[*1]

Civil Court of the City of New York, Kings County, July 28, 2021

APPEARANCES OF COUNSEL

Brian E. Kaufman for defendant.

Richard Rozhik for plaintiff.

The decision/order on defendant’s motion for summary judgment and plaintiff’s cross motion for summary judgment is decided as follows:

It is well settled that a proponent for summary judgment must make a prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to eliminate any material issues of fact (see CPLR 3212 [b]; Zuckerman v City of New York, 49 NY2d 557, 562 [1980]; see also Alvarez v Prospect Hosp., 68 NY2d 320, 324 [1986]; Winegrad v New York Univ. Med. Ctr., 64 NY2d 851, 852 [1985]; Sillman v Twentieth Century-Fox Film Corp., 3 NY2d 395, 404 [1957]).

A moving defendant seeking summary judgment to dismiss the complaint based upon failure to appear for an examination under oath (hereinafter EUO) must show timely mailing of the EUO scheduling letters and that the assignee, in fact, failed to appear (see 11 NYCRR 65-1.1; Nationwide Affinity Ins. Co. of Am. v George, 183 AD3d 755, 756 [2d Dept 2020]).

Defendant did so here. Defendant established that it scheduled plaintiff’s EUO four times by letters dated, October 26, 2017, January 10, 2018, March 26, 2018, and May 25, 2018, for EUOs noticed for January 8, 2018, March 20, 2018, May 23, 2018, and July 12, 2018, respectively. Defendant also established that plaintiff failed to appear at each of the noticed EUOs.

Moreover, defendant demonstrated that plaintiff repeatedly sent letters to counsel for Nationwide stating that it needed two additional months to appear for the EUO, while requesting [*2]an explanation regarding the basis of the EUO and impermissibly demanding a $3,500 appearance fee per claimant to appear at the noticed examinations under oath. The said letters were sent on December 27, 2017 (in relation to the January 8, 2018 EUO), March 16, 2018 (in relation to the March 20, 2018 EUO), May 9, 2018, and May 21, 2018 (in relation to the May 23, 2018 EUO), and June 28, 2018 (in relation to the July 12, 2018 EUO). Each of the aforementioned letters were sent within days or weeks of the respective scheduled EUOs although each EUO request provided nearly two months’ notice as per plaintiff’s request to accommodate plaintiff’s claim that it had a busy calendar. Despite repeatedly claiming to be unavailable to attend the EUO and successfully obtaining two{**73 Misc 3d at 253} months’ adjournment, plaintiff failed to submit an affidavit of an individual with personal knowledge to establish its unavailability on any of the dates the EUO was noticed for or an affidavit attesting to any date it provided defendant that plaintiff would be available to appear.

The purpose of the No-Fault Law and regulations, Insurance Law § 5102 et seq. and 11 NYCRR part 65, is to ensure prompt payment of medical claims for treatment provided to people injured in automobile accidents regardless of fault. If an EUO is requested as additional verification an insurer must schedule it within a reasonable time frame and as “expeditiously as possible.” (Eagle Surgical Supply, Inc. v Progressive Cas. Ins. Co., 21 Misc 3d 49, 51 [App Term, 2d Dept, 2d & 11th Jud Dists 2008].) Plaintiff frustrated the intent of the no-fault regulation by attempting to delay the claim over a period of nine months by claiming it needed two months’ notice for each noticed EUO, thereafter receiving two months’ notice of the EUOs and then continuing to claim it was unavailable and further, without authority, requiring $3,500 for the appearance.

The record demonstrates that plaintiff failed to appear for EUOs scheduled on four occasions, January 8, 2018, March 20, 2018, May 23, 2018, and July 12, 2018. Moreover, the record demonstrates that although defendant Nationwide attempted to accommodate plaintiff by noticing the EUO four times at plaintiff’s request, plaintiff nonetheless failed to appear for any of the noticed EUOs. The last scheduled EUO was for July 12, 2018, and the claims were timely denied on July 19, 2018.

Both parties were given an opportunity to orally argue this motion, at which time plaintiff raised the issue of a timely denial based on a recent case, Quality Health Supply Corp. v Nationwide Ins. (69 Misc 3d 133[A], 2020 NY Slip Op 51226[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]). It appears that Quality Health stands for the proposition that a denial issued more than 30 days after the second EUO no-show, despite the scheduling of subsequent EUOs, is untimely. In Quality Health, the record before the court failed to establish that there were any objections to the EUO request and/or requests seeking an adjournment or postponement of the EUO.

