Reported in New York Official Reports at Longevity Med. Supply, Inc. v Nationwide Ins. (2020 NY Slip Op 51133(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Nationwide Ins., Appellant.
Hollander Legal Group , P.C. (Allan S. Hollander of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Richard J. Montelione, J.), entered November 13, 2018. The order, insofar as appealed from and as limited by the brief, denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, 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 plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs), and plaintiff cross-moved for summary judgment. As limited by the brief, defendant appeals from so much of an order of the Civil Court entered November 13, 2018 as denied defendant’s motion.
We find that defendant established that the EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), that plaintiff’s assignor had failed to appear for the duly scheduled EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 [2006]), and that the claims had been timely denied on that ground (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123; ARCO Med. NY, P.C. v Lancer Ins. Co., 34 Misc 3d 134[A], 2011 NY Slip Op 52382[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists [2011]). Plaintiff failed to raise a triable issue of fact in opposition. Contrary to the Civil Court’s determination, “appearance at an [EUO] is required whether the insurance company demands the [EUO] before the claim form is submitted or after the claim form is submitted” (Stephen Fogel Psychological, P.C., 35 AD3d at 721; LDE Med. Servs., P.C. v Interboro Ins. Co., 31 Misc 3d 146[A], 2011 NY Slip Op 50946[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]). Consequently, although the first EUO scheduling letter was mailed to the assignor before defendant received plaintiff’s first claim form, the scheduling letter was not a nullity (id.).
Accordingly, the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: October 2, 2020
Reported in New York Official Reports at Silver Acupuncture, P.C. v GEICO Indem. Co. (2020 NY Slip Op 51134(U))
[*1]| Silver Acupuncture, P.C. v GEICO Indem. Co. |
| 2020 NY Slip Op 51134(U) [69 Misc 3d 128(A)] |
| Decided on October 2, 2020 |
| 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 October 2, 2020
PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2019-78 K C
against
GEICO Indemnity Company, Respondent.
Kopelevich & Feldsherova, P.C. (David Landfair of counsel), for appellant. Law Office of Goldstein & Flecker (Lawrence J. Chanice of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Lorna McAllister, J.) entered September 20, 2018. The order granted defendant’s motion to dismiss the complaint pursuant to CPLR 3216.
ORDERED that the order is affirmed, with $25 costs.
In February 2013, plaintiff commenced this action to recover assigned first-party no-fault benefits. Defendant interposed an answer on April 16, 2013. In October 2017, defendant moved pursuant to CPLR 3216 to dismiss the complaint on the ground that defendant had not been served with a notice of trial within 90 days of defendant’s service upon plaintiff, on March 27, 2017, of a 90-day demand. In opposition to the motion, plaintiff’s counsel stated that a notice of trial had been filed on July 20, 2018. Plaintiff argued that law office failure was the reason for the delay and that it had a meritorious cause of action. By order entered September 20, 2018, the Civil Court granted defendant’s motion to dismiss the complaint.
