Progressive Cas. Ins. Co. v Excel Prods., Inc. (2019 NY Slip Op 02569)

Reported in New York Official Reports at Progressive Cas. Ins. Co. v Excel Prods., Inc. (2019 NY Slip Op 02569)

Progressive Cas. Ins. Co. v Excel Prods., Inc. (2019 NY Slip Op 02569)
Progressive Cas. Ins. Co. v Excel Prods., Inc.
2019 NY Slip Op 02569 [171 AD3d 812]
April 3, 2019
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, May 29, 2019

[*1]

 Progressive Casualty Insurance Company et al., Respondents,
v
Excel Products, Inc., Appellant.

The Rybak Firm, PLLC, Brooklyn, NY (Maksim Leyvi and Andrew S. Fisher of counsel), for appellant.

McCormack & Mattei, P.C., Garden City, NY (Melanie J. Rosen and Debra Ruderman of counsel), for respondents.

In an action, inter alia, for a judgment declaring that the plaintiffs are not obligated to pay certain no-fault claims submitted by the defendant, the defendant appeals from an order of the Supreme Court, Nassau County (Randy Sue Marber, J.), dated May 26, 2017. The order denied the defendant’s motion pursuant to CPLR 317 and 5015 (a) (1) to vacate a judgment of the same court entered September 3, 2015, upon its failure to appear or answer the complaint.

Ordered that the order is affirmed, with costs.

The plaintiffs commenced this action, inter alia, for a judgment declaring that they are not obligated to pay certain no-fault claims submitted by the defendant on the grounds that the defendant failed to comply with conditions precedent to coverage or to verify its claims. The plaintiffs served the defendant by delivering a copy of the summons and complaint to the Secretary of State pursuant to Business Corporation Law § 306. After the defendant failed to answer or appear, the plaintiffs moved for entry of a default judgment. The Supreme Court granted the plaintiffs’ unopposed motion, and a default judgment was entered on September 3, 2015. On September 10, 2015, the plaintiffs served the defendant with a copy of the judgment with notice of entry. In January 2017, the defendant moved pursuant to CPLR 317 and 5015 (a) (1) to vacate the judgment entered September 3, 2015. The court denied the motion, and the defendant appeals.

Pursuant to CPLR 317, a defaulting defendant who was “served with a summons other than by personal delivery” may be permitted to defend the action upon a finding by the court that the defendant did not personally receive notice of the summons in time to defend and has a potentially meritorious defense (CPLR 317; see Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138, 141 [1986]; Booso v Tausik Bros., LLC, 148 AD3d 1108, 1108 [2017]; Gershman v Midtown Moving & Stor., Inc., 123 AD3d 974, 975 [2014]). Service on a corporation through delivery of process to the Secretary of State is not “personal delivery” to the corporation (CPLR 317; see Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d at 142; Booso v Tausik Bros., LLC, 148 AD3d at 1108). A defendant seeking to vacate a default in appearing or answering pursuant to CPLR 5015 (a) (1) must demonstrate both a reasonable excuse for the default and a potentially meritorious defense to the action (see Xiao Lou Li v China Cheung Gee Realty, LLC, 139 AD3d 724, 726 [2016]; Sussman v Jo-Sta Realty Corp., 99 AD3d 787, 788 [2012]).

Here, the defendant’s principal submitted an affidavit in support of the motion in which she denied receipt of a copy of the summons and complaint and affirmed that she did not have notice of the action until in or about January 2017. However, the address she listed as the defendant’s office was the same as the address that was on file with the Secretary of State. In addition, affidavits of service submitted by the plaintiffs demonstrated that notice of service and other documents in this action were mailed to that address. Under those circumstances, the conclusory and unsubstantiated denial of receipt of the summons and complaint was insufficient to establish that the defendant did not have actual notice of the action in time to defend (see Stevens v Stepanski, 164 AD3d 935, 937 [2018]; Xiao Lou Li v China Cheung Gee Realty, LLC, 139 AD3d at 726; Capital Source v AKO Med., P.C., 110 AD3d 1026, 1027 [2013]; Udell v Alcamo Supply & Contr. Corp., 275 AD2d 453, 454 [2000]).