The court finds that the case herein is distinguishable from Quality Health because the defendant herein demonstrated to the court that plaintiff requested that defendant Nationwide notice the EUO additional times, and that defendant in good faith was attempting to accommodate plaintiff’s request by rescheduling the EUOs.{**73 Misc 3d at 254}

Defendant has submitted sufficient proof to demonstrate that plaintiff failed to appear at four duly scheduled EUOs and therefore, failed to comply with a condition precedent to coverage. The plaintiff failed to provide evidence to rebut defendant’s showing.

Plaintiff’s contention that defendant is unable to establish the January 8, 2018 no-show as the transcript states a time of 11:45 p.m. (as opposed to 11:45 a.m.) lacks merit. The court finds that the EUO was noticed for 11:00 a.m. and that the affidavit of Allan Hollander stated that the scheduled start time of the EUO was 11:00 a.m. This is an obvious error in the transcript. Further, the December 27, 2017 correspondence from The Rybak Firm, PLLC, confirmed that FJL Medical Services PC would “be unavailable to appear for the requested EUO currently scheduled for [*3]January 8, 2018.” The court finds that the error in the transcript is insignificant to raise a triable issue of fact.

In light of the above, defendant’s motion for summary judgment is granted and plaintiff’s complaint is hereby dismissed.

CV-739339-17/KI

Hollander Legal Group, P.C., Melville (Jonathan Drapan of counsel), for Nationwide Ins., defendant.

The Rybak Firm, LLC, New York City (Oleg Rybak of counsel), for MSB Physical Therapy P.C., plaintiff.

Recitation, as required by CPLR 2219(a), of the papers considered in the review of this motion:

Papers Numbered

Notice of Motion, Affirmation and Affidavits Annexed

Exhibits A-Z 1-18

Notice of Cross Motion, Affirmation in Support of Cross Motion and In Opposition to Motion, Affidavits Annexed Exhibits 1-8 19-22

Affirmation in Opposition to Cross Motion Exhibits A-B 23-24

Replying Affidavits NONE

In this action seeking to recover assigned first-party no-fault benefits, defendant moves for summary judgment dismissing the complaint on the ground that plaintiff failed to appear at duly scheduled Examinations Under Oath (EUOs) on four separate occasions (Motion Seq. No. 001). Plaintiff opposes the motion and cross-moves for summary judgment in its favor against defendant, or in the alternative, moves for an order compelling defendant to provide discovery (Motion Seq. No. 002). Defendant opposes the cross motion.

The issue presented is whether plaintiff raised triable issues of fact as to whether plaintiff had failed to appear at the EUOs, where defendant refused plaintiff’s requests to reschedule the EUOs for lengthy adjournments of two to three months. Additionally, another issue presented is [*2]whether the EUOs scheduled before defendant received the bills at issue tolled the 30-day period for defendant to pay or otherwise deny the bills received, where the record contains no evidence that defendant had otherwise sent any requests for additional verification during the relevant 30-day periods for some of those bills.

A prior decision and order dated July 12, 2021 decided both the motion and cross motion. However, that decision and order is hereby recalled and vacated, because this court inadvertently overlooked defendant’s opposition papers to plaintiff’s cross motion, which are now considered in this amended decision and order.

BACKGROUND

On September 7, 2016, plaintiff’s assignor, Sayquan U. Bright, was allegedly injured in a motor vehicle accident (see defendant’s exhibit A in support of motion, complaint ¶ 2). This action concerns eight bills for dates of service during the period of January 13, 2017 through February 15, 2017:

(see defendant’s exhibits E-H in support of motion).

Prior to the alleged receipt of the bills, by a letter dated November 8, 2016, purportedly sent by certified mailed and first class mail to plaintiff, defendant’s counsel scheduled an EUO of plaintiff on November 21, 2016 at 2:00 p.m., at its office in Melville, New York, regarding 14 claimants which plaintiff treated, including Bright (see defendant’s exhibit I in support of motion, scheduling letter).

By a letter dated November 17, 2016 (four days before the scheduled EUO), purportedly sent by fax, the Rybak Firm PLLC responded that it represented plaintiff, requested that the EUO be rescheduled to a location in Brooklyn, New York, and advised that plaintiff “will be unavailable for the months of November and December due to the upcoming seasonal holidays” (defendant’s exhibit J in support of motion). Plaintiff’s counsel also noted that the EUO date conflicted with another scheduled EUO for a different medical provider which plaintiff’s counsel [*3]represented (id.). Plaintiff’s counsel therefore requested that plaintiff’s EUO be rescheduled to January, and requested reimbursement of $1,500 per claimant prior to the commencement of the EUO (id.). In closing, the letter stated, “Your failure to respond to this letter at least three (3) business days prior to the next scheduled EUO will be deemed a waiver of Nationwide’s rights to conduct EUO for the above named assignee(s)” (id.).

