Compas Med., P.C. v Geico Ins. Co., 2013 NY Slip Op 52016(U)(App. Term 2d Dept 2013)
“In this action by a provider to recover assigned first-party no-fault benefits, defendant moved to stay the action, pursuant to CPLR 2201, pending a final determination of a declaratory judgment action that had been commenced by defendant in the Supreme Court, Nassau County, entitled Geico Ins. Co. v Andre (Index No. 8085/2011). In that action, Geico alleged that the defendants named therein had engaged in a large-scale illegal scheme involving staged accidents and fraudulent billing practices and therefore Geico sought a declaration that it was not obligated to pay, among other things, no-fault benefits to those defendants. Both plaintiff and its assignor are named as defendants in the declaratory judgment action.
“[A] court has broad discretion to grant a stay in order to avoid the risk of inconsistent adjudications, application of proof and potential waste of judicial resources” (Zonghetti v [*2]Jeromack, 150 AD2d 561, 563 ). Under the circumstances presented herein, it was not an improvident exercise of discretion for the Civil Court to grant defendant’s motion to stay this action pending the resolution of the Supreme Court declaratory judgment action (see CPLR 2201).”
The Law Office of Jason Tenenbaum, P.C., Garden City (Jason
Tenenbaum of counsel), for appellant.
Law Offices of Melissa Betancourt, P.C., Brooklyn (Melissa
Betancourt of counsel), for Empire Acupuncture, PC,
Amos Weinberg, Great Neck, for Multiple Medical Health
Services P.C. and Infinite Chiropractic, PLLC, respondents.
American Tr. Ins. Co. v Marte-Rosario, 2013 NY Slip Op 07416 (1st Dept. 2013)
“Plaintiff established its entitlement to summary judgment by submitting an affidavit of service demonstrating that the notices scheduling independent medical examinations (IMEs), in connection with a no-fault insurance claim filed by Maria Marte-Rosario, were properly mailed to her and her counsel, and the doctor’s affidavit establishing Marte-Rosario’s failure to appear at the scheduled IMEs (see American Tr. Ins. Co. v Solorzano, 108 AD3d 449 [1st Dept 2013]). The affidavit of service raised a presumption that a proper mailing occurred, which defendants failed to rebut by submitting a returned letter to Marte-Rosario from her counsel, with the name of her street apparently misspelled; in any event, there is no evidence rebutting the showing that the notices were served on Marte-Rosario’s counsel (see Matter of Ariel Servs., Inc. v New York City Envtl. Control Bd., 89 AD3d 415 [1st Dept 2011]). As it is undisputed that Marte-Rosario’s appearance at scheduled IMEs was a condition precedent to coverage, plaintiff was entitled to deny the claim (see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559 [1st Dept 2011],lv denied 17 NY3d 705 ).”
The address in this case for Assignor was “632 Faile Street, #1, Bronx, New York 10474.” It was noted in certain proofs that correspondences were sent to: “632 Failes Street, #1, Bronx, New York 10474.” Thus, a letter was presented showing that correspondence was returned if mailed to that address. The Court held that this did not matter, and would require an affidavit of non-receipt of Marte-Rosario on this score to defeat the motion.
Moreover, the court said that even if the letter was not received by Marte-Rosario, it was received by her personal injury attorney,The Law Offices of Barry Richard Feldman, LLC. Also, be aware that there was no proof in the record, i.e., a letter of representation, that Claimant was actually represented by Mr. Feldman. Under Appellate Term, and now Appellate Division jurisprudence, the burden is on the objectant – i.e. the medical provider or EIP – to demonstrate that the purported attorney was not counsel for Claimant when the letters were sent.
A very powerful case.
Interboro v. Boris Kleyman, Index #: 152395/10 (Supreme Ct. NY Co. 2013)
In this particular matter, Plaintiff moved to reargue the prior order of Supreme Court, dismissing the matters against certain Defendants on the basis the a provider has the unilateral choice to chose to arbitrate its bills.