Similarly, the affidavit of the defendant’s principal was insufficient to establish a reasonable excuse for the defendant’s default pursuant to CPLR 5015 (a) (1) (see Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d at 141-142; Xiao Lou Li v China Cheung Gee Realty, LLC, 139 AD3d at 726; Gershman v Midtown Moving & Stor., Inc., 123 AD3d at 975). In addition, that branch of the motion which was pursuant to CPLR 5015 (a) (1) was untimely, since the motion was not made within one year after the defendant was served with a copy of the judgment with notice of entry (see CPLR 5015 [a] [1]; Deutsche Bank Natl. Trust Co. v White, 110 AD3d 759, 760 [2013]).

In light of the foregoing, it is unnecessary to determine whether the defendant demonstrated the existence of a potentially meritorious defense for purposes of either CPLR 317 or 5015 (a) (1) (see Xiao Lou Li v China Cheung Gee Realty, LLC, 139 AD3d at 726; Capital Source v AKO Med., P.C., 110 AD3d at 1027).

The defendant’s remaining contentions are improperly raised for the first time on appeal (see Collins v 7-11 Corp., 146 AD3d 931, 932 [2017]).

Accordingly, we agree with the Supreme Court’s denial of the defendant’s motion pursuant to CPLR 317 and 5015 (1) (1) to vacate the judgment. Rivera, J.P., Cohen, Miller and Barros, JJ., concur.

North Val. Med., P.C. v Allstate Ins. Co. (2019 NY Slip Op 50904(U))

Reported in New York Official Reports at North Val. Med., P.C. v Allstate Ins. Co. (2019 NY Slip Op 50904(U))

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

North Valley Medical, P.C., as Assignee of Genevia Fisher and Benny Francis, Respondent,

against

Allstate Insurance Company, Appellant.

Peter C. Merani, P.C. (Eric M. Wahrburg of counsel), for appellant. Petre and Zabokritsky, P.C. (Mark Petre of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (John J. Kelley, J.), entered January 26, 2017. The order denied defendant’s motion to dismiss the complaint or, in the alternative, to compel plaintiff to produce its owner for an examination before trial, and granted plaintiff’s cross motion for summary judgment.

ORDERED that the order is modified by providing that the branch of defendant’s motion seeking to compel plaintiff to produce its owner for an examination before trial is granted and plaintiff’s cross motion for summary judgment 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, defendant moved to dismiss the complaint, pursuant to CPLR 3211, arguing, among other things, that plaintiff had been reimbursed pursuant to the fee schedule of the practitioner provider option (PPO) agreement entered into between plaintiff and MultiPlan, Inc. (MultiPlan) and that plaintiff had failed to name Multiplan as a necessary party. In the alternative, defendant sought to compel plaintiff to produce its owner for an examination before trial (EBT). Plaintiff cross-moved for summary judgment. By order entered January 26, 2017, the Civil Court denied defendant’s motion and granted plaintiff’s cross motion for summary judgment.

A review of the record indicates that the Civil Court properly denied the branch of defendant’s motion seeking, pursuant to CPLR 3211, to dismiss the complaint. The affidavits and documents annexed to defendant’s moving papers failed to establish that the corporate plaintiff was a party to the PPO contract, dated October 1998, which states that it is between Emerth L. Coburn, M.D., as an “individual practitioner,” and MultiPlan.