According to defendant’s counsel, Allan S. Hollander, plaintiff failed to appear at the EUO, and counsel placed a statement on the record accordingly at 2:53 p.m. (see defendant’s exhibit K in support of motion, aff of Allan S. Hollander ¶ 5 and tr. at 5). Hollander stated that plaintiff’s counsel “asked for a date in January . . . and I responded to him via a letter, that we would select a date in January to conduct his client’s examination under oath” (tr. at 6).

EUO of plaintiff on January 23, 2017

By a letter dated November 22, 2016, purportedly sent by first class mail to plaintiff’s counsel, defendant’s counsel scheduled an EUO of plaintiff on January 23, 2017 at 11:00 a.m. at American Stenographic Court Reporting in Brooklyn, New York regarding the 14 claimants, including Bright (see defendant’s exhibit L in support of motion, scheduling letter). The letter further stated,

“Provided your client appears at the examination under oath and answers questions with respect to the corporate structure of MSB Physical Therapy and the treatment of the patients named herein, Nationwide will honor your client’s reimbursement request and present your client a check for $1,500.00. Nationwide will show your client the check prior to the examination under oath and will provide your client with the check subsequent to its completion”

(id.). By a letter dated November 28, 2016, purportedly sent by first class mail to plaintiff’s counsel, defendant’s counsel again notified plaintiff of the EUO on January 23, 2017 at 11:00 a.m. in Brooklyn, New York (defendant’s exhibit M in support of motion).

By a letter dated January 10, 2017, purportedly sent by first class mail, plaintiff’s counsel responded,

“MSB Physical has extended their schedule till the end of February 2017, and will be unavailable to appear for the requested EUO currently scheduled for January 23, 2017. Please take further notice that it is very common amongst medical providers to have their schedules fully booked for about the same period of 2-4 months depending on the circumstances, as well to clear or extend them accordingly, which is usually the main reason of their unavailability to appear for a potential EUO”

(defendant’s exhibit N in support of motion). Plaintiff’s counsel again indicated that the EUO was scheduled on the same date as the EUO of another provider which plaintiff’s counsel represented (id.). Plaintiff’s counsel requested an EUO be scheduled in March (id.). Lastly, plaintiff’s counsel indicated that it had suggested an amount of $1,500 per claimant for reimbursement (id.).

By a letter dated January 17, 2017 addressed to plaintiff’s counsel, defendant’s counsel responded, in relevant part,

“Please be advised that a representative from this office will be present to place a default statement on the record concerning your client’s non-appearance at the EUO on January 23, 2017. Your correspondence further states that your client now needs an additional [*4]two to four months to appear and be ready for the examination under oath.

As such, this office will document the default of your client’s appearance at the EUO on January 23, 2017. Thereafter, this office will send notification noticing your client for a third and final EUO to take place on March 21, 2017. You should already be aware that your client failed to appear and/or asked to adjourn an EUO scheduled for November 21, 2016. Thereafter, your client was noticed two months later for the EUO to take place on January 23, 2017. As such, in good faith, Nationwide will afford your client one final opportunity to appear for an EUO for March 21, 2017.

Additionally, your correspondence asks for reimbursement in the amount of $1,500 for appearing at an examination under oath. . . . If your client wants more than $1,500.00 for its appearance at the EUO, your client will have to substantiate same by submitting proof of actual loss of earnings in the amount greater than $1,500.00″‘

(defendant’s exhibit O in support of motion).

According to defendant’s counsel, Christopher Volpe, plaintiff failed to appear at the EUO on January 23, 2017, and counsel placed a statement on the record accordingly at 1:35 p.m. (see defendant’s exhibit P in support of motion, aff of Christopher Volpe ¶ 4 and tr. at 5-6).

EUO of plaintiff on March 21, 2017

By a letter dated January 25, 2017, purportedly sent by first class mail to plaintiff’s counsel, defendant’s counsel scheduled an EUO of plaintiff on March 21, 2017 at 11:00 a.m. at American Stenographic Court Reporting in Brooklyn, New York regarding 14 claimants, including Bright (see defendant’s exhibit Q in support of motion, scheduling letter).

By a letter dated March 16, 2017, purportedly sent by fax, plaintiff’s counsel responded,

“Please accept this letter as a good faith effort on the part of MSB Physical to comply with all the policy requirements of Nationwide Affinity Insurance Company of America and Titan Indemnity Company (“Nationwide”). As mentioned before, our client is prepared to meet its obligations to cooperate in the investigation of all claims, and is ready to proceed with a mutually convenient and properly scheduled EUO with the basis for this request provided. . . .

However, once again Nationwide has failed to provide our client with all good cause and objective reasons for determination that an EUO of MSB Physical is necessary to verify and establish proof of claim, while our client has an absolute right to request for the basis of this EUO request, and Nationwide has a corresponding basis to provide such an explanation. . . .

