Reported in New York Official Reports at Vega Chiropractic, P.C. v Clarendon Natl. Ins. Co. (2009 NY Slip Op 52536(U))
| Vega Chiropractic, P.C. v Clarendon Natl. Ins. Co. |
| 2009 NY Slip Op 52536(U) [25 Misc 3d 144(A)] |
| Decided on August 31, 2009 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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
2008-1575 K C.
against
Clarendon National Insurance Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Dolores L. Waltrous, J.), entered April 24, 2008. The order granted defendant’s motion for summary judgment and denied plaintiff’s cross motion for summary judgment.Order affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment and plaintiff cross-moved for summary judgment. The Civil Court granted defendant’s motion and denied plaintiff’s cross motion.
Contrary to plaintiff’s contention, defendant’s motion for summary judgment established that plaintiff’s assignor failed to attend scheduled chiropractic/acupuncture independent medical examinations (IMEs) and that the letters scheduling said IMEs were timely sent pursuant to the standard office practice or procedure designed to ensure that such items were properly addressed and mailed (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]). Plaintiff’s remaining contention lacks merit.
Accordingly, we find that the Civil Court properly granted defendant’s motion for summary judgment dismissing the complaint (see Tuncel v Progressive Cas. Ins. Co., 21 Misc 3d 143[A], 2008 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2008]) and denied plaintiff’s cross motion for summary judgment.
Pesce, P.J., Rios and Steinhardt, JJ., concur.
Decision Date: August 31, 2009
Reported in New York Official Reports at Great Wall Acupuncture, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52308(U))
| Great Wall Acupuncture, P.C. v GEICO Ins. Co. |
| 2009 NY Slip Op 52308(U) [25 Misc 3d 137(A)] |
| Decided on August 31, 2009 |
| 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
2008-239 Q C.
against
GEICO Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered November 2, 2007, deemed from a judgment of the same court entered January 18, 2008 (see CPLR 5501 [c]). The judgment, entered pursuant to the November 2, 2007 order denying plaintiff’s motion for summary judgment and, upon a search of the record, granting defendant summary judgment, dismissed the complaint.
Judgment reversed without costs, order, insofar as it denied so much of plaintiff’s motion as sought summary judgment upon the unpaid portion of a $1,080 claim form received by defendant on December 23, 2004, and, insofar as it, upon a search of the record, granted defendant summary judgment as to the unpaid portion of said claim form, vacated, so much of plaintiff’s motion as sought summary judgment upon the unpaid portion of said claim form granted, and matter remitted to the Civil Court for a calculation of statutory interest and an assessment of attorney’s fees.
In support of a motion for summary judgment in this action by a provider to recover assigned first-party no-fault benefits, plaintiff showed that it had submitted a bill to defendant seeking to recover at a rate of $90 for each session of acupuncture rendered to plaintiff’s assignors by plaintiff’s licensed acupuncturist. Defendant paid plaintiff for the sessions at the reduced rate of $29.30 per session, which, defendant claimed, was the amount paid to licensed chiropractors for similar services. Plaintiff sought full reimbursement, i.e., the $60.70 balance allegedly due for each session, contending that the amounts which it had charged were not unreasonable and were within the range of the prevailing fees in the geographic area in which plaintiff operated, that is, between $85 and $100 per session. The court denied plaintiff’s motion [*2]for summary judgment, searched the record and granted defendant summary judgment dismissing the complaint. This appeal by plaintiff ensued. A judgment dismissing the complaint was subsequently entered, from which the appeal is deemed to be taken (see CPLR 5501 [c]).
Contrary to defendant’s assertion, the affidavit submitted by plaintiff’s billing manager was sufficient to establish that the documents annexed to plaintiff’s moving papers were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]).
Defendant failed to establish that it timely denied the unpaid portion of the claims set forth on the claim form seeking the sum of $1,080 for assignor Clarence Beckford, which form defendant received on December 23, 2004 (see Insurance Department Regulations [11 NYCRR] § 65-3.8). As a result, its defense that plaintiff’s $1,080 claim exceeded the amount permitted by the workers’ compensation fee schedule is precluded (see Infinity Health Prods., Ltd. v Eveready Ins. Co., 21 Misc 3d 1 [App Term, 2d & 11th Jud Dists 2008]), and plaintiff was entitled to summary judgment upon the unpaid portion of said $1,080 claim.