Upon receiving a 90-day demand, a plaintiff must either comply with the demand by filing a notice of trial within 90 days thereafter (see CPLR 3216 [b] [3]; [c]), or move before the default date either to vacate the demand or to extend the 90-day period pursuant to CPLR 2004 (see Felix v County of Nassau, 52 AD3d 653 [2008]; Katina, Inc. v Town of Hempstead, 13 AD3d 343 [2004]; A.M. Med. P.C. v State Farm Mut. Ins. Co., 22 Misc 3d 43 [App Term, 2d Dept, 2d & 11th Jud Dists 2008]). Here, since plaintiff filed a notice of trial more than 90 days after its receipt of the 90-day demand and had not moved prior thereto to vacate the demand or to extend the 90-day period, it was required, in opposition to defendant’s motion to dismiss, to establish both a justifiable excuse for its delay and the existence of a meritorious cause of action (see CPLR 3216 [e]; Baczkowski v Collins Constr. Co., 89 NY2d 499 [1997]; Felix, 52 AD3d 653; A.M. Med. P.C., 22 Misc 3d 43). While a court, in its discretion, may accept a claim of law [*2]office failure as an excuse (see CPLR 2005), here, the affirmation submitted by plaintiff’s attorney in opposition to defendant’s motion did not provide a credible explanation of the law office failure that had caused the delay (see Premier Surgical Servs., P.C. v Allstate Ins. Co., 58 Misc 3d 160[A], 2018 NY Slip Op 50273[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018]; Bayshore Chiropractic, P.C. v Allstate Ins. Co., 56 Misc 3d 141[A], 2017 NY Slip Op 51121[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]; Comeau v McClacken, 5 Misc 3d 134[A], 2004 NY Slip Op 51455[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2004]). Consequently, plaintiff’s claim of law office failure did not rise to the level of a justifiable excuse. In view of the foregoing, it is unnecessary to consider whether plaintiff demonstrated the existence of a meritorious cause of action (see generally Levi v Levi, 46 AD3d 519 [2007]; Premier Surgical Servs, P.C., 58 Misc 3d 160[A], 2018 NY Slip Op 50273[U]).
Accordingly, the order is affirmed.
ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: October 2, 2020JPF Med. Servs., P.C. v Nationwide Ins. (2020 NY Slip Op 51122(U))
Reported in New York Official Reports at JPF Med. Servs., P.C. v Nationwide Ins. (2020 NY Slip Op 51122(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Nationwide Ins., Respondent.
The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Hollander Legal Group , P.C. (Allan S. Hollander of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Michael Gerstein, J.), entered August 9, 2018. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.
ORDERED that the order is modified by providing that defendant’s 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, 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 for summary judgment.
To obtain summary judgment on its asserted defense of policy exhaustion, defendant had to prove that it had paid the limits of the policy in accordance with 11 NYCRR 65-3.15 (see Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294 [2007]; Alleviation Med. Servs., P.C. v Allstate Ins. Co., 55 Misc 3d 44 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]). Here, defendant failed to demonstrate, as a matter of law, that it had made any payments under the policy because, as plaintiff argues, defendant’s claim specialist did not lay a sufficient foundation for the payment log, upon which defendant relied, to be accepted as proof that the payments listed therein had been made (see CPLR 4518 [a]; People v Kennedy, 68 NY2d 569 [1986]; Charles Deng Acupuncture, P.C. v 21st Century Ins. Co., 61 Misc 3d 154[A], 2018 NY Slip Op 51815[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018]). Although defendant’s claim specialist referred to an affidavit annexed as exhibit K, which presumably discussed the payment log, an affidavit was not attached to the papers received by the court. Consequently, defendant failed to make a prima facie showing of its entitlement to summary judgment dismissing the complaint.
Plaintiff’s motion for summary judgment was properly denied, as the proof submitted by plaintiff failed to establish that the claims had not been timely denied (see Viviane Etienne Med. [*2]Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).
Accordingly, the order is modified by providing that defendant’s motion for summary judgment dismissing the complaint is denied.
WESTON, J.P., ALIOTTA and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 18, 2020
Reported in New York Official Reports at Right Aid Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2020 NY Slip Op 51120(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
State Farm Mutual Automobile Ins. Co., Respondent.
The Rybak Firm, PLLC (Oleg Rybak and Karina Barska of counsel), for appellant. Freiberg, Peck & Kang, LLP (Yilo J. Kang of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Cenceria P. Edwards, J.), entered March 15, 2019. The order, insofar as appealed from as limited by the brief, granted defendant’s motion to dismiss the complaint.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, the affidavit of service alleges that the summons and complaint were served by mail pursuant to CPLR 312-a. However, plaintiff’s papers do not contain an acknowledgment of service. Defendant moved to dismiss the complaint on the ground that plaintiff had failed to obtain personal jurisdiction over it. Plaintiff cross-moved for summary judgment. In an order entered March 15, 2019, insofar as appealed from as limited by the brief, the Civil Court granted defendant’s motion.