As for the scheduled EUO, please be advised that MSB Physical has extended their schedule for the next two (2) months, and will be unavailable to appear for the requested EUO currently scheduled for March 21, 2017. There is nothing wrong or illegal about that, but common medical practice for medical providers to have their schedules fully booked for about the same period 2-4 months depending on the circumstances, as well as to clear or extend them accordingly, which is usually the main reason of their unavailability to appear for a potential EUO.

Accordingly, as the law provides that an EUO be scheduled for a time and place that is convenient to the person who is being examined, we preserve our client’s rights. Please let our office know which other dates in May 2017 Nationwide is available to conduct the EUO of MSB Physical so that we may arrange for a mutually convenient date, time and location. Pursuant to 11 NYCRR 65-3.2 and 11 NYCRR 65-3.5(e), the refusal to adjourn an EUO is a direct violation of the No-Fault regulations”

(defendant’s exhibit R in support of motion).

According to defendant’s counsel, Caitriona McCarthy, plaintiff failed to appear at the EUO on March 21, 2017, and counsel placed a statement on the record accordingly at 12:01 p.m. (see defendant’s exhibit S in support of motion, aff of Caitriona McCarthy ¶ 4 and tr. at 6-7).

EUO of plaintiff on May 19, 2017

By a letter dated March 23, 2017, purportedly sent by first class mail to plaintiff’s counsel, defendant’s counsel scheduled an EUO of plaintiff on May 19, 2017 (see defendant’s exhibit T). The letter further stated, in pertinent part,

“Your client has now missed its March 21, 2017 EUO date. You had asked this office previously to notice the examination under oath two months in advance due to the fact that your client’s calendar was booked in January. As such, Nationwide, in good faith, noticed the EUO two months from January to March 21, 2017 to afford your client every opportunity to clear its calendar and appear for its noticed examination under oath.

Nevertheless, once again, on the eve of the examination under oath, four days before said examination under oath, you are contacting this office and stating your client cannot appear due to its busy schedule.

You are stating in this correspondence that Nationwide has not provided your client with its good reasons and objective basis for noticing your client for an examination under oath. Please be advised that your client has been noticed for an examination under oath for the following reasons, which included but are not limited to:

1. The listed owner of MSB Physical Therapy, Maria Sheila Buslon, P.T., lives and works in Florida. This raises questions as to the true ownership and control of the New York P.C.;

2. The treating physical therapist, Ankit Baldevbhai Patel, is performing services as an employee of MSB Physical Therapy, P.C. and PFJ Medical P.C. on the same dates;

3. There is no Workers’ Compensation policy found for your client’s entity;

4. There is no phone number found on any of the bills or letterhead for your client’s company; and

5. Clinic inspections into your client’s facility have been refused.

The aforementioned are some of the reasons why Nationwide has noticed your client for an examination under oath. Nationwide is trying to determine whether or not your client is properly structured under the Business Corporation Laws of the State of New York and eligible to receive New York State No-Fault Benefits.

* * *

Your client has failed to appear for three examinations under oath with respect to the above claims. Nationwide will notice the examination under oath of your client for a day in May, 2017. The May examination under oath will be the final opportunity for your client to appear for an examination under oath with regard to the claims at issue. The date of that examination under oath will be May 19, 2017 . . . “

(defendant’s exhibit T in support of motion; see also defendant’s exhibit Y in support of motion, aff of Linda Arnold ¶ 4).

By a letter dated March 29, 2017, purportedly sent by first class mail to plaintiff’s counsel, defendant’s counsel scheduled an EUO of plaintiff on May 19, 2017 at 11:00 a.m. at American Stenographic Court Reporting in Brooklyn, New York regarding 14 claimants, including Bright (see defendant’s exhibit U in support of motion, scheduling letter).

According to defendant’s counsel, Michael Weaver, plaintiff failed to appear at the EUO on May 19, 2017, and counsel placed a statement on the record accordingly at 12:10 p.m. (see defendant’s exhibit V in support of motion, aff of Michael Weaver ¶ 4 and tr. at 6-7).

By a letter dated June 23, 2017, purportedly sent by first class mail, plaintiff’s counsel wrote,

“This correspondence is in reply to your letter dated June 1, 2017 pertaining our client’s outstanding EUO, which is still required to be submitted by our client to Nationwide Affinity Insurance Company of America and Titan Indemnity Company (“Nationwide”).

Please accept this letter as another good faith effort on the part of MSB Physical to comply with all policy requirements of Nationwide. . . .

However, upon numerous requests, up to date our client has not been provided with all good cause and objective reasons for determination that an EUO of MSB Physical is necessary to verify and establish proof of claim. Instead, you repeatedly list the same irrelevant and misleading reasons (based upon mere speculation and suspicion as opposed to a good faith substantive basis), which we have already objected to in our previous correspondence regarding this matter dated May 18, 2017.