With respect to the branch of defendant’s motion seeking, in the alternative, to compel plaintiff to produce its owner for an EBT, it is noted that CPLR 3101 (a) provides for the “full disclosure of all matter material and necessary in the prosecution or defense of an action.” What is “material and necessary” is left to the sound discretion of the court (see Matter of U.S. Pioneer Elecs. Corp. [Nikko Elec. Corp. of Am.], 47 NY2d 914, 916 [1979]; Gillen v Utica First Ins. Co., 41 AD3d 647 [2007]). Here, according to defendant, Dr. Coburn explicitly requested Multiplan to include within the scope of his individual PPO contract with Multiplan all bills submitted to [*2]Multiplan bearing plaintiff’s name and taxpayer identification number. Consequently, the Civil Court improvidently exercised its discretion in denying defendant’s alternate relief of compelling an EBT of Dr. Coburn, since defendant is seeking material and necessary evidence to support its defense, as defendant paid plaintiff’s claims in accordance with the provisions of the PPO contract.

Furthermore, plaintiff failed to establish its prima facie entitlement to summary judgment, as the affidavit and annexed documentation submitted in support of its cross motion do not establish that the claims in question had not been timely denied (see Viviane Etienne Med. 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]). In view of the foregoing, plaintiff’s cross motion should have been denied.

Accordingly, the order is modified by providing that the branch of defendant’s motion seeking to compel plaintiff to produce its owner for an examination before trial is granted and plaintiff’s cross motion for summary judgment is denied.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: March 29, 2019
Prompt Med. Supply, Inc. v State Farm Mut. Auto Ins. Co. (2019 NY Slip Op 50504(U))

Reported in New York Official Reports at Prompt Med. Supply, Inc. v State Farm Mut. Auto Ins. Co. (2019 NY Slip Op 50504(U))

Prompt Med. Supply, Inc. v State Farm Mut. Auto Ins. Co. (2019 NY Slip Op 50504(U)) [*1]
Prompt Med. Supply, Inc. v State Farm Mut. Auto Ins. Co.
2019 NY Slip Op 50504(U) [63 Misc 3d 137(A)]
Decided on March 29, 2019
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 March 29, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2017-916 K C
Prompt Medical Supply, Inc., as Assignee of Sandra Lindie, Appellant,

against

State Farm Mutual Auto Ins. Co., Respondent.

Kopelevich & Feldsherova, P.C. (David Landfair of counsel), for appellant. Rossillo & Licata, P.C. (Melissa A. Berkman, Esq.), for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered December 7, 2016. The order granted defendant’s motion to vacate a judgment of that court entered October 12, 2016 upon defendant’s failure to appear or answer the complaint, and to compel plaintiff to accept defendant’s late answer.

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 to vacate a judgment of that court entered October 12, 2016 upon defendant’s failure to appear or answer the complaint, and to compel plaintiff to accept defendant’s late answer.

For the reasons stated in Prompt Med. Supply Inc., as Assignee of Gladstone Lawrence v State Farm Mut. Auto Ins. Co. (___ Misc 3d ___, 2019 NY Slip Op _____ [appeal No. 2017-858 K C], decided herewith), the order is affirmed.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: March 29, 2019
Prompt Med. Supply, Inc. v State Farm Mut. Auto Ins. Co. (2019 NY Slip Op 50503(U))

Reported in New York Official Reports at Prompt Med. Supply, Inc. v State Farm Mut. Auto Ins. Co. (2019 NY Slip Op 50503(U))

Prompt Med. Supply, Inc. v State Farm Mut. Auto Ins. Co. (2019 NY Slip Op 50503(U)) [*1]
Prompt Med. Supply, Inc. v State Farm Mut. Auto Ins. Co.
2019 NY Slip Op 50503(U) [63 Misc 3d 137(A)]
Decided on March 29, 2019
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 March 29, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2017-858 K C
Prompt Medical Supply, Inc., as Assignee of Gladstone Lawrence, Appellant,

against

State Farm Mutual Auto Ins. Co., Respondent.

Kopelevich & Feldsherova, P.C. (David Landfair of counsel), for appellant. Rossillo & Licata, P.C., for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered December 7, 2016. The order granted defendant’s motion to vacate a judgment of that court entered October 12, 2016 upon defendant’s failure to appear or answer the complaint, and to compel plaintiff to accept defendant’s late answer.