Initially, it is noted that defendant’s motion to dismiss the complaint pursuant to CPLR 3211 (a) was made after issue had been joined. Generally, such a motion must be made “before service of the responsive pleading is required” (CPLR 3211 [a]), although “[w]hether or not issue has been joined, the court, after adequate notice to the parties, may treat the motion as a motion for summary judgment” (CPLR 3211 [c]). Here, no such notice appears in the record; however, plaintiff does not raise the untimeliness of defendant’s motion, and, in any event, the specific issue raised regarding the lack of personal jurisdiction is purely a legal one, and notice is therefore not required (see generally Mihlovan v Grozavu, 72 NY2d 506, 508 [1988]; Four Seasons Hotels v Vinnik, 127 AD2d 310, 320 [1987]; Renelique v State-Wide Ins. Co., 50 Misc 3d 137[A], 2016 NY Slip Op 50095[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]).
When service of the summons in a Civil Court action is other than by personal delivery, service is complete upon the filing of proof of service (see CCA 410 [b]), and, with respect to a purported service by mailing pursuant to CPLR 312-a, proof of service involves an [*2]acknowledgment of receipt of the summons and complaint, as provided for in CPLR 312-a (see CPLR 306 [d]; see generally Domny Med. Servs., P.C. v First Acceptance Ins. Co. Inc., 66 Misc 3d 129[A], 2019 NY Slip Op 52048[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]; Active Care Med. Supply Corp. v Kemper Ins. Co., 63 Misc 3d 163[A], 2019 NY Slip Op 50923[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]; Richard A. Hellander, M.D., P.C. v Metlife Auto & Home Ins. Co., 48 Misc 3d 59, 61-62 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). Here, the record fails to demonstrate that a signed acknowledgment of receipt was returned to plaintiff (see CPLR 312-a [d]), or that service was otherwise completed within 120 days of the filing of the summons and complaint (see CCA 411). Thus, plaintiff failed to acquire personal jurisdiction over defendant (see CPLR 312-a [b]; Krasa v Dial 7 Car & Limousine Serv., Inc., 147 AD3d 744, 745 [2017]; Castillo v JFK Medport. Inc., 116 AD3d 899, 900 [2014]; Klein v Educational Loan Servicing, LLC, 71 AD3d 957, 958 [2010]; Bennett v Acosta, 68 AD3d 910, 911 [2009]; Horseman Antiques, Inc. v Huch, 50 AD3d 963, 964 [2008]).
We note that we do not consider any materials which are dehors the record on appeal (see Chimarios v Duhl, 152 AD2d 508 [1989]), nor do we consider any arguments that are raised for the first time on appeal (see Joe v Upper Room Ministries, Inc., 88 AD3d 963 [2011]).
Accordingly, the order, insofar as appealed from, is affirmed.
ALIOTTA, P.J., SIEGAL and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 11, 2020
Reported in New York Official Reports at Longevity Med. Supply, Inc. v American Ind. Ins. Co. (2020 NY Slip Op 51118(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
American Independent Ins. Co., American Independent Insurance Companies, Inc., and Good2go Auto Insurance, Defendants, and Omni Indemnity Company, Appellant.
Longevity Medical Supply, Inc., as Assignee of Young, Flora, Respondent,
against
American Independent Ins. Co., American Independent Insurance Companies, Inc., and Good2go Auto Insurance, Appellants, Omni Indemnity Company, Defendant.
Freiberg, Peck & Kang, LLP (Yilo J. Kang of counsel), for appellants and defendants. The Rybak Firm, PLLC (Damin J. Toell and Karina Barska of counsel), for respondent.
Appeals from an order of the Civil Court of the City of New York, Kings County (Lorna J. McAllister, J.), entered September 18, 2018. The order, insofar as appealed from by defendant Omni Indemnity Company and insofar as separately appealed from by defendants American Independent Ins. Co., American Independent Insurance Companies, Inc., and Good2go Auto Insurance, denied defendants’ motion to dismiss the complaint.