With respect to the remaining claim forms which are the subject of this action, defendant’s claims employees established that defendant timely paid a portion of each of said claims and that defendant timely denied the $60.70 per session balance allegedly due on them. For the reasons stated in Great Wall Acupuncture v GEICO Gen. Ins. Co. (16 Misc 3d 23 [App Term, 2d & 11th Jud Dists 2007]), it was proper for defendant to use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which plaintiff was entitled to receive for the acupuncture services rendered by its acupuncturist (see AVA Acupuncture, P.C. v GEICO Gen. Ins. Co., 23 Misc 3d 140[A], 2009 NY Slip Op 51017[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; AVA Acupuncture, P.C. v GEICO Gen. Ins. Co., 17 Misc 3d 41 [App Term, 2d & 11th Jud Dists 2007]). Therefore, we decline to disturb so much of the order as, upon a search of the record, granted defendant summary judgment dismissing plaintiff’s complaint with respect to said claims.
Pesce, P.J., Rios and Steinhardt, JJ., concur.
Decision Date: August 31, 2009
Reported in New York Official Reports at Urban Radiology, P.C. v American Tr. Ins. Co. (2009 NY Slip Op 51734(U))
| Urban Radiology, P.C. v American Tr. Ins. Co. |
| 2009 NY Slip Op 51734(U) [24 Misc 3d 142(A)] |
| Decided on July 31, 2009 |
| 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 STEINHARDT, JJ
2008-1576 K C.
against
American Transit Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Lila Gold, J.), entered December 14, 2007. The order denied defendant’s motion to vacate a default judgment and compel plaintiff to accept its late answer.
Order modified by providing that defendant’s motion is granted to the extent of vacating the default judgment with respect to plaintiff’s $2,322.73 claim for services rendered to assignor Patrick Seraphin and compelling plaintiff to accept defendant’s late answer with respect to said claim; as so modified, affirmed without costs.
In this action to recover assigned first-party no-fault benefits, defendant moved to vacate a default judgment and to compel plaintiff to accept its late answer. The Civil Court denied defendant’s motion, and the instant appeal by defendant ensued.
It is well settled that in order to vacate a default judgment, the defendant must demonstrate both a reasonable excuse for its delay in appearing and answering the complaint as well as a meritorious defense to the action (see CLR 5015 [a] [1]; 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]). In the case at bar, defendant’s no-fault supervisor, who was also the claims representative who handled the instant claims, submitted an affidavit in which he stated that defendant had lost the file containing the summons and complaint and had not found out about the default until June 25, 2007. The record also indicates that defendant’s attorney initiated the instant motion to vacate the default judgment promptly in July 2007. On these facts, defendant’s failure to answer the complaint was excusable (see e.g. Perez v Travco Ins. Co., 44 AD3d 738 [2007]; Sound Shore Med. Ctr. v Lumbermens Mut. Cas. Co., 31 AD3d at 743; Dodge v Commander, 18 AD3d 943, 946 [2005]; Triangle Transp. Inc. v Markel Ins. Co., 18 [*2]AD3d 229 [2005]; Allstate Ins. Co. v Progressive Cas. Ins. Co., 20 Misc 3d 139[A], 2008 NY Slip Op 51567[U] [App Term, 2d & 11th Jud Dists 2008]).
A review of the record indicates that defendant demonstrated a potentially meritorious defense to plaintiff’s $2,322.73 claim for the services it rendered to assignor Patrick Seraphin. The affidavits of defendant’s claims representative and mail room supervisor show that defendant timely denied said claim within the 30-day statutory time period as required by Insurance Department Regulations (11 NYCRR) § 65-3.8 (c) (see also Insurance Law § 5106 [a]), based upon, inter alia, a peer review report concluding that there was no medical necessity for the services rendered to Seraphin. In regard to the claims for the services plaintiff rendered to assignor Guy Louis, defendant argued that it did not have to pay or deny these claims because plaintiff had failed to respond to its verification requests and, thus, the 30-day statutory time period within which it had to respond to the claims had been tolled. However, defendant failed to demonstrate merit to said defense since the affidavits did not show that defendant’s requests for additional verification were timely (see Insurance Department Regulations [11 NYCRR] § 65-3.5 [b]) and, consequently, the action with respect to said claims was not premature.