At this point, while Nationwide’s reasons for the EUO being objected to before are irrelevant under the circumstances, we have no other choice, but to reiterate our previous request to provide our client will all good cause and objective reasons for determination that an EUO of MSB Physical is necessary to verify and establish proof of claim. As you know, our client has an absolute right to request that Nationwide explains the basis for this EUO request, and Nationwide has a corresponding obligation to provide such explanation.

Once provided with same, once an agreement is reach as for a mutually convenient and properly scheduled EUO, and once the issue of our client’s reimbursement is negotiated, our client is ready to proceed”

(defendant’s exhibit W in support of motion).^[FN1]

By a letter dated June 29, 2017, defendant’s counsel responded to plaintiff’s counsel dated June 23, 2017, stating, in relevant part, “Your client has now failed to attend its examination under oath on four separate occasions with respect to the claims at issue” (defendant’s exhibit X in support of motion). Defendant’s counsel reiterated the five reasons for plaintiff’s EUO from its prior letter dated March 23, 2017 (id.).

Denial of Claim Forms

On June 8, 2017, defendant allegedly issued denials of all eight bills at issue in this action, stating, in relevant part:

“MSBP Physical Therapy PC has failed to respond to multiple requests for additional verification and has refused to provide pertinent information that will assist Nationwide in determining the amounts due and payable, pursuant to section 65-1.1(d). Additionally, this failure to submit to the examination under oath scheduled for 11/21/2016, 01/23/2017, 03/21/2017 and 05/19/2017, duly requested, is a violation of the policy[‘]s contractual duties and a violation of proof of claim conditions that precede coverage . . . , and as a result, all no fault billing for services rendered under this policy are being denied”

(see defendant’s exhibits E-H in support of motion, NF-10 forms Box 33).

On November 2, 2017, plaintiff commenced this action asserting eight causes of action to recover assigned first-party no-fault benefits for the eight bills, with interest, plus a ninth cause of action attorneys’ fees (see defendant’s exhibit A in support of motion, summons and complaint). ^[FN2] On December 7, 2017, defendant allegedly answered the complaint (see defendant’s exhibit B in support of motion, answer and affidavit of service).

DISCUSSION

“On a motion for summary judgment, the moving party must make a prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to demonstrate the absence of any material issues of fact. If the moving party produces the required evidence, the burden shifts to the nonmoving party to establish the existence of material issues of fact which require a trial of the action”

(Xiang Fu He v Troon Mgt., Inc., 34 NY3d 167, 175 [2019] [internal citations and quotation marks omitted]).

Defendant argues that it is entitled to summary judgment dismissing the complaint because plaintiff failed to appear for duly scheduled EUOs on four separate occasions, i.e., on November 26, 2016, January 23, 2017, March 21, 2017, and May 29, 2017 (affirmation of [*5]defendant’s counsel ¶¶ 18, 23-70).

“[A]n appearance at an EUO is a condition precedent to the insurer’s liability on the policy” (GLM Med., P.C. v State Farm Mut. Auto. Ins. Co., 30 Misc 3d 137 [A], 2011 NY Slip Op 50194 [U] [App Term, 2d Dept, 2nd, 11th & 13th Jud Dists 2011]).

“To establish its prima facie entitlement to summary judgment dismissing a complaint on the ground that a provider had failed to appear for an EUO, an insurer must demonstrate, as a matter of law, that it had twice duly demanded an EUO from the provider, that the provider had twice failed to appear, and that the insurer had issued a timely denial of the claims”

(Oleg’s Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., 63 Misc 3d 152[A], 2019 NY Slip Op 50760 [U], * 1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019] [internal citations omitted]).

Generally, “proof that an item was properly mailed gives rise to a rebuttable presumption that the item was received by the addressee” (Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 114 AD3d 33, 46 [2d Dept 2013], affd 25 NY3d 498 [2015] [internal quotation marks and citations omitted]). A party can establish proof of mailing “through evidence of actual mailing (e.g., an affidavit of mailing or service) or—as relevant here—by proof of a sender’s routine business practice with respect to the creation, addressing, and mailing of documents of that nature” (CIT Bank N.A. v Schiffman, 36 NY3d 550, 556 [2021]; New York & Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 547, 547 [2d Dept 2006], citing Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679, 680 [2d Dept 2001]).

“Actual mailing may be established by a proper certificate of mailing or by an affidavit of one with personal knowledge” (J.M. Chiropractic Servs., PLLC v State Farm Mut. Ins. Co., 36 Misc 3d 135[A], 2012 NY Slip Op 51348[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012] [internal citation, emendations and quotation marks omitted]). For proof by office practice, “the office practice must be geared so as to ensure the likelihood that the item is always properly addressed and mailed” (Progressive Cas. Ins. Co. v Metro Psychological Servs., P.C., 139 AD3d 693, 694 [2d Dept 2016], citing Nassau Ins. Co. v Murray, 46 NY2d 828, 830 [1978]).