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 to vacate a judgment of that court entered October 12, 2016 upon defendant’s failure to appear or answer the complaint, and to compel plaintiff to accept defendant’s late answer.

A defendant seeking to vacate a default in appearing or answering based on an excusable default must demonstrate both a reasonable excuse for the default and the existence of a potentially meritorious defense to the action (see CPLR 5015 [a] [1]; Eugene Di Lorenzo, Inc. v A.C. Dutton Lbr. Co., 67 NY2d 138, 141 [1986]). The determination of what constitutes a reasonable excuse for a default lies within the sound discretion of the motion court (see Matter of Gambardella v Ortov Light., 278 AD2d 494 [2000]).

Contrary to plaintiff’s contention, the Civil Court did not improvidently exercise its discretion in finding that defendant had established a reasonable excuse for not timely answering the complaint, in that defendant had reasonably believed that plaintiff might withdraw the action and, in any event, plaintiff had told defendant that it would not commence any default proceedings (see DeStaso v Bottiglieri, 52 AD3d 453, 455 [2008]; Saltzman v Knockout Chem. & Equip. Co., 108 AD2d 908, 908 [1985]). Contrary to plaintiff’s further argument, defendant [*2]demonstrated that it had a potentially meritorious defense in that plaintiff had failed to provide requested verification.

Accordingly, the order is affirmed.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: March 29, 2019
Lida’s Med. Supply, Inc. v American Ind. Ins. Co. (2019 NY Slip Op 50502(U))

Reported in New York Official Reports at Lida’s Med. Supply, Inc. v American Ind. Ins. Co. (2019 NY Slip Op 50502(U))

Lida’s Med. Supply, Inc. v American Ind. Ins. Co. (2019 NY Slip Op 50502(U)) [*1]
Lida’s Med. Supply, Inc. v American Ind. Ins. Co.
2019 NY Slip Op 50502(U) [63 Misc 3d 137(A)]
Decided on March 29, 2019
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 March 29, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2017-764 K C
Lida’s Medical Supply, Inc., as Assignee of Armstrong, Sherlock, Respondent,

against

American Independent Ins. Co., Appellant.

Freiberg, Peck & Kang, LLP (Yilo J. Kang of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell and Karina Barska of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered January 6, 2017. The order, insofar as appealed from, denied defendant’s motion to dismiss the complaint pursuant to CPLR 3211 (a) (8).

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendant’s motion to dismiss the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from so much of an order of the Civil Court as denied defendant’s motion which sought to dismiss the complaint pursuant to CPLR 3211 (a) (8) on the ground that the Civil Court lacked personal jurisdiction over defendant.

For the reasons states in Pavlova v American Ind. Ins. Co. (60 Misc 3d 128[A], 2018 NY Slip Op 50943[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018]), the order, insofar as appealed from, is reversed, and defendant’s motion to dismiss the complaint is granted (see also Matter of Government Empls. Ins. Co. v Basedow, 28 AD3d 766 [2006]; Matter of Eagle Ins. Co. v Gutierrez-Guzman, 21 AD3d 489 [2005]).

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: March 29, 2019
Pro Health Acupuncture, P.C. v GEICO Ins. (2019 NY Slip Op 50501(U))

Reported in New York Official Reports at Pro Health Acupuncture, P.C. v GEICO Ins. (2019 NY Slip Op 50501(U))

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

Pro Health Acupuncture, P.C., as Assignee of Anthony Johnson, Respondent,

against

GEICO Insurance, Appellant.

The Law Office of Printz & Goldstein (Lawrence J. Chanice of counsel), for appellant. Zara Javakov, P.C. (Zara Javakov and Zachary Whiting of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Mary V. Rosado, J.), entered February 10, 2017. The order, insofar as appealed from, denied defendant’s motion to dismiss the complaint pursuant to CPLR 3216.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and defendant’s motion to dismiss the complaint pursuant to CPLR 3216 is granted.