ORDERED that, on the court’s own motion, the appeals are consolidated for the purposes of disposition; and it is further,
ORDERED that the order, insofar as appealed from, is reversed, with $30 costs on each appeal, and defendants’ motion to dismiss the complaint is granted.
In this action by a provider to recover assigned first-party no-fault benefits, the affidavit of service alleges that the summons and complaint were served by mail pursuant to CPLR 312-a. However, plaintiff’s papers do not contain an acknowledgment of service. Defendants moved to dismiss the complaint on the ground that plaintiff had failed to obtain personal jurisdiction over them. Plaintiff cross-moved for summary judgment. In an order entered September 18, 2018, insofar as appealed from, the Civil Court denied defendants’ motion.
When service of the summons in the Civil Court is other than by personal delivery, service is complete upon the filing of proof of service (see CCA 410 [b]), and, with respect to a purported service by mailing pursuant to CPLR 312-a, proof of service involves an acknowledgment of receipt of the summons and complaint as provided for in CPLR 312-a (see [*2]CPLR 306 [d]; see generally Domny Med. Servs., P.C. v First Acceptance Ins. Co. Inc., 66 Misc 3d 129[A], 2019 NY Slip Op 52048[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]; Active Care Med. Supply Corp. v Kemper Ins. Co., 63 Misc 3d 163[A], 2019 NY Slip Op 50923[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]; Richard A. Hellander, M.D., P.C. v Metlife Auto & Home Ins. Co., 48 Misc 3d 59, 61-62 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). Here, the record fails to demonstrate that a signed acknowledgment of receipt was returned to plaintiff (see CPLR 312-a [d]), or that service was otherwise completed within 120 days of the filing of the summons and complaint (see CCA 411). Thus, plaintiff failed to acquire personal jurisdiction over defendants (see CPLR 312-a [b]; Krasa v Dial 7 Car & Limousine Serv., Inc., 147 AD3d 744, 745 [2017]; Castillo v JFK Medport. Inc., 116 AD3d 899, 900 [2014]; Klein v Educational Loan Servicing, LLC, 71 AD3d 957, 958 [2010]; Bennett v Acosta, 68 AD3d 910, 911 [2009]; Horseman Antiques, Inc. v Huch, 50 AD3d 963, 964 [2008]).
Accordingly, the order, insofar as appealed from, is reversed and defendants’ motion to dismiss the complaint is granted.
ALIOTTA, P.J., SIEGAL and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 11, 2020
Reported in New York Official Reports at Big Apple Ortho Prods., Inc. v MTA Bus Co. (2020 NY Slip Op 51112(U))
[*1]| Big Apple Ortho Prods., Inc. v MTA Bus Co. |
| 2020 NY Slip Op 51112(U) [69 Misc 3d 126(A)] |
| Decided on September 4, 2020 |
| 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 September 4, 2020
PRESENT: : MICHELLE WESTON, J.P., DAVID ELLIOT, BERNICE D. SIEGAL, JJ
2018-1841 K C
against
MTA Bus Company, Defendant, New York City Transit Authority, Nonparty-Appellant.
Jones Jones, LLP (Agnes Neiger of counsel), for nonparty-appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.
Appeal from an amended order of the Civil Court of the City of New York, Kings County (Michael Gerstein, J.), entered August 9, 2018. The amended order, insofar as appealed from, denied the branches of a motion by New York City Transit Authority seeking (1) to vacate so much of an order of that court (Theresa M. Ciccotto, J.) entered January 12, 2017 as granted the branch of plaintiff’s prior unopposed motion seeking to amend the caption to add New York City Transit Authority as defendant, or, (2) in the alternative, upon the granting of the branch of New York City Transit Authority’s motion seeking to compel plaintiff to accept a late answer and deem the answer duly served, for summary judgment dismissing the complaint.