Here, to establish proof of mailing of the EUO scheduling notices, defendant submitted an affidavit from Allan S. Hollander, a former partner with the firm of Bruno, Gerbino & Soriano LLP (see defendant’s exhibit Z in support of motion, aff of Allan S. Hollander). According to Hollander, tracking confirmations from the United States Postal Service established delivery by certified mail of the EUO scheduling notices dated November 28, 2016, January 25, 2017, and March 29, 2017 (Hollander aff ¶¶ 9, 13,17, 24). However, as plaintiff’s counsel points out, the record does not contain any copies of such tracking confirmations. Thus, defendant failed to prove mailing by proof of actual mailing via certified mail.

Neither did Hollander’s affidavit establish proof of mailing by a standard office practice or procedure. Hollander stated,

“At the time of the subject correspondence, including the EUO scheduling letters and responses to Plaintiff’s correspondence, it was the ordinary course of business at Bruno Gerbino & Soriano to mail such correspondences, via the United States Postal Service by Certified Mail, Return Receipt Requested, and 1st class mail on the same date that they [*6]are created and dated and to the address and facsimile numbers listed thereon.

Specifically, after it was created, the EUO request letters were placed in a United States Postal Service bin, located on the third (3rd) floor of the law office of Bruno, Gerbino & Soriano, and the envelope with the proper Certified Mail, Return Receipt Requested material annexed thereto.

Thereafter, a different individual would affix the proper postage to the envelope to the envelope containing the EUO request letter. This parcel of mail, as well as other mail contained in the above-referenced bin, were taken to the mail room located in the lower lobby of Bruno Gerbino & Soraino’s [sic] building. . . . A member of the United States Postal Service would then take the mail to the U.S. Post Office located in Melville, New York. The empty mail bin would be returned to Bruno Gerbino & Soriano the following business day”

(Hollander aff ¶¶ 24-26).

Although Hollander maintained that the EUO scheduling letters were mailed on the same date that they were created and dated, nothing in office procedures described supported that assertion. Hollander described the procedures, but did not state when they occurred, except to say that the empty mail bin was returned the following business day. Hollander also maintained that the envelopes containing the EUO scheduling letters were addressed to the addresses listed on the scheduling letters, but he did not state that the letters were mailed in windowed envelopes. In the absence of any recitation of as to how the names and addresses on the EUO scheduling letters were checked for accuracy on the unwindowed envelopes, this court agrees with plaintiff’s counsel that, on this record, defendant did not establish that the office practice and procedure followed was designed to ensure proper mailing (Orthotech Express Corp. v MVAIC, 37 Misc 3d 128[A], 2012 NY Slip Op 51913[U], *1 [App Term, 1st Dept 2012] [“in any event, defendant acknowledged receipt of the claim”]).

Notwithstanding the above, defendant established proof of mailing of the EUO scheduling letters based on the letters in response from plaintiff’s counsel, which acknowledged receipt of the EUO scheduling letters (see Socrates Med. Health, P.C. v Motor Vehicle Acc. Indemnification Corp., 28 Misc 3d 141[A], 2010 NY Slip Op 51606[U], *1 [App Term, 1st Dept 2010] [“in any event, defendant acknowledged receipt of the claim”]). Thus, plaintiff fails to raise a triable issue of fact as to whether the EUO scheduling letters were mailed.

2. Plaintiff’s failure to appear

Although plaintiff did not appear at the EUO scheduled on November 21, 2016, this does not constitute a failure to appear because Hollander’s statement on the record on November 21, 2016 appears to suggest that the parties mutually agreed to reschedule the EUO to a date in January 2017 (Avicenna Med. Arts, P.L.L.C. v. Ameriprise Auto & Home, 47 Misc 3d 145 [A], 2015 NY Slip Op 50701 [U][App Term 2d Dept, 2d, 11th & 13th Jud Dists 2015).

