March 18, 2005

Simmons v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 02105)

Headnote

The case involved a dispute between Patricia Simmons and State Farm Mutual Automobile Insurance Company. After State Farm refused to continue providing no-fault insurance benefits to Patricia Simmons, she and other plaintiffs commenced legal action against the insurance company. The main issue was whether State Farm had met its burden of showing lack of cooperation of its insured and had established that the plaintiff was able to return to work. The court decided that State Farm failed to meet its burden of showing lack of cooperation of its insured and was unable to establish that the plaintiff was able to return to work. Therefore, the court affirmed the lower court's decision to grant State Farm's motion only in part and denied it with respect to the first cause of action, ultimately dismissing the complaint.

Reported in New York Official Reports at Simmons v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 02105)

Simmons v State Farm Mut. Auto. Ins. Co. (2005 NY Slip Op 02105)
Simmons v State Farm Mut. Auto. Ins. Co.
2005 NY Slip Op 02105 [16 AD3d 1117]
March 18, 2005
Appellate Division, Fourth Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, May 18, 2005
Patricia Simmons et al., Respondents, v State Farm Mutual Automobile Insurance Company, Appellant.

[*1]

Appeal from an order and judgment (one paper) of the Supreme Court, Ontario County (Craig J. Doran, A.J.), dated April 23, 2004. The order and judgment, insofar as appealed from, denied that part of defendant’s motion for summary judgment dismissing the first cause of action.

It is hereby ordered that the order and judgment so appealed from be and the same hereby is unanimously affirmed without costs.

Memorandum: Plaintiffs commenced this action after defendant refused to continue providing no-fault insurance benefits to Patricia Simmons (plaintiff). Defendant moved for summary judgment dismissing the complaint, and Supreme Court granted defendant’s motion only in part, denying the motion with respect to the first cause of action but otherwise dismissing the complaint. We affirm.

Contrary to the contention of defendant, it failed to meet its “heavy burden of showing lack of cooperation of its insured” as a matter of law (Nationwide Mut. Ins. Co. v Graham, 275 AD2d 1012, 1013 [2000]; see Thrasher v United States Liab. Ins. Co., 19 NY2d 159, 168-169 [1967]). Furthermore, defendant submitted conflicting medical opinions concerning the degree of plaintiff’s disability from work, thereby raising an issue of credibility for the trier of fact to resolve and rendering summary judgment inappropriate (see e.g. Gedon v Bry-Lin Hosps., 286 AD2d 892, 894 [2001], lv denied 98 NY2d 601 [2002]; Cavallaro v Baker, 187 AD2d 976 [1992]). By failing to establish that plaintiff was able to return to work, defendant failed to establish that plaintiff’s alleged refusal to participate in vocational rehabilitation constituted ” ‘willful and avowed obstruction’ ” (Thrasher, 19 NY2d at 168; see Matter of New York Cent. Mut. Fire Ins. Co. [Salomon], 11 AD3d 315, 316 [2004]). Present—Hurlbutt, J.P., Smith, Pine, Lawton and Hayes, JJ.