ORDERED that the amended order entered August 9, 2018, insofar as appealed from, is reversed, without costs, and the branch of the motion by New York City Transit Authority seeking to vacate so much of the order entered January 12, 2017 as granted the branch of plaintiff’s prior unopposed motion seeking to amend the caption to add New York City Transit Authority as defendant is granted and that branch of plaintiff’s motion is denied; and it is further,
ORDERED that, on the court’s own motion, so much of the amended order entered August 9, 2018 as granted the branch of the motion by New York City Transit Authority seeking to compel plaintiff to accept a late answer and deem the answer duly served is vacated and that branch of the motion is denied as academic.
Plaintiff commenced this action to recover assigned first-party no-fault benefits and served the summons and complaint upon MTA Bus Company, the named defendant. Plaintiff then moved for “leave to amend the Summons and Complaint . . . to remove the named defendant MTA Bus Company as a defendant in this action and to add New York City Transit Authority as the herein defendant.” Plaintiff also sought leave to serve an amended summons and complaint. The motion was served by mail on New York City Transit Authority (NYCTA) on January 11, 2017 and was returnable on January 12, 2017. The motion was unopposed. By [*2]order entered January 12, 2017, the Civil Court (Theresa M. Ciccotto, J.) granted the motion and ordered that the action against MTA Bus Company was discontinued, that the caption was amended to name NYCTA as defendant, and that the summons and complaint were deemed to have been served upon NYCTA.
Thereafter, NYCTA moved, pursuant to CPLR 5015 (a) (4), to vacate so much of the January 12, 2017 order as added it as defendant, on the ground that, because plaintiff’s motion had not been properly served, the court lacked jurisdiction to issue the order deciding the motion. NYCTA stated that it had not received the motion, which was returnable January 12, 2017, until January 20, 2017. NYCTA moved, in the alternative, to compel plaintiff to accept a late answer from NYCTA, to deem the answer duly served, and for summary judgment dismissing the complaint on the ground that the notice of claim and claim forms had not been timely submitted. Plaintiff opposed the motion. By amended order entered August 9, 2018, the Civil Court (Michael Gerstein, J.) denied the branches of NYCTA’s motion seeking to vacate the stated portion of the January 12, 2017 order and the alternative relief seeking summary judgment dismissing the complaint, finding that “despite lack of proper notice,” the NYCTA suffered no prejudice, and, thus, “the Court accepts Defendant’s late answer.”
“The failure to give a party proper notice of a motion deprives the court of jurisdiction to entertain the motion and renders the resulting order void” (Citimortgage, Inc. v Reese, 162 AD3d 847, 848 [2018]; see Wells Fargo Bank, N.A. v Whitelock, 154 AD3d 906, 907 [2017]). In moving to add NYCTA as defendant, plaintiff failed to comply with CPLR 2214 (b), as the affidavit of service states that plaintiff served the motion papers on NYCTA by mail on January 11, 2017, while the return date of the motion was the following day, January 12, 2017. Consequently, the Civil Court lacked jurisdiction to consider that branch of plaintiff’s motion, and the branch of NYCTA’s motion seeking to vacate the stated portion of the January 12, 2017 order is granted. We leave undisturbed so much of the amended order entered August 9, 2018 as denied the branch of NYCTA’s motion seeking summary judgment dismissing the complaint, as that branch of the motion has been rendered academic. We note that plaintiff’s motion, denominated as a motion to amend the complaint, was actually a motion for leave to add a new party, which was required to have been made on notice to the original party, MTA Bus Company (see Testing Labs. of NY Inc. v Krainin, 124 Misc 667 [App Term, 1st Dept 1925]; 19 Carmody-Wait 2d § 19:111 at 356).
We further note that NYCTA is not aggrieved by so much of the Civil Court’s amended order entered August 9, 2018 as granted the branch of NYCTA’s motion seeking to compel plaintiff to accept a late answer and deem the answer duly served. Nevertheless, in light of our finding that the order entered January 12, 2017 was a nullity and that, consequently, NYCTA is not a party to this action, on the court’s own motion, we vacate so much of the amended order as granted that branch of NYCTA’s motion in order to grant just and complete relief to NYCTA, and that branch of NYCTA’s motion is denied as academic (see Wheeler v Buxton Indus. Equip. Co., 292 AD2d 521, 522 [2002]; City of Mount Vernon v Mount Vernon Hous. Auth., 235 AD2d 516, 517 [1997]; Bukhatir Mackinnon Ltd. v Sarfraz, 130 AD2d 358, 362 [1987]).
