Putting the wrong floor is not fatal

Unitrin Advantage Ins. Co. v Cohen & Kramer M.D., P.C., 2020 NY Slip Op 06474 (1st Dept. 2020)

Plaintiff insurer’s evidence, including affidavits attesting in detail to the regular business procedures and practices in the handling of its no-fault claims, including providing notice of scheduled IME exams to claimants, together with the mailing ledgers, which were signed and date-stamped by U.S. Postal Service employees, and listed therein IME notices received for mailing to the claimant here at his resident address, provided sufficient proof of proper mailing to support a presumption that the IME notices were received by the claimant (see Badio v Liberty Mut. Fire Ins. Co., 12 AD3d 229 [1st Dept 2004]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2d Dept 2001]). Although the notices incorrectly added the designation “1st Floor” to the address, there is no dispute that the address was otherwise correct and that claimant resided at that building (see Cadle Co. v Tri-Angle Assoc., 18 AD3d 100 [1st Dept 2005]).

The burden on the motion having shifted, defendant failed to offer any evidence in opposition, such as an affidavit from the claimant disavowing receipt of the IME notices or even describing the building composition in a manner that would support an inference that the inclusion of a floor in the address would result in nonreceipt. Plaintiff thus established that the injured claimant failed to appear for three properly scheduled IMEs, constituting breach of a condition precedent to no-fault coverage, warranting the denial of defendant’s claims to no-fault benefits for its medical services rendered to the claimant (see 11 NYCRR 65-1.1; Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559 [1st Dept 2011], lv denied 17 NY3d 705 [2011])

The converse is true – the failure to put the suite or floor number is proof of mailing. The one thing that is necessary is to have the purported recipient sign an affidavit of non receipt.

Mailing

M&T Bank v Biordi, 2019 NY Slip Op 07775 (2d Dept. 2019)

The irony – and I have commented on this before – is that the great Appellate Term mailing debates have transitioned to Appellate Division mailing debates as RPAPL 1304 has spawned an incredible amount of litigation in the mortgage context.

“Attached to the affidavit were copies of 90-day notices, bearing indicia of mailing by certified mail, but not first-class mail, and bearing no postmark or date of mailing. The plaintiff additionally submitted an affidavit of mailing of an Assistant Treasurer/Manager of Hudson City, who attested to the mailing of 90-day notices by first-class and certified mail, but did not attest to personal knowledge of the mailing and did not set forth any details regarding Hudson City’s mailing practices or procedures. Since the plaintiff failed to provide evidence of the actual mailing, or evidence of a standard office mailing procedure designed to ensure that items are properly addressed and mailed, sworn to by someone with personal knowledge of the procedure, the plaintiff failed to establish its strict compliance with RPAPL 1304 “

Certified Mail and Regular Mail

Central Park Physical Medicine & Rehab., P.C. v IDS Prop. & Cas. Ins. Co., 2019 NY Slip Op 51148(U)(App. Term 2d Dept. 2019)

(1) “While the District Court held that defendant had failed to establish that the follow-up EUO scheduling letter had been mailed by certified mail, that finding, even if correct, would not excuse the failure of plaintiff to appear for the duly scheduled EUOs, since the record does not contain any evidence showing that the mailing of the EUO scheduling letters to plaintiff by first-class mail had been insufficient”

(2) “Defendant further demonstrated 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) the denial of claim forms, which denied the claims on the ground that plaintiff had failed to appear for the duly scheduled EUOs. Plaintiff failed to raise a triable issue of fact in opposition to defendant’s prima facie showing “

Verifications were mailed

Lenox Hill Radiology & MIA, P.C. v Global Liberty Ins. Co. of N.Y., 2018 NY Slip Op 51810(U)(App. Term 2d Dept. 2018)

The relevance here is that my friend Rookie took the District Court published cased and convinced some Civil Court judges that we could not prove mailing.  It made me feel like the partner who could not prove the no show.  Anyway, that case was reversed and so Rookie will take the case out of his Room 809 oral argument tool bag I am assuming.

“Contrary to the determination of the District Court, defendant established the timely mailing of the initial and follow-up verification requests (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). As defendant also sufficiently established that it had not received the requested verification, and plaintiff did not show that the verification had been provided to defendant prior to the commencement of the action, the 30-day period within which defendant was required to pay or deny the claims did not begin to run”

Nexus between receipt and mailing

Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co., 2018 NY Slip Op 51681(U)(App. Term 2d Dept. 2018)

” Plaintiff challenges the Civil Court’s implicit CPLR 3212 (g) finding that the first EUO scheduling letter had been timely mailed, arguing that the individual who executed the affidavit of mailing of the EUO scheduling letters did not demonstrate knowledge of the practice and procedures for receipt of the claim forms, which were mailed to defendant’s office in Atlanta, Georgia. Plaintiff also challenges the Civil Court’s implicit CPLR 3212 (g) finding that defendant established plaintiff’s failure to appear for the EUOs. However, a review of the record establishes that the Civil Court correctly determined that defendant had established plaintiff’s failure to appear for the EUOs. Moreover, defendant’s practices and procedures regarding the receipt of its mail are irrelevant”

The last sentence is well quite interesting.