As can be seen, the Court realized that the weight of judicial authority holds that an insurance carrier has the right, in the first instance, to litigate coverage issues in a Supreme Court action. Thus, leave to reargue was granted and, upon reargument, the motion to dismiss was denied en toto.
It should be noted that the initial opinion was published. Hopefully, this opinion will in turn be published.
**CORRECTION** Opinion was published today, 11/7/13
I will say that Justice Kern, to her credit, will reverse herself on reargument when presented with persuasive authority to do same.
American Transit v. Delia Ortiz. (Sup. Ct. Bronx Co. 2013)
American Transit v. Joshua Fagan (Sup. Ct. NY Co. 2013)
Perhaps the Supreme Court judges are naturally good at sifting through baseless “you didn’t do that” arguments?
Some decisions from judges who have not written too much on the no-fault DJ have concurred with the majority of other judges on this issue.
American Transit v. McGarrell (Sup. Ct. Bronx Co. 2013)(Ruiz, J.)
Again, the Court finds that discovery is not necessary to properly oppose a summary judgment motion
American Transit v. Ash (Sup. Ct. NY Co. 2013)(Madden)
Court took judicial notice of the correct zipcode where Assignor resided (as opposed to what was on the NF-2), found a justiciable controversy through submitted affidavits and did not delay motion pending disclosure
American Transit v. Lopez (Sup. Ct. Bronx Co. 2013)(Ruiz, J.)
American Transit v. Hiraldo (Sup. Ct. Bronx Co. 2013)(Ruiz, J.)
American Transit v. Hiraldo, Index #: 306538/12 (Sup. Ct. Bx Co. 2013)
In this declaratory judgment action, St. Barnabus argued that a Claimant’s failure to attend IME’s is irrelevant as to them because the hospital is obligated as a matter of law to provide emergent care and treatment to the patient. In this regard, the hospital cited the EMTALA for support of this proposition.
The Court astutely noted: “While [a hospital might be obligated to treat the uninsured patient], nothing prevents the Defendant hospital from proceeding against Ariel Hiraldo for payment for services rendered.”
American Transit v. Mercedes., Index #: 152414/13 (Sup. NY Co. 2013)
This one is notable because the Assignor’s meritoious defense in opposition to the motion for leave to enter a default was that she was not at fault for the accident. The Judge was not too impressed.
Eagle Surgical Supply, Inc. v AIG Indem. Ins. Co., 2013 NY Slip Op 51441(U)(App. Term 2d Dept. 2013)
“the parties entered into a so-ordered stipulation, dated July 25, 2008, pursuant to which defendant was to provide plaintiff with responses to its interrogatories within 60 days or be precluded from offering evidence at trial.”
“In 2009, defendant commenced a declaratory judgment action in Supreme Court, Nassau County, against, among others, plaintiff and its assignor, in regard to a number of accidents, including the July 2007 accident. The Supreme Court issued a stay of all pending and future actions between the parties in February 2009. On June 15, 2010, a default declaratory judgment was entered in the Supreme Court in favor of defendant, finding, among other things, that the policy in connection with plaintiff’s claim is “null and void,” that defendant had no duty to provide coverage for the subject no-fault claim, and that since plaintiff and its assignor had “violated their respective obligation [sic] to appear for an examination under oath . . . [defendant] has no duty to defend or indemnify [plaintiff and its assignor] . . . for any claims of personal injury, no-fault, UM or SUM benefits.”
“In 2011, plaintiff moved, in the Civil Court action, for a final order of preclusion and summary judgment. Defendant cross-moved for summary judgment dismissing the Civil Court complaint on the ground that the June 15, 2010 declaratory judgment had res judicata effect. Thereafter, by order dated September 16, 2011, the Civil Court granted plaintiff’s motion and denied defendant’s cross motion.”
“…It is well settled that default judgments can have res judicata effect (see Lazides v P & G Enters., 58 AD3d 607 ; Ava Acupuncture, P.C. v N Y Cent. Mut. Fire Ins. Co., 34 Misc 3d 149[A], 2012 NY Slip Op 50233[U] [App Term, 2d, 11th & 13th Jud Dists 2012]).”