Accordingly, the amended order entered August 9, 2018, insofar as appealed from, is reversed, and the branch of the motion by New York City Transit Authority seeking to vacate so much of the order entered January 12, 2017 as granted the branch of plaintiff’s unopposed motion [*3]seeking to amend the caption to add New York City Transit Authority as defendant is granted and that branch of plaintiff’s motion is denied. On the court’s own motion, so much of the amended order entered August 9, 2018 as granted the branch of the motion by New York City Transit Authority seeking to compel plaintiff to accept a late answer and deem the answer duly served is vacated and that branch of the motion is denied as academic.
WESTON, J.P., ELLIOT and SIEGAL, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: September 4, 2020Focus Chiropractic, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51006(U))
Reported in New York Official Reports at Focus Chiropractic, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51006(U))
| Focus Chiropractic, P.C. v Global Liberty Ins. Co. of N.Y. |
| 2020 NY Slip Op 51006(U) [68 Misc 3d 133(A)] |
| Decided on August 28, 2020 |
| 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 August 28, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, WAVNY TOUSSAINT, JJ
2019-127 K C
against
Global Liberty Ins. Co. of N.Y., Appellant.
Law Office of Jason Tenenbaum, P.C. (Shaaker Bhuiyan of counsel), for appellant. Gary Tsirelman, P.C. (Gary Tsirelman, Esq.), for respondent (no brief filed).
Appeal from an order of the Civil Court of the City of New York, Kings County (Lorna J. McAllister, J.), entered November 2, 2018. The order, insofar as appealed from as limited by the brief, denied the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claim which was denied on the ground that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations.
ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claim which was denied on the ground that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations 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 grounds that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs) and that the amounts plaintiff sought to recover upon the remaining claims exceeded the amount permitted by the workers’ compensation fee schedule. In opposition to defendant’s motion, plaintiff only submitted an affirmation from plaintiff’s counsel. As limited by its brief, defendant appeals from so much of an order of the Civil Court entered November 2, 2018 as denied the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claim which was denied on the ground that plaintiff’s assignor had failed to appear for duly scheduled IMEs.
The affidavit submitted by defendant in support of its motion sufficiently established that the IME scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) to plaintiff’s assignor, thereby duly scheduling the IMEs. Defendant also established that the assignor had failed to appear for the scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Thus, defendant demonstrated that plaintiff had failed to comply with a condition [*2]precedent to coverage (id. at 722). Defendant further established that when the claim at issue was subsequently received, it was timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) on that ground. As plaintiff failed to raise a triable issue of fact, the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claim which was denied on the ground that plaintiff’s assignor had failed to appear for duly scheduled IMEs should have been granted.
Accordingly, the order, insofar as appealed from, is reversed and the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the claim which was denied on the ground that plaintiff’s assignor had failed to appear for duly scheduled IMEs is granted.
ALIOTTA, P.J., ELLIOT and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 28, 2020
Reported in New York Official Reports at S.O.V. Acupuncture, P.C. v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51004(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
Global Liberty Ins. Co. of N.Y., Appellant.
Law Office of Jason Tenenbaum, P.C. (Jason Tenenbaum of counsel), for appellant. Gary Tsirelman, P.C. (Douglas Mace of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Richard J. Montelione, J.), entered October 11, 2018. The order denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order is modified by providing that the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for dates of service December 28, 2015 and April 19, 2016, and so much of the unpaid portion of the claims billed using CPT codes 97810, 97811, 99202, and 99212, and the claims billed using CPT code 97026, except for dates of service December 11, 2015, March 1, 2016, March 17, 2016 and March 28, 2016, are granted; as so modified, the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the grounds that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs), that a portion of one claim was submitted more than 45 days after the subject services had been rendered, and that the amounts plaintiff sought to recover upon the remaining claims exceeded the amount permitted by the workers’ compensation fee schedule. In opposition to defendant’s motion, plaintiff only submitted an affirmation from plaintiff’s counsel. By order entered October 11, 2018, the Civil Court denied defendant’s motion.
