava Acupuncture, P.C. v NY Cent. Mut. Fire Ins. Co., 34 Misc 3d 149[A], 2012 NY Slip Op 50233[U] [App Term, 2d, 11th & 13th Jud Dists 2012] SZ Med., P.C. v Erie Ins. Co., 24 Misc 3d 126[A], 2009 NY Slip Op 51221[U] [App Term, 2d, 11th & 13th Jud Dists 2009]), as any judgment in favor of plaintiff in the instant action would destroy or impair rights or interests established by the Supreme Court judgment (see Schuykill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 [1929] S.Z. Med., P.C. v Erie Ins. Co., 24 Misc 3d 126[A], 2009 NY Slip Op 51221[U]).

Accordingly, the order is affirmed.

Aliotta, J.P., Pesce and Solomon, JJ., concur. [*2]
Decision Date: January 10, 2014

Interboro Ins. Co. v Clennon (2014 NY Slip Op 00092)

Reported in New York Official Reports at Interboro Ins. Co. v Clennon (2014 NY Slip Op 00092)

Interboro Ins. Co. v Clennon (2014 NY Slip Op 00092)
Interboro Ins. Co. v Clennon
2014 NY Slip Op 00092 [113 AD3d 596]
January 8, 2014
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, March 5, 2014
Interboro Insurance Company, Respondent,
v
Michael Clennon et al., Defendants, and Compas Medical, P.C., et al., Appellants.

[*1] The Rybak Firm, PLLC, Brooklyn, N.Y. (Damin J. Toell and Andrew S. Fisher of counsel), for appellants.

Law Office of Jason Tenenbaum P.C., Garden City, N.Y., for respondent.

In an action, inter alia, for a judgment declaring that the plaintiff has no obligation to pay certain no-fault claims, the defendants Compas Medical, P.C., T&J Chiropractic, P.C., Charles Deng Acupuncture, P.C., and Great Health Care Chiropractic, P.C., appeal, as limited by their brief, from so much of a judgment of the Supreme Court, Nassau County (Adams, J.), dated November 22, 2011, as, upon an order of the same court entered July 6, 2011, among other things, granting that branch of the plaintiff’s motion which was for summary judgment on the complaint insofar as asserted against those defendants, declared that those defendants were not entitled to recover no-fault benefits.

Ordered that the judgment is affirmed insofar as appealed from, with costs.

“The failure to comply with the provision of an insurance policy requiring the insured to submit to an examination under oath . . . is a material breach of the policy, precluding recovery of the policy proceeds” (Argento v Aetna Cas. & Sur. Co., 184 AD2d 487, 487-488 [1992]; see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559 [2011]). Here, the plaintiff insurer established as a matter of law that it twice duly demanded an examination under oath from the appellants’ assignor, who had allegedly been injured in a motor vehicle accident, that the assignor twice failed to appear, and that the plaintiff issued a timely denial of the claims arising from the appellants’ treatment of the assignor. Based upon the foregoing, the plaintiff established its prima facie entitlement to judgment as a matter of law. In opposition, the appellants failed to raise a triable issue of fact as to either the propriety of the demand for the examination under oath or whether the assignor actually appeared at the examination.

Moreover, the appellants failed to establish that summary judgment was premature in light of outstanding discovery. “A party who contends that a summary judgment motion is premature is required to demonstrate that discovery might lead to relevant evidence or [that] the facts essential to justify opposition to the motion were exclusively within the knowledge and control of the movant” (Cajas-Romero v Ward, 106 AD3d 850, 852 [2013]; see CPLR 3212 [f]). Here, in support of [*2]their contention that the plaintiff’s motion was premature, the appellants did not establish what information they hoped to discover that would demonstrate the existence of a triable issue of fact. Eng, P.J., Dillon, Dickerson and Sgroi, JJ., concur.