Defendant established that plaintiff failed to appear for EUOs on January 23, 2017, March 21, 2017, and May 19, 2017, by submitting certified transcripts from the EUOs scheduled and held on those days. Although plaintiff argues that defendant must also submit an affidavit from someone with personal knowledge that plaintiff failed to appear at an EUO and that the [*7]EUO transcripts must be signed or notarized by defendant’s SIU investigator (see affirmation of plaintiff’s counsel in support of cross motion and in opposition to motion [Rybak affirmation] ¶¶ 146, 163, 175, 198, 205, 208, 227), the transcripts memorializing the missed appearances, which were certified as true and accurate by stenographers, are sufficient (Active Chiropractic, P.C. v Praetorian Ins. Co., 43 Misc 3d 134[A], 2014 NY Slip Op 50634[U] [App Term 2d Dept, 2d, 11th & 13th Jud Dists 2014]; see also Atlantic Radiology Imaging, P.C. v Metro. Prop. & Cas. Ins. Co., 50 Misc 3d 147[A], 2016 NY Slip Op 50321[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]). ^[FN3] In any event, defendant submitted affidavits from the attorneys who were physically present at the court reporting location in Brooklyn, New York on the dates and scheduled times of the EUOs (NL Quality Med., P.C. v GEICO Ins. Co., 68 Misc 3d 131[A], 2020 NY Slip Op 50997[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020; T & J Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co., 47 Misc 3d 130[A], 2015 NY Slip Op 50406[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]).

In opposition, plaintiff argues that defendant failed to establish that it had objective reasons for requesting plaintiff’s EUO (see Rybak affirmation ¶¶ 154, 160-162). However, the Appellate Term, Second Department has repeatedly ruled, “contrary to plaintiff’s contention, defendant was not required to set forth objective reasons for requesting EUOs in order to establish its prima facie entitlement to summary judgment” (21st Century Pharmacy, Inc. v Integon Natl. Ins. Co., 69 Misc 3d 142[A], 2020 NY Slip Op 51364[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020], citing Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 [2d Dept 2014]; see also Gentlecare Ambulatory Anesthesia Servs. v GEICO Ins. Co., 65 Misc 3d 138[A], 2019 NY Slip Op 51684[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]).

Contrary to plaintiff’s argument (see Rybak affirmation ¶¶ 152, 155), “there is no requirement to establish willfulness” (Goldstar Equip., Inc. v Mercury Cas. Co., 59 Misc 3d 138[A], 2018 NY Slip Op 50576[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018]). “The doctrine of willfulness . . . applies in the context of liability policies, and has no application in the no-fault context” (Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 561 [1st Dept 2011]).

Plaintiff’s reliance upon Meridian Psychological Services, P.C. v Allstate Insurance Company (51 Misc 3d 128[A], 2016 NY Slip Op 50375[U] [App Term, 2d Dept, 2d, 11th & [*8]13th Jud Dists 2016]) is misplaced. There, the attorney testified at a nonjury trial that, “for the second EUO, she checked at 11:30 a.m. to see whether the assignor had appeared and continued to check for another 15 minutes, but plaintiff’s assignor never appeared. However, the letter scheduling the second EUO scheduled the EUO for 11:00, not 11:30” (id.). Here, unlike Meridian Psychological Services, P.C., the certified EUO transcripts reflect that defendant’s counsel stated on the record that EUO were to begin at 11:00 a.m. (see defendant’s exhibits P, S, and V in support of motion), which was the time reflected on the EUO scheduling letters. Thus, no reasonable inference could be drawn that plaintiff had appeared at the EUOs and left before defendant’s counsel had checked for plaintiff’s appearance. Additionally, for the EUO on January 23, 2017, counsel expressly stated that he had been present since 11:00 a.m. (see defendant’s exhibit P, tr at 7). Neither does plaintiff submit an affidavit from anyone claiming that plaintiff had appeared for any of the EUOs.

Contrary to plaintiff’s argument, the EUO scheduling letters complied with 11 NYCRR 65-3.5 (e). They identically stated, in relevant part, “Nationwide will reimburse you for the reasonable cost of transportation and any loss of earnings of earnings in order to comply with this request, upon submission of receipts and proper documentation” (see defendant’s exhibits M, Q, and U in support of motion).

To the extent that plaintiff argues that the EUO scheduling letters were not in “proper form” because the defendant did not designate a location and time was not “mutually convenient” for plaintiff (see Rybak affirmation ¶ 159), this argument is unavailing. The no-fault regulations do not require an insurer to schedule EUOs according to plaintiff’s convenience. Rather, they provide, “All examinations under oath and medical examinations requested by the insurer shall be held at a place and time reasonably convenient to the applicant” (11 NYCRR 65-3.5 [e]). On the record presented, plaintiff fails to raise a triable issue of fact as to whether the EUO were scheduled at reasonably convenient times.

The regulations do not place a limit on the number of times an applicant for no-fault benefits can request to reschedule an EUO. Courts have ruled that an EUO that is mutually rescheduled prior to the appointed time would not be deemed to constitute a failure to appear (Avicenna Med. Arts, P.L.L.C. v. Ameriprise Auto & Home, 47 Misc 3d 145 [A], 2015 NY Slip Op 50701[U] [App Term 2d Dept, 2d, 11th & 13th Jud Dists 2015]; Metro Psychological Servs., P.C. v Mercury Cas. Co., 49 Misc 3d 143[A], 2015 NY Slip Op 51644[U] [App Term, 1st Dept 2015]).