In view of the fact that defendant has shown a reasonable excuse for its default and a meritorious defense as to the claim for services rendered to assignor Patrick Seraphin, we find that the Civil Court improvidently exercised its discretion in denying that part of defendant’s motion which sought to vacate the default judgment and compel plaintiff to accept a late answer with respect to plaintiff’s $2,322.73 claim (see New York Univ. Hosp. Rusk Inst. v Illinois Natl. Ins. Co., 31 AD3d 511, 512 [2006]).
Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 31, 2009
Reported in New York Official Reports at Great Wall Acupuncture, P.C. v Auto One Ins. Co. (2009 NY Slip Op 51733(U))
| Great Wall Acupuncture, P.C. v Auto One Ins. Co. |
| 2009 NY Slip Op 51733(U) [24 Misc 3d 142(A)] |
| Decided on July 31, 2009 |
| 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 STEINHARDT, JJ
2008-1094 Q C.
against
Auto One Insurance Company, Respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered April 3, 2008. The order, insofar as appealed from, (1) granted plaintiff’s motion to strike defendant’s answer pursuant to CPLR 3126 only to the extent of directing defendant to respond to plaintiff’s demand for written interrogatories and for discovery and inspection within 60 days of the date of the order or be precluded from offering or soliciting evidence at trial; (2) granted defendant’s cross motion, which sought to compel plaintiff to produce its owner, Valentina Anikeyeva, for a deposition and to provide discovery, to the extent of directing plaintiff to respond to items 1-3, 6, 8, 10, 11 and 14 of defendant’s supplemental demand for discovery and inspection, and (3) stated that defendant “reserves [its] right to re-notice owner for EBT.”
Order, insofar as appealed from, modified by providing that defendant’s cross motion to compel discovery is denied; as so modified, affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court granted plaintiff’s motion to strike defendant’s answer pursuant to CPLR 3126 to the extent of compelling defendant to respond to plaintiff’s demands for written interrogatories and for discovery and inspection within 60 days or be precluded from offering or soliciting evidence at trial. The court also granted defendant’s cross motion to compel a deposition and responses to discovery demands to the extent of compelling plaintiff to respond to items 1-3, 6, 8, 10, 11 and 14 of defendant’s supplemental demand for discovery and inspection. The court further stated that defendant “reserves [its] right to re-notice owner for EBT.”
Although plaintiff contends that the court erred when it failed to strike defendant’s answer due to defendant’s failure to provide responses to plaintiff’s discovery demands, “striking [a [*2]pleading] is inappropriate absent a clear showing that the failure to comply with discovery demands is willful, contumacious, or in bad faith” (Conciatori v Port Auth. of NY & N.J., 46 AD3d 501, 504 [2007]; see Espinal v City of New York, 264 AD2d 806 [1999]). In our view, plaintiff failed to make such a “clear showing” (Conciatori, 46 AD3d at 504). Accordingly, contrary to plaintiff’s contention, the record does not support “the extreme relief requested by the plaintiff[]” (id.).
However, plaintiff correctly argues that the Civil Court erred when it ordered plaintiff to respond to specified items set forth in defendant’s supplemental demand for discovery and inspection. By cross-moving to compel responses to its supplemental demand for discovery and inspection on the same day as it served said supplemental demand, defendant failed to give plaintiff an opportunity to respond to the supplemental demand or to object thereto. Indeed, defendant cross-moved before plaintiff even received the supplemental demand. As a result, defendant’s cross motion should have been denied as premature (see Sagiv v Gamache, 26 AD3d 368 [2006]).
Plaintiff further argues that defendant is not entitled to a deposition of plaintiff’s owner, Valentina Anikeyeva. We note that the Civil Court did not compel plaintiff to produce her for a deposition. In any event, under the facts of this case, such a contention lacks merit (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]).
Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 31, 2009
Reported in New York Official Reports at WJJ Acupuncture, P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51731(U))
| WJJ Acupuncture, P.C. v Utica Mut. Ins. Co. |
| 2009 NY Slip Op 51731(U) [24 Misc 3d 142(A)] |
| Decided on July 31, 2009 |
| 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 STEINHARDT, JJ
2008-564 K C.
against
Utica Mutual Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Genine D. Edwards, J.), entered April 19, 2007, deemed from a judgment entered July 2, 2007 (see CPLR 5501 [c]). The judgment, entered pursuant to the April 19, 2007 order granting plaintiff’s motion for summary judgment, awarded plaintiff the principal sum of $4,267.13.
Judgment reversed without costs, so much of the order entered April 19, 2007 as granted plaintiff’s motion for summary judgment upon its claims pertaining to assignors Natasha Wright and Junior Ford vacated, said branches of plaintiff’s motion for summary judgment denied without prejudice, and matter remitted to the Civil Court for the calculation of statutory interest and attorney’s fees upon the $428.56 claim pertaining to assignor Steven Stryr.
Plaintiff commenced the instant action to recover first-party no-fault benefits assigned to it by Natasha Wright, Junior Ford and Steven Stryr. By order dated April 19, 2007, the Civil Court granted plaintiff’s motion for summary judgment, and this appeal ensued. The appeal is deemed to be from the judgment that was subsequently entered pursuant to the April 19, 2007 order (see CPLR 5501 [c]).
Contrary to plaintiff’s contention, the subject order was not entered upon defendant’s default inasmuch as the CPLR 2219 (a) recitation states that the court considered defendant’s opposing papers (see CPLR 2219 [a]; Mitchell v Sebrew, 17 Misc 3d 137[A], 2007 NY Slip Op 52301[U] [App Term, 2d & 11th Jud Dists 2007]; A.B. Med. Servs PLLC v New York Cent. Mut. Fire Ins. Co., 6 Misc 3d 133[A], 2005 NY Slip Op 50115[U] [App Term, 2d & 11th Jud Dists 2005]).
Defendant contends on appeal, as it did before the Civil Court, that plaintiff’s motion for [*2]summary judgment was made in violation of a previously ordered stay issued by the Supreme Court, Nassau County (Brennan, J.). Upon a review of the order issued by Justice Brennan, which was appended to defendant’s opposition papers, we find that the order barred plaintiff from moving for summary judgment upon plaintiff’s claims pertaining to assignors Natasha Wright and Junior Ford (see A.T. Med., P.C. v State Farm Ins. Co., 19 Misc 3d 138[A], 2008 NY Slip Op 50875[U] [App Term, 2d & 11th Jud Dists 2008]). Consequently, plaintiff’s motion for summary judgment is denied without prejudice with respect to these claims.
However, inasmuch as the stay is inapplicable to claims pertaining to assignor Steven Stryr, the stay did not bar the branch of plaintiff’s motion which sought summary judgment upon the $428.56 claim to recover assigned first-party no-fault benefits for services rendered to Stryr. As the sole argument raised on appeal by defendant concerns the stay issued by Justice Brennan, defendant failed to establish that plaintiff was not entitled to summary judgment upon the $428.56 claim pertaining to Stryr.
Accordingly, the judgment is reversed, so much of the order entered April 19, 2007 as granted plaintiff’s motion for summary judgment upon its claims pertaining to assignors Natasha Wright and Junior Ford is vacated, said branches of plaintiff’s motion for summary judgment are denied without prejudice, and the matter is remitted to the Civil Court for the calculation of statutory interest and an assessment of attorney’s fees due on plaintiff’s claim for $428.56, pertaining to assignor Steven Stryr, pursuant to Insurance Law § 5106 (a) and the regulations promulgated thereunder.
Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 31, 2009
Reported in New York Official Reports at Astoria Advanced Med., P.C. v Allstate Ins. Co. (2009 NY Slip Op 51729(U))
| Astoria Advanced Med., P.C. v Allstate Ins. Co. |
| 2009 NY Slip Op 51729(U) [24 Misc 3d 142(A)] |
| Decided on July 29, 2009 |
| 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 STEINHARDT, JJ
2008-413 K C.
against
Allstate Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Lila Gold, J.), entered July 20, 2007. The order granted so much of defendant’s motion as sought to disqualify Gary Tsirelman, Esq., and Gary Tsirelman, P.C. from representing plaintiff in this action.