VA substantive law; NY Procedural law

Acupuncture Now, P.C. v GEICO Ins. Co., 2018 NY Slip Op 51084(U)(App. Term 2d Dept. 2018)

“While defendant asserts that Virginia law applies to this case, as the insurance policy had been obtained in Virginia, and it insured a Virginia resident and vehicle, defendant failed to demonstrate that it had mailed its cancellation notice in accordance with its office practices and procedures (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) “by registered or certified mail,” as required by the applicable statute (Va. Code Ann. § 38.2-2208 [A] [1] [a]). Consequently, the Civil Court should have denied the branch of defendant’s cross motion seeking summary judgment dismissing the complaint on the ground that defendant had properly cancelled the policy and that there was, therefore, no coverage at the time of the accident at issue.”

What is interesting here is that Civil Courts will apply substantive law from sister states but then apply NY procedural law.  This has been displayed many times (this is nothing new).  It appears “mailing” is procedural at best.

State Farm and Georgia – passes Appellate Term scrutiny

Maiga Prods. Corp. v State Farm Mut. Auto. Ins. Co., 2018 NY Slip Op 50736(U)(App. Term 2d Dept. 2018)

I kept hearing musings about how State Farm’s receiving mail in Georiga and processing denials/payments/verifications and other CSO’s was somehow fatal to the timeliness of the disclaimer, verification or payment.  The usual “how do we know” line was also brought up.  But at the end of the day, State Farm processes its incoming mail through a modern 21st century system, logs its receipt and then sends its outgoing mail in a proper “Non-Allstate” and “Non-Progressive” manner.  Read the John Niles Allstate affidavit (old version) or the Appellate Division Progressive case for context to this comment.

I know Maiga was trying to bank on the Westchester v. Philadelphia case, but the facts just do not add up in the STate Farm context.

In any event, the mailing challenge was properly defeated.

“The Civil Court further found that the only remaining issues for trial were plaintiff’s prima facie case and “[defendant’s] procedure for receipt of the bills in Georgia and processing and transmittal to and in [defendant’s] Ballston Spa [office].” Defendant appeals, contending that it was entitled to summary judgment dismissing the complaint.”

“[W]e note that defendant’s transmittal of the claims from one of its offices to another of its offices does not raise a triable issue of fact.”

Mailing again

Wells Fargo Bank, NA v Mandrin, 2018 NY Slip Op 02826 (2d Dept. 2018)

“Proof of the requisite mailing is established with proof of the actual mailings, such as affidavits of mailing or domestic return receipts with attendant signatures, or proof of a standard office mailing procedure designed to ensure that items are properly addressed and mailed, sworn to by someone with personal knowledge of the procedure ”

“The unsubstantiated and conclusory statement of a vice president of the plaintiff that a 90-day pre-foreclosure notice “was forwarded by regular and certified mail” to Mandrin “in full compliance with all requirements of RPAPL § 1304” was insufficient to establish that the notice was actually mailed to Mandrin by first-class and certified mail “

Mailing – CPLR 4518(a)

Bank of Am., N.A. v Wheatley, 2018 NY Slip Op 01175 (2d Dept. 2018)

“The plaintiff failed to make the requisite showing. In support of its motion, the plaintiff submitted the affidavit of Sherry Benight, an officer of Select Portfolio Servicing, Inc. (hereinafter SPS), the loan servicer, along with two copies of a 90-day notice addressed to the defendant and a proof of filing statement pursuant to RPAPL 1306 from the New York State Banking Department. While mailing may be proved by documents meeting the requirements of the “business records exception” to the hearsay rule, Benight, in her affidavit, did not aver that she was familiar with the plaintiff’s mailing practices and procedures, and therefore did not establish proof of a standard office practice and procedure designed to ensure that items are properly addressed and mailed”

I have to imagine this would be a mailing ledger or some other documentary proof showing that an item was mailed?  A little different than in the no-fault scenario

Arizona and ATIC

Arizona Premium Fin. Co., Inc. v American Tr. Ins. Co., 2017 NY Slip Op 09263 (!st Dept, 2017)

I spent a few hours earlier this year reading the case file on this one.  For starters, ATIC’s attorney at the deposition of the ATIC defendants violated the new rules in spirit and substance.  I would have flipped out if I were Arizona’s attorney.

While an attorney at a deposition should not be a potted plant, they should not be actively interfering with the questioning.  Substantively, the case involved claims of notices of cancellation that Arizona through the POA it possessed and invoked not being received by ATIC.  Arizona  was granted summary judgment on less than half the claims (it was clearly received).  On the remainder, the mailroom gentleman ad his deposition admitted at his deposition that he would received incorrectly addressed envelopes (that was the issue of fact) requiring a jury trial on whether ATIC received the cancellations.  Just amazing.

As a plaintiff, when ATIC denies receipt, you might want to read Louis Campbell’s deposition in this case.