Plaintiff commenced this action to recover assigned first-party no-fault benefits on May 10, 2011. Defendant interposed an answer on June 29, 2011. Defendant served plaintiff’s attorney with a 90-day written demand pursuant to CPLR 3216 (b) (3), which was received on October 5, 2015. By notice of motion dated March 16, 2016, defendant moved, pursuant to CPLR 3216, to dismiss the complaint, alleging that plaintiff had not filed a notice of trial or otherwise responded to the 90-day demand. Plaintiff served a notice of trial on November 4, 2016 and served opposition to defendant’s motion on November 22, 2016, but did not seek to explain its delay in responding to the 90-day demand or set forth a meritorious cause of action until it served a sur-reply on February 6, 2017, four days before the motion was scheduled for oral argument. Defendant appeals from so much of an order of the Civil Court as denied its motion to dismiss.

Once a 90-day demand is served upon a plaintiff, the plaintiff must either comply with the demand by filing a notice of trial within 90 days (see CPLR 3216 [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 [*2]& 11th Jud Dists 2008]). Since plaintiff failed to do any of these, it was required, in opposition to defendant’s motion to dismiss, to establish both a justifiable excuse for its delay in properly responding to the 90-day demand and the existence of a meritorious cause of action (see Baczkowski v Collins Constr. Co., 89 NY2d 499 [1997]; Felix, 52 AD3d 653; A.M. Med., P.C., 22 Misc 3d 43). Plaintiff sought to make the required showing for the first time in sur-reply papers, which the Civil Court should not have considered (see HSBC Bank USA, N.A. v Roumiantseva, 130 AD3d 983 [2015]; Flores v Stankiewicz, 35 AD3d 804 [2006]). Consequently, defendant’s motion should have been granted.

Accordingly, the order, insofar as appealed from, is reversed and defendant’s motion to dismiss the complaint pursuant to CPLR 3216 is granted.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: March 29, 2019
First Class Med., P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 50477(U))

Reported in New York Official Reports at First Class Med., P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 50477(U))

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

First Class Medical, P.C., as Assignee of Zaleena Moulah, Respondent,

against

Ameriprise Insurance Company, Appellant.

Bruno, Gerbino & Soriano, LLP (Nathan Shapiro of counsel), for appellant. Gabriel & Shapiro, LLC (Max Valerio of counsel), for respondent.

Appeal from an order of the District Court of Suffolk County, Third District (James F. Matthews, J.), dated August 28, 2017. The order, insofar as appealed from as limited by the brief, denied the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon 17 of 21 claims set forth therein, other than those in the amounts of $148.69, $188.16, $54.74 and $138.72, and granted plaintiff’s cross motion for summary judgment upon the entire complaint.

ORDERED that the order, insofar as appealed from, 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 17 of 21 claims set forth therein, other than those in the amounts of $148.69, $188.16, $54.74 and $138.72, are granted, and the branches of plaintiff’s cross motion seeking summary judgment upon so much of the complaint as sought to recover upon those 17 claims are denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much of an order of the District Court as denied the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon 17 of 21 claims set forth therein, other than those in the amounts of $148.69, $188.16, $54.74 and $138.72, and granted plaintiff’s cross motion for summary judgment upon the entire complaint. The District Court determined that letters scheduling examinations under oath (EUOs) of plaintiff were defective because they did not specify the claims to which the letters pertained.