Order affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted so much of a motion by defendant as sought to disqualify Gary Tsirelman, Esq., and Gary Tsirelman, P.C. from representing plaintiff in this action.
“Whether counsel should be allowed to act as both attorney and witness is a matter addressed to the sound discretion of the court. . . In a disqualification situation any doubt is to be resolved in favor of disqualification” (Solomon v New York Prop. Ins. Underwriting Assn., 118 AD2d 695, 695-696 [1986] [citations omitted]). In the instant case, Gary Tsirelman is both counsel to and sole owner of plaintiff medical provider, and defendant has raised an issue of fact as to whether plaintiff is eligible to receive reimbursement of first-party no-fault benefits (see State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]). In light of defendant’s showing that Tsirelman will almost certainly be called as a witness, and that the ultimate determination may well hinge in part on his credibility, the Civil Court properly disqualified Gary Tsirelman, Esq., and Gary Tsirelman, P.C. from representing plaintiff in this action (see Code of Professional Responsibility DR 5-102 [22 NYCRR 1200.21], now Rules of Professional Conduct rule 3.7 [22 NYCRR 1200.29]; Luk Lamellen u. Kupplungsbau GmbH v Lerner, 167 AD2d 451, 452 [1990]; Solomon, 118 AD2d 695). [*2]
Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 29, 2009
Reported in New York Official Reports at Alexander Alperovich, M.D., P.C. v Auto One Ins. Co. (2009 NY Slip Op 51721(U))
| Alexander Alperovich, M.D., P.C. v Auto One Ins. Co. |
| 2009 NY Slip Op 51721(U) [24 Misc 3d 141(A)] |
| Decided on July 29, 2009 |
| 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 STEINHARDT, JJ
2008-1028 K C.
against
Auto One Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Loren Baily-Schiffman, J.), entered February 28, 2008. The order denied plaintiff’s motion for summary judgment.
Order reversed without costs, plaintiff’s motion for summary judgment granted and matter remitted to the Civil Court for the calculation of statutory interest and an assessment of attorney’s fees.
In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court denied plaintiff’s motion for summary judgment, holding that there are questions of fact as to whether plaintiff’s assignor is an innocent third party or was involved in, or had knowledge of, the identity theft which resulted in defendant’s issuance of the automobile insurance policy. The instant appeal by plaintiff ensued.
While defendant contends that plaintiff is not entitled to summary judgment because the insurance policy was obtained fraudulently as a result of identity theft, the record is bereft of any evidence that plaintiff’s assignor participated in or was aware of such a fraudulent scheme (cf. A.B. Med. Servs. PLLC v Commercial Mut. Ins. Co., 12 Misc 3d 8 [App Term, 2d & 11th Jud Dists 2006]). Since defendant did not cancel the insurance policy prior to the accident (see Vehicle and Traffic Law § 313), defendant failed to demonstrate the existence of an issue of fact so as to defeat plaintiff’s motion for summary judgment (see Matter of Metlife Auto & Home v Agudelo, 8 AD3d 571 [2004]; D.A.V. Chiropractic, P.C. v GEICO Indem. Co., 21 Misc 3d 138[A], 2008 NY Slip Op 52304[U] [App Term, 9th & 10th Jud Dists 2008]; cf. A.B. Med. Servs. PLLC, 12 Misc 3d 8). Accordingly, the order is reversed, plaintiff’s motion for summary judgment is granted, and the matter is remitted to the Civil Court for the calculation of statutory [*2]interest and an assessment of attorney’s fees pursuant to Insurance Law § 5106 (a) and the regulations promulgated thereunder.
Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 29, 2009
Reported in New York Official Reports at LMK Psychological Serv., P.C. v American Tr. Ins. Co. (2009 NY Slip Op 06004)
| LMK Psychological Serv., P.C. v American Tr. Ins. Co. |
| 2009 NY Slip Op 06004 [64 AD3d 752] |
| July 28, 2009 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| LMK Psychological Service, P.C., et al.,
Appellants, v American Transit Insurance Co., Respondent. |
—[*1]
Stern & Montana, LLP, New York, N.Y. (Richard Montana of counsel), for
respondent.
