October 13, 2016

Renelique v Utica Mut. Ins. Co. (2016 NY Slip Op 51530(U))

Headnote

The relevant facts for the court to consider in this case were whether the first scheduled examination under oath (EUO) letter sent to the plaintiff was timely, and whether the defendant had properly and timely denied the claim based on the plaintiff's failure to comply with the EUO requirement. The main issue decided by the court was whether the defendant had met the burden of proof in establishing that the first EUO scheduling letter sent to the plaintiff was timely and whether the denial of the claim based on the plaintiff's failure to appear for the EUO was valid. The holding of the case was that the defendant failed to demonstrate that it had properly and timely denied the claim based on the plaintiff's failure to comply with the condition of appearing for the EUO. As a result, the court reversed the order granting the defendant's motion for summary judgment and denied the motion.

Reported in New York Official Reports at Renelique v Utica Mut. Ins. Co. (2016 NY Slip Op 51530(U))

Renelique v Utica Mut. Ins. Co. (2016 NY Slip Op 51530(U)) [*1]

Renelique v Utica Mut. Ins. Co.

2016 NY Slip Op 51530(U) [53 Misc 3d 141(A)]

Decided on October 13, 2016

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This opinion is uncorrected and will not be published in the printed Official Reports.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 13, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-352 Q C

Pierre Jean Jacques Renelique, as Assignee of NYEMMA WICKAM, Appellant,
against
Utica Mutual Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered January 13, 2014. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is reversed, with $30 costs, and defendant’s motion for summary judgment dismissing the complaint is denied.

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 it had timely and properly denied the claim at issue based upon plaintiff’s failure to appear for duly scheduled examinations under oath (EUOs). By order entered January 13, 2014, the Civil Court granted defendant’s motion.

As plaintiff argues, defendant’s moving papers failed to establish that the first EUO scheduling letter defendant sent to plaintiff was timely, as defendant stated that the letter was sent 35 days after defendant had received the claim (see Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins., 48 Misc 3d 139[A], 2015 NY Slip Op 51220[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134[A], 2015 NY Slip Op 50476[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). Consequently, defendant failed to demonstrate that it had properly and timely denied the claim based upon plaintiff’s failure to comply with a condition precedent to coverage (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006] [appearance at an EUO is a condition precedent to coverage]).

Accordingly, the order is reversed and defendant’s motion for summary judgment is denied.

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

Decision Date: October 13, 2016