Defendant established that the EUO scheduling letters had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Contrary to [*2]the finding by the District Court, the EUO scheduling letters were not “defective.” We note that the initial EUO scheduling letter identified the assignor, the date of the accident and defendant’s file number. The initial EUO scheduling letter resulted in a toll of defendant’s time to pay or deny plaintiff’s claims as to each claim form which had been submitted by the same plaintiff for the same assignor and accident prior to the EUO request, as long as the request had been timely with respect to such claim, and to any claim form received subsequent to that request, but before plaintiff breached a policy condition by failing to appear for two properly scheduled EUOs (see 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]; see also Tsatskis v State Farm Fire & Cas. Co., 36 Misc 3d 129[A], 2012 NY Slip Op 51268[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2012]). Defendant further established that plaintiff had failed to appear for the duly scheduled EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]) and that defendant had timely mailed (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) its denial of claim forms denying the claims on that ground. In opposition, plaintiff failed to raise a triable issue of fact. However, defendant concedes that it failed to timely request EUOs for claims in the amounts of $148.69, $188.16, $54.74 and $138.72 and offers no basis to disturb so much of the order as granted plaintiff summary judgment on those claims.

Defendant, if it be so advised, may move in the District Court to resettle the order of the District Court to correct the error regarding defendant’s name in the caption therein.

Accordingly, the order, insofar as appealed from, 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 17 of 21 claims set forth therein, other than those in the amounts of $148.69, $188.16, $54.74 and $138.72, are granted, and the branches of plaintiff’s cross motion seeking summary judgment upon so much of the complaint as sought to recover upon those 17 claims are denied.

ADAMS, P.J., GARGUILO and EMERSON, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: March 28, 2019
Noel v Nationwide Ins. Co. of Am. (2019 NY Slip Op 02348)

Reported in New York Official Reports at Noel v Nationwide Ins. Co. of Am. (2019 NY Slip Op 02348)

Noel v Nationwide Ins. Co. of Am. (2019 NY Slip Op 02348)
Noel v Nationwide Ins. Co. of Am.
2019 NY Slip Op 02348 [170 AD3d 1186]
March 27, 2019
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, May 1, 2019

[*1]

 Kellon Noel, Respondent,
v
Nationwide Insurance Company of America, Appellant.

Hollander Legal Group, P.C. (Harris J. Zakarin, P.C., Melville, NY, of counsel), for appellant.

Aleksandr Vakarev, Brooklyn, NY (Harlan Wittenstein of counsel), for respondent.

In an action to recover no-fault benefits for medical expenses, the defendant appeals from an order of the Supreme Court, Kings County (Bernard J. Graham, J.), dated October 26, 2017. The order, inter alia, in effect, denied that branch of the defendant’s motion which was for summary judgment dismissing the complaint.

Ordered that the order is reversed, on the law, with costs, and that branch of the defendant’s motion which was for summary judgment dismissing the complaint is granted.

On October 3, 2014, the plaintiff allegedly was injured when he was struck by a motor vehicle owned by George W. Nellen. The defendant was Nellen’s motor vehicle insurance carrier at the time of the accident. The plaintiff submitted an application for no-fault benefits for medical expenses to the defendant. The defendant denied the plaintiff’s application on the ground that the plaintiff’s injuries were not causally related to the alleged motor vehicle accident.

The plaintiff commenced this action to recover no-fault benefits for medical expenses. After issue was joined, the defendant moved pursuant to CPLR 3212, 3211 (a) (1), (3) and (7) to dismiss the complaint. The defendant alleged, inter alia, that the plaintiff had assigned his eligibility to receive no-fault benefits from the defendant to various medical providers, and, thus, he had no standing to maintain the action. The Supreme Court denied those branches of the defendant’s motion which were pursuant to CPLR 3211 (a) (1) and (7), and in effect denied those branches of the defendant’s motion which were pursuant to CPLR 3211 (a) (3) and 3212, on the grounds that the motion was premature due to outstanding disclosure. The defendant appeals.

The defendant demonstrated its prima facie entitlement to judgment as a matter of law by submitting evidence that the plaintiff assigned his right to no-fault benefits to 10 different medical providers (see Alvarez v Prospect Hosp., 68 NY2d 320 [1986]; Winegrad v New York Univ. Med. Ctr., 64 NY2d 851 [1985]). In opposition, the plaintiff failed to raise a triable issue of fact (cf. Abruscato v Allstate Prop. & Cas. Ins. Co., 165 AD3d 1209 [2018]).