In an action to recover no-fault medical payments under certain contracts of insurance, the plaintiffs appeal, as limited by their brief, (1) from so much of an order of the Supreme Court, Westchester County (Bellantoni, J.), entered January 16, 2008, as denied their motion for summary judgment on the complaint and granted those branches of the defendant’s cross motion which were for summary judgment dismissing the first, third, fourth, fifth, sixth, eighth, ninth, tenth, eleventh, twelfth, fourteenth, fifteenth, and sixteenth causes of action, and (2) from so much of an order of the same court entered July 2, 2008, as, upon reargument, adhered to the original determination in the order entered January 16, 2008.
Ordered that appeal from the order entered January 16, 2008, is dismissed, as that order was superseded by the order entered July 2, 2008, made upon reargument; and it is further,
Ordered that the order entered July 2, 2008, is modified, on the law, by deleting the provisions thereof, upon reargument, adhering to the original determination in the order entered January 16, 2008, granting those branches of the defendant’s cross motion which were for summary judgment dismissing the first, third, fourth, fifth, sixth, eighth, ninth, tenth, eleventh, twelfth, fourteenth, fifteenth, and sixteenth causes of action, and substituting therefor a provision, upon reargument, vacating so much of the order entered January 16, 2008, as granted those branches of the cross motion; as so modified, the order entered July 2, 2008, is affirmed insofar as appealed from, without costs or disbursements, and the matter is remitted to the Supreme Court, Westchester County, for a new determination of those branches of the cross motion following a prompt application to the Workers’ Compensation Board to determine the parties’ rights under the Workers’ Compensation Law.
The plaintiffs, as assignees of no-fault benefits (see Insurance Law § 5101 et seq.), brought this action to recover for health services rendered to the beneficiaries of the defendant’s no-fault insurance contracts. Each assignor received medical treatment from the plaintiffs following separate automobile accidents. The complaint contained 17 causes of action. The plaintiffs moved for summary judgment on the complaint and the defendant cross-moved, inter alia, for summary judgment dismissing the complaint. The Supreme Court, inter alia, denied the plaintiffs’ motion, and granted those branches of the defendant’s cross motion which were to dismiss the first, third, fourth, fifth, sixth, eighth, ninth, tenth, eleventh, twelfth, fourteenth, fifteenth, and sixteenth causes [*2]of action. The court concluded that, because the assignors in the aforementioned causes of action were injured during the course of their respective employment, the plaintiffs were barred from recovery pursuant to Workers’ Compensation Law § 11. The plaintiffs moved, and the defendant cross-moved, for leave to reargue. Upon reargument, the court adhered to its original determination. We modify.
There has been no determination by the Workers’ Compensation Board as to whether the assignors are entitled to Workers’ Compensation benefits for their injuries (see Nunes v Window Network, LLC, 54 AD3d 834, 835 [2008]; cf. Thompson v Grumman Aerospace Corp., 78 NY2d 553 [1991]). The Workers’ Compensation Board has primary jurisdiction to determine factual issues concerning coverage under the Workers’ Compensation Law (see Botwinick v Ogden, 59 NY2d 909, 911 [1983]; Bastidas v Epic Realty, LLC, 58 AD3d 776 [2009]; Santigate v Linsalata, 304 AD2d 639, 640 [2003]). Where “a plaintiff fails to litigate that issue before the Board, ‘the court should not express an opinion as to the availability of compensation but remit the matter to the Board’ ” (O’Hurley-Pitts v Diocese of Rockville Ctr., 57 AD3d 633, 634 [2008], quoting Liss v Trans Auto Sys., 68 NY2d 15, 21 [1986]). Accordingly, in considering the defendant’s cross motion, the Supreme Court should not have entertained the defendant’s contention that the plaintiffs were barred from recovery pursuant to Workers’ Compensation Law § 11. Those claims must be referred to the Workers’ Compensation Board for a determination as to whether the plaintiffs have a valid cause of action to recover no-fault benefits, or whether they are relegated to benefits under the Workers’ Compensation Law (cf. O’Hurley-Pitts v Diocese of Rockville Ctr., 57 AD3d at 634; Nunes v Window Network, LLC, 54 AD3d at 835).