However, one cannot assume that an EUO is mutually rescheduled merely because a request to reschedule an EUO was made (Alas Lifespan Wellness, PT, P.C. v Citywide Auto Leasing, Inc., 64 Misc 3d 131[A], 2019 NY Slip Op 51040[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019] [a phone call from the assignor on the day of the scheduled IME asking to adjourn the IME, without more, is insufficient to show that an issue of fact exists as to whether the IME was mutually rescheduled]).

If plaintiff requested to reschedule an EUO and received no response, then the insurer is not entitled to summary judgment dismissing the complaint as a matter of law (Island Life Chiropractic, P.C. v State Farm Mut. Auto. Ins. Co., 64 Misc 3d 130[A], 2019 NY Slip Op 51038[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019] [plaintiff’s owner submitted an affidavit in which he stated that he had called defendant to reschedule each EUO and that he left messages for defendant’s investigator, but that plaintiff was not contacted by defendant in response to the messages]).

If an insurer refuses a timely and proper request to reschedule, then an issue of fact arises as to whether the EUOs were scheduled to be held at a time or place which was “reasonably convenient” to plaintiff (Parisien v Metlife Auto & Home, 68 Misc 3d 126[A], 2020 NY Slip Op 50845[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]). One lower court has ruled that an insurer may not unreasonably refuse to adjourn the exams “where a good-faith request is made to re-schedule and the adjournment sought is not excessive” (Diagnostic Radiographic Imaging, P.C. v GEICO, 42 Misc 3d 1205[A], 2013 NY Slip Op 52247[U] [Civ Ct, Kings County 2013]; see also A.B. Med. Servs. PLLC v USAA Gen. Indem. Co., 9 Misc 3d 19, 22, 2005 NY Slip Op 25297 [App Term, 2d Dept 2005]).

Here, defendant’s submissions indicate that the requests of plaintiff’s counsel to reschedule were made days before the EUOs were to occur, even though defendant’s counsel had mailed the scheduling letters well in advance before the scheduled EUOs. Assuming, for the sake of argument, that the requests of plaintiff’s counsel were timely, plaintiff did not raise a triable issue of fact as to whether these requests to reschedule were proper, or that they were made in good faith. Plaintiff requested lengthy adjournments of the EUO for two to three months, ostensibly for the reason that plaintiff is a doctor. If that reason, without more, constituted a good faith basis for an adjournment, then plaintiff could postpone an EUO indefinitely.

As discussed above, when an insurer schedules an EUO, the insurer must inform the applicant seeking no-fault benefits that “the applicant will be reimbursed for any loss of earnings and reasonable transportation expenses incurred in complying with the request” (11 NYCRR 65-3.5 [e]), which occurred here. Thus, any concern for the loss of earnings would not be a valid reason to reschedule an EUO. Additionally, when requesting to reschedule, plaintiff offered no specific dates which would be convenient for plaintiff. On this motion, plaintiff did not come forward within any additional information to support the contention that such lengthy adjournments would be reasonable under the circumstances. Thus, plaintiff fails to raise a triable issue of fact as to whether its requests for adjournments for two to three months were either proper, or made in good faith.

To the extent plaintiff contends that defendant “failed to provide[ ] that . . . Assignor [sic] is reasonably paid for his or her time and traveling expenses” and “failed to agree to reimburse the provider” (Rybak affirmation ¶¶159, 166), this argument is similarly unavailing. Plaintiff demanded a flat, up-front reimbursement in the amount of “$1,500 per claimant” at the commencement of the EUO (see defendant’s exhibit J in support of motion, letter from plaintiff’s counsel dated November 17, 2016). However, plaintiff’s counsel cites no authority for the proposition that the insurer must reimburse the lost earnings before the EUO takes place, and that the lack of reimbursement prior to the EUO would excuse the person to be examined from having to appear. As a practical matter, the duration of an EUO may be an important factor in calculating the reimbursement of lost earnings. Additionally, defendant indicated that it wished to inquire about defendant’s ownership and operations, which would be information common to all the claimants (defendant’s exhibit T in support of motion). In this case, the request of plaintiff’s counsel for a flat, up-front fee of $1,500 per claimant was improper (Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co., 51 Misc 3d 143[A], 2016 NY Slip Op 50698[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016] [“plaintiff improperly demanded that defendant pay a flat, up-front fee of $4,500 for plaintiff to attend the EUO, as opposed to seeking reimbursement for any loss of earnings and reasonable transportation [*9]expenses as set forth in the regulations”]).

Thus, plaintiff fails to raise a triable issue of fact as to whether plaintiff failed to appear for duly scheduled EUOs.

3. Timely Denial of the Claims

“[A]n insurer must either pay or deny a