We disagree with the Supreme Court’s denial of the defendant’s motion without prejudice with leave to renew due to outstanding disclosure. The plaintiff failed to establish that discovery might lead to relevant evidence, or that facts essential to justify opposition to the motion were exclusively within the knowledge and control of the defendant (see CPLR 3212 [f]; Portalatin v City of New York, 165 AD3d 1302 [2018]; Williams v Spencer-Hall, 113 AD3d 759, 760 [2014]; Boorstein v 1261 48th St. Condominium, 96 AD3d 703, 704 [2012]).

Accordingly, the Supreme Court should have granted that branch of the defendant’s motion which was for summary judgment dismissing the complaint. Mastro, J.P., Cohen, Maltese and LaSalle, JJ., concur.

Global Liberty Ins. Co. v Haar Orthopaedics & Sports Med., P.C. (2019 NY Slip Op 02317)

Reported in New York Official Reports at Global Liberty Ins. Co. v Haar Orthopaedics & Sports Med., P.C. (2019 NY Slip Op 02317)

Global Liberty Ins. Co. v Haar Orthopaedics & Sports Med., P.C. (2019 NY Slip Op 02317)
Global Liberty Ins. Co. v Haar Orthopaedics & Sports Med., P.C.
2019 NY Slip Op 02317 [170 AD3d 1125]
March 27, 2019
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, May 1, 2019

[*1]

 Global Liberty Insurance Co., Appellant,
v
Haar Orthopaedics & Sports Med., P.C., as Assignee of John Thomas, Defendant.

Law Office of Jason Tenenbaum, P.C., Garden City, NY, for appellant.

In an action for a judgment declaring that the plaintiff is not obligated to pay a claim for no-fault insurance benefits submitted by the defendant on behalf of its assignor John Thomas, the plaintiff appeals from an order of the Supreme Court, Nassau County (Anthony L. Parga, J.), entered October 30, 2017. The order denied the plaintiff’s unopposed motion for leave to enter a default judgment against the defendant.

Ordered that the order is reversed, on the law, with costs, the plaintiff’s motion for leave to enter a default judgment against the defendant is granted, and the matter is remitted to the Supreme Court, Nassau County, for the entry of a judgment declaring that the plaintiff is not obligated to pay a claim for no-fault insurance benefits submitted by the defendant on behalf of its assignor John Thomas.

The plaintiff, a no-fault insurance carrier, commenced this action seeking a de novo adjudication of an insurance dispute concerning the denial of a no-fault claim involving the defendant (see Insurance Law § 5106 [c]). The plaintiff sought a judgment declaring that the plaintiff is not obligated to pay the claim for no-fault insurance benefits submitted by the defendant on behalf of its assignor John Thomas, on the grounds that the services were not medically necessary, were not related to the subject motor vehicle accident, and/or were billed in excess of the fee schedule. The defendant had been awarded more than $5,000 against the plaintiff as a result of a master arbitration award.

The plaintiff moved for leave to enter a default judgment against the defendant based upon the defendant’s failure to answer the complaint or appear in this action. The defendant failed to oppose the motion. The Supreme Court denied the plaintiff’s motion on the basis that the master arbitration award confirming an original arbitration award was supported by evidence in the record, was rationally based, and was not arbitrary or capricious. The plaintiff appeals.

On a motion for leave to enter a default judgment pursuant to CPLR 3215, the movant is required to file proof of (1) service of the summons and complaint, (2) the facts constituting the claim, and (3) the other party’s default (see CPLR 3215 [f]; Global Liberty Ins. Co. v W. Joseph Gorum, M.D., P.C., 143 AD3d 768, 769 [2016]; Liberty County Mut. v Avenue I Med., P.C., 129 AD3d 783, 784-785 [2015]; Fried v Jacob Holding, Inc., 110 AD3d 56, 59 [2013]). To demonstrate the facts constituting the claim, the movant need only submit sufficient proof to enable a court to determine if the claim is viable (see Woodson v Mendon Leasing Corp., 100 NY2d 62, 71 [2003]; Fried v Jacob Holding, Inc., 110 AD3d at 60; Neuman v Zurich N. Am., 36 AD3d 601, 602 [2007]).