The Supreme Court properly denied the plaintiffs’ motion for summary judgment on the complaint, as the plaintiffs failed to demonstrate, prima facie, their entitlement to judgment as a matter of law.
The plaintiffs’ remaining contentions either are without merit or have been rendered academic in light of our determination. Skelos, J.P., Santucci, Balkin and Leventhal, JJ., concur.
Reported in New York Official Reports at Psychology YM, P.C. v Nationwide Mut. Ins. Co. (2009 NY Slip Op 51634(U))
| Psychology YM, P.C. v Nationwide Mut. Ins. Co. |
| 2009 NY Slip Op 51634(U) [24 Misc 3d 140(A)] |
| Decided on July 24, 2009 |
| 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 STEINHARDT, JJ
2008-1515 K C.
against
Nationwide Mutual Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Kathryn E. Freed, J.), entered April 4, 2007, deemed from a judgment of the same court entered June 20, 2007 (see CPLR 5501 [c]). The judgment, entered pursuant to the April 4, 2007 order granting plaintiff’s motion for summary judgment, awarded plaintiff the principal sum of $578.90.
Judgment reversed without costs, order granting plaintiff’s motion for summary judgment vacated and plaintiff’s motion for summary judgment denied.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court granting plaintiff’s motion for summary judgment. The appeal is deemed to be from the judgment that was subsequently entered pursuant to the order (see CPLR 5501 [c]).
Since plaintiff’s motion for summary judgment was supported by an affidavit of an employee of a third-party billing company which failed to comply with CPLR 4518, plaintiff failed to make a prima facie showing of its entitlement to summary judgment (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 15 Misc 3d 144[A], 2007 NY Slip Op 51161[U] [App Term, 2d & 11th Jud Dists, 2007], affd 55 AD3d 644 [2008]; Andrew Carothers, M.D., P.C. v GEICO Indem. Co., ___ Misc 3d ___, 2009 NY Slip Op 29155 [App Term, 2d, 11th & 13th Jud Dists 2009]; Bath Med. Supply, Inc. v Deerbrook Ins. Co., 14 Misc 3d 135[A], 2007 NY Slip Op 50179[U] [App Term, 2d & 11th Jud Dists 2007]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Consequently, plaintiff’s motion for summary judgment should have been denied.
In light of the foregoing, we reach no other issue.
Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 24, 2009
Reported in New York Official Reports at Andromeda Med. Care, P.C. v Utica Mut. Ins. Co. (2009 NY Slip Op 51629(U))
| Andromeda Med. Care, P.C. v Utica Mut. Ins. Co. |
| 2009 NY Slip Op 51629(U) [24 Misc 3d 139(A)] |
| Decided on July 24, 2009 |
| 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 STEINHARDT, JJ
2008-505 K C.
against
Utica Mutual Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Alice Fisher Rubin, J.), entered July 10, 2007. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion seeking summary judgment and sanctions.
Order modified by providing that defendant’s motion for summary judgment is denied; as so modified, affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion seeking summary judgment and sanctions.
The affidavits proffered by defendant in support of its motion for summary judgment were executed out of state. Although the affidavits were accompanied by documents that purported to be certificates of conformity, the certificates did not comply with Real Property Law § 299-a and, thus, the affidavits did not comply with CPLR 2309 (c) (see Ford Motor Credit Co. v Prestige Gown Cleaning Serv., 193 Misc 2d 262 [2002]). Since this defect was duly objected to by plaintiff in the Civil Court, defendant failed to introduce competent evidence in admissible form establishing its entitlement to summary judgment (see Impulse Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co., 19 Misc 3d 127[A], 2008 NY Slip Op 50498[U] [App Term, 2d & 11th Jud Dists 2008]). Consequently, defendant’s motion for summary judgment should have been denied (id.).
Contrary to plaintiff’s contention, plaintiff’s cross motion for summary judgment was properly denied. Plaintiff failed to establish that its billing records constituted evidence in admissible form pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]; Midborough Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co., 13 Misc 3d 132[A], 2006 NY Slip Op 51879[U] [App Term, 2d [*2]& 11th Jud Dists 2006]). Plaintiff’s remaining contentions lack merit.
Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 24, 2009