September 27, 2016

Arguelles, M.D., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51422(U))

Headnote

The main issues in this case were whether the plaintiff was entitled to summary judgment on the fourth through sixth causes of action to recover assigned first-party no-fault benefits and whether the defendant's cross motion seeking summary judgment to dismiss those causes of action should be granted. The court considered the fact that the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs), and that the plaintiff had failed to demonstrate that the claims had not been timely denied or that the defendant had issued timely denials that were conclusory, vague, or without merit as a matter of law. The holding of the court was that the branches of the defendant's cross motion seeking summary judgment dismissing the fourth through sixth causes of action were denied, and the order was affirmed, without costs. Therefore, the plaintiff was not entitled to summary judgment, but the defendant's motion to dismiss the causes of action was also denied.

Reported in New York Official Reports at Arguelles, M.D., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51422(U))

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

Arguelles, M.D., P.C., as Assignee of BETTY ST. FLEUR, Appellant,
against
American Transit Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Richard G. Latin, J.), entered March 27, 2014. The order, insofar as appealed from and as limited by the brief, denied the branches of plaintiff’s motion seeking summary judgment on the fourth through sixth causes of action and granted the branches of defendant’s cross motion seeking summary judgment dismissing those causes of action.

ORDERED that the order, insofar as appealed from, is modified by providing that the branches of defendant’s cross motion seeking summary judgment dismissing the fourth through sixth causes of action are denied; as so modified, the order, insofar as appealed from, is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals, as limited by its brief, from so much of an order of the Civil Court as denied the branches of plaintiff’s motion seeking summary judgment on the fourth through sixth causes of action, and granted the branches of defendant’s cross motion seeking summary judgment dismissing those causes of action on the ground that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs).

Contrary to plaintiff’s contention, plaintiff failed to demonstrate its entitlement to summary judgment on the fourth through sixth causes of action, as the proof submitted by plaintiff failed to establish that these claims 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 denials 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]). However, plaintiff correctly argues that defendant failed to submit proof by someone with personal knowledge attesting to the nonappearance of plaintiff’s assignor for the IMEs in question (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]; Bright Med. Supply Co. v IDS Prop. & Cas. Ins. Co., 40 Misc 3d 130[A], 2013 NY Slip Op 51123[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]; Alrof, Inc. v Safeco Natl. Ins. Co., 39 Misc 3d 130[A], 2013 NY Slip Op 50458[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]).

Accordingly, the order, insofar as appealed from, is modified by providing that the branches of defendant’s cross motion seeking summary judgment dismissing the fourth through [*2]sixth causes of action are denied.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: September 27, 2016