In support of its motion, the plaintiff submitted proof of service of the summons and complaint via the Secretary of State (see Business Corporation Law §§ 306 [b]; 1513; CPLR 311 [a] [1]), and an additional copy of the summons and complaint upon the defendant pursuant to CPLR 3215 (g) (4). In further support, the plaintiff submitted its attorney’s affirmation, inter alia, attesting to the defendant’s failure to answer or appear in this action, thereby admitting all traversable allegations (see Rokina Opt. Co. v Camera King, 63 NY2d 728, 730 [1984]). It also submitted, inter alia, a copy of the complaint verified by its attorney (see CPLR 105 [u]; 3020 [d] [3]; 3215 [f]; Clarke v Liberty Mut. Fire Ins. Co., 150 AD3d 1192, 1195 [2017]; Martin v Zangrillo, 186 AD2d 724 [1992]), its expert’s affirmed peer review, the arbitration award in excess of $5,000, and the master arbitration award confirming the original arbitration award, which were sufficient to establish that the plaintiff had a viable cause of action against the defendant (see Woodson v Mendon Leasing Corp., 100 NY2d at 71; Global Liberty Ins. Co. v W. Joseph Gorum, M.D., P.C., 143 AD3d at 770). The defendant failed to oppose the plaintiff’s motion (see Fried v Jacob Holding, Inc., 110 AD3d at 60).

Accordingly, the plaintiff’s motion for leave to enter a default judgment against the defendant should have been granted. Since this is a declaratory judgment action, the matter must be remitted to the Supreme Court, Nassau County, for the entry of a judgment declaring that the plaintiff is not obligated to pay a claim for no-fault insurance benefits submitted by the defendant on behalf of its assignor John Thomas (see Lanza v Wagner, 11 NY2d 317, 334 [1962]). Mastro, J.P., Balkin, LaSalle and Connolly, JJ., concur.

Vital Chiropractic, P.C. v Nationwide Ins. Co. (2019 NY Slip Op 50425(U))

Reported in New York Official Reports at Vital Chiropractic, P.C. v Nationwide Ins. Co. (2019 NY Slip Op 50425(U))

Vital Chiropractic, P.C. v Nationwide Ins. Co. (2019 NY Slip Op 50425(U)) [*1]
Vital Chiropractic, P.C. v Nationwide Ins. Co.
2019 NY Slip Op 50425(U) [63 Misc 3d 132(A)]
Decided on March 22, 2019
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 March 22, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., MICHELLE WESTON, BERNICE D. SIEGAL, JJ
2017-625 K C
Vital Chiropractic, P.C., as Assignee of Lavonne Baucom Lamar, Appellant,

against

Nationwide Insurance Company, Respondent.

Law Office of Melissa Betancourt, P.C. (Melissa Betancourt and Jamin Koo of counsel), for appellant. Gialleonardo, McDonald, Safranek & Turchetti (Kevon Lewis of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Joy F. Campanelli, J.), entered February 14, 2017. 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 the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon a claim in the amount of $342.01 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.Contrary to plaintiff’s contention, the proof submitted by defendant was sufficient to establish the proper mailing of the independent medical examination (IME) scheduling letters (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and that plaintiff’s assignor had failed to appear for the IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Defendant further demonstrated that it had timely mailed (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) its NF-10 forms denying the claims at issue, except for the claim seeking reimbursement in the amount of $342.01. As to that claim, we find on this record that there is an issue of fact as to whether defendant ever received it. Consequently, neither party is entitled to summary judgment upon that claim.

Plaintiff’s remaining contentions lack merit.

Accordingly, the order is modified by providing that the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover upon a claim in the amount of $342.01 is denied.

PESCE, P.J., WESTON and SIEGAL, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: March 22, 2019