“Although the conditional preclusion order contained in the July 2008 so-ordered stipulation became absolute upon defendant’s failure to comply therewith (see e.g. Panagiotou v Samaritan Vil., Inc., 66 AD3d 979 ; State Farm Mut. Auto. Ins. Co. v Hertz Corp., 43 AD3d 907, 908 ; Siltan v City of New York, 300 AD2d 298 ; Midisland Med., PLLC v NY Cent. Mut. Ins. Co., 27 Misc 3d 141[A], 2010 NY Slip Op 50993[U] [App Term, 2d, 11th & 13th Jud Dists 2010]; Coleman v Thompson, 5 Misc 3d 136[A], 2004 NY Slip Op 51543[U] [App Term, 2d & 11th Jud Dists 2004]), thereby precluding defendant “from offering evidence at trial,” it did not preclude the Civil Court from giving res judicata effect to the June 10, 2010 declaratory judgment (see e.g. Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co., 61 AD3d 13, 20 ; Ptasznik v Schultz, 47 AD2d 197, 198 ).”
In this case, note that the Court cites to pinpoint citation 61 AD3d 13, 20. Page 20 of Kingsbrook states that a Court must take judicial notice of: “…undisputed court records and files…. Even material derived from official government Web sites may be the subject of judicial notice…”
Eagle Surgical Supply, Inc. v AIG Ins. Co., 2013 NY Slip Op 51449(U)(App. Term 2d Dept. 2013)
“By order dated September 29, 2008, the Civil Court granted plaintiff’s motion, finding that defendant had failed to rebut plaintiff’s prima facie case, and awarded plaintiff the principal sum of $502.63.”
“On June 3, 2010, the Supreme Court awarded defendant a default declaratory judgment which found, among other things, that since plaintiff and its assignor had “violated their respective obligation [sic] to appear for an examination under oath . . . [defendant] has no duty to defend or indemnify the [plaintiff and its assignor] . . . for any claims of personal injury, no-fault, UM or SUM benefits” for motor vehicle accidents occurring on specified dates.”
“The instant Civil Court action was commenced to recover no-fault benefits for services plaintiff had provided to its assignor for injuries the assignor had sustained in a motor vehicle accident on May 31, 2007. The declaratory judgment states that it applies to 28 incidents, and lists the dates of the incidents. However, May 31, 2007 is not included in the declaratory judgment action among the dates set forth therein. Therefore, defendant has not shown that plaintiff, by entering judgment in the Civil Court action, seeks to relitigate claims or causes of action arising out of the same transaction or series of transactions (see Matter of Hunter, 4 AD3d at 269).”
“Res judicata, or claim preclusion, is invoked when a party, or those in privity with the party, seek to relitigate a disposition on the merits of claims or causes of action arising out of the same transaction or series of transactions which were raised or could have been raised in the prior litigation (see Matter of Hunter, 4 NY3d 260, 269 ; Schuylkill Fuel Corp. v Nieberg Realty Corp., 250 NY 304, 306-307 ). The instant Civil [*2]Court action was commenced to recover no-fault benefits for services plaintiff had provided to its assignor for injuries the assignor had sustained in a motor vehicle accident on May 31, 2007. The declaratory judgment states that it applies to 28 incidents, and lists the dates of the incidents. However, May 31, 2007 is not included in the declaratory judgment action among the dates set forth therein. Therefore, defendant has not shown that plaintiff, by entering judgment in the Civil Court action, seeks to relitigate claims or causes of action arising out of the same transaction or series of transactions”
It appears that the subsequently filed declaratory judgment action would have collaterally estopped plaintiff and allowed the vacatur of the Civil Court action had it listed the May 31, 2007 date of loss in its complaint…
Mr. Five Boro took at dive in the IME no-show DJ matter of American Transit Ins. Co. v. Beltre, under Bronx Co. Index #: 310468/11 (Sup. Ct. Bronx Co. 2012 [Suarez, J.S.C.])