In support of its motion, defendant submitted an affidavit which sufficiently established that the IME scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). To the extent plaintiff’s counsel argued that the IME scheduling letters had been mailed to the wrong address, the record demonstrates conclusively that the address to which the IME scheduling letters had been mailed matched the one provided by plaintiff’s assignor on the assignor’s handwritten, sworn application for no-fault benefits (NF-2) which was submitted to defendant. Consequently, defendant established that the address to which the IME scheduling letters were mailed was proper (see Valdan Acupuncture, [*2]P.C. v 21st Century Advantage Ins. Co., 63 Misc 3d 156[A], 2019 NY Slip Op 50822[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]; Sunlight Med. Care, P.C. v Esurance Ins. Co., 49 Misc 3d 130[A], 2015 NY Slip Op 51410[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). Defendant also established that the assignor had failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Thus, defendant demonstrated that plaintiff had failed to comply with a condition precedent to coverage (id. at 722). As defendant’s motion further established that defendant had timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) the claim for services rendered on April 19, 2016 on that ground, and plaintiff failed to raise a triable issue of fact in opposition to this branch of defendant’s motion, defendant was entitled to summary judgment dismissing so much of the complaint as sought to recover upon the claim for services rendered on April 19, 2016.
With respect to the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover for services rendered on December 28, 2015, the affidavit of defendant’s claims adjuster established that the claim for services rendered on December 28, 2015 had been submitted more than 45 days after those services had been rendered (see 11 NYCRR 65-2.4 [c]) and that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) its denial of claim form, which denied the claim on that ground. Furthermore, defendant’s denial of claim form advised plaintiff that late notice would be excused if reasonable justification for the failure to give timely notice was provided (11 NYCRR 65-2.4 [c]). As plaintiff failed to raise a triable issue of fact in response to defendant’s prima facie showing, the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover for services rendered on December 28, 2015 should have been granted.
With respect to the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover the unpaid portion of plaintiff’s claims which were denied on the ground that the amount sought exceeded the amount permitted by the workers’ compensation fee schedule, defendant established that it had fully paid plaintiff for the services billed under CPT codes 97810, 97811, 99202, and 99212 in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). Likewise, defendant demonstrated that it had fully paid plaintiff for the services billed under CPT codes 97026, except for the services rendered on December 11, 2015, March 1, 2016, March 17, 2016 and March 28, 2016, in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see id.). Thus, defendant established its prima facie entitlement to summary judgment upon the unpaid portion of those claims. As plaintiff failed to raise a triable issue of fact, the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of those claims should have been granted. However, as defendant concedes that the affidavit of its professional fee schedule coder stated that plaintiff was entitled to recover upon claims seeking payment for services billed using CPT 90739, defendant is not entitled to summary judgment with respect to those claims.
Accordingly, the order is modified by providing that the branches of defendant’s motion [*3]seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for dates of service December 28, 2015 and April 19, 2016, and so much of the unpaid portion of the claims billed using CPT codes 97810, 97811, 99202, and 99212, and claims billed using CPT code 97026, except for dates of service December 11, 2015, March 1, 2016, March 17, 2016 and March 28, 2016, are granted.
ALIOTTA, P.J., ELLIOT and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 28, 2020
Reported in New York Official Reports at Quest Supply, Inc. v NY Cent. Mut. Fire Ins. Co. (2020 NY Slip Op 51003(U))
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
against
NY Central Mutual Fire Ins. Co., Appellant.
Nightingale Law, P.C. (Michael S. Nightingale of counsel), for appellant. Gary Tsirelman, P.C. (Devon Riley Christian of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Lorna J. McAllister, J.), entered October 26, 2018. The order, insofar as appealed from, denied the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover the sum of $1,150.
ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover the sum of $1,150 is granted.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved, insofar as is relevant to this appeal, for summary judgment dismissing so much of the complaint as sought to recover the sum of $1,150, on the ground that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs). In support of the motion, defendant submitted an affidavit by an employee of the company which had been retained by defendant to schedule the pre-claim IMEs, which affidavit sufficiently demonstrated that the scheduling letters had been properly mailed to plaintiff’s assignor (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant proffered affidavits from the chiropractors who were to perform chiropractic and acupuncture IMEs, which sufficiently established that plaintiff’s assignor had failed to appear for those duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). In addition, an affidavit executed by defendant’s claim representative demonstrated that the denial of claim form, which denied the claim seeking to recover the sum of $1,150 based on the assignor’s nonappearance at the IMEs, had been timely mailed (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123).
In opposition, the affirmation of plaintiff’s counsel failed to demonstrate the existence of a triable issue of fact, since no issue was raised with respect to the scheduling letters mailed directly to plaintiff’s assignor (see generally MML Med. Care, P.C. v Praetorian Ins. Co., 46 Misc 3d 127[A], 2014 NY Slip Op 51792[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists [*2]2014]). Plaintiff’s remaining contention regarding defendant’s proof that the assignor had failed to appear for the IMEs lacks merit.
Accordingly, the order, insofar as appealed from, is reversed, and the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover the sum of $1,150 is granted.
ALIOTTA, P.J., SIEGAL and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 28, 2020
Reported in New York Official Reports at Colin v Global Liberty Ins. Co. of N.Y. (2020 NY Slip Op 51002(U))
| Colin v Global Liberty Ins. Co. of N.Y. |
| 2020 NY Slip Op 51002(U) [68 Misc 3d 132(A)] |
| Decided on August 28, 2020 |
| 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 August 28, 2020
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : THOMAS P. ALIOTTA, P.J., DAVID ELLIOT, WAVNY TOUSSAINT, JJ
2018-2315 K C
against
Global Liberty Ins. Co. of N.Y., Appellant.
Law Office of Jason Tenenbaum, P.C. (Shaaker Bhuiyan of counsel), for appellant. Kopelevich & Feldsherova, P.C. (David Landfair of counsel), for respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Lorna J. McAllister, J.), entered October 25, 2018. The order, insofar as appealed from and as limited by the brief, denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, 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 plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs). By order entered October 25, 2018, the Civil Court, insofar as is relevant to this appeal, denied the motion, but found, in effect pursuant to CPLR 3212 (g), that defendant had established timely mailing of the denial of claim forms.
In support of its motion, defendant submitted an affidavit by a supervisor employed by Omnimed Evaluation Services, which had been retained by defendant to schedule IMEs, which affidavit sufficiently established that the IME scheduling letters had been timely and properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). The record demonstrates conclusively that the address to which the IME scheduling letters had been mailed to plaintiff’s assignor matched the one provided by plaintiff’s assignor on the assignor’s sworn application for no-fault benefits (NF-2) and on plaintiff’s NF-3 forms, all of which were submitted to defendant. To the extent plaintiff contends that defendant was required to also send the IME scheduling letters to the same address but with a zip code which differed by one digit simply because the police report set forth that zip code, that contention lacks merit. Not only did plaintiff’s assignor swear under penalty of perjury that the zip code which defendant used was the correct zip code, plaintiff’s opposition papers did not contain an affidavit from plaintiff’s assignor which asserted that the zip code to which defendant mailed the IME scheduling letters was incorrect. Defendant also established that the assignor had failed to appear [*2]for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Thus, defendant demonstrated that plaintiff had failed to comply with a condition precedent to coverage (id. at 722). In view of the foregoing, and as plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment, the order, insofar as appealed from, is reversed and defendant’s motion for summary judgment dismissing the complaint is granted.
ALIOTTA, P.J., ELLIOT and TOUSSAINT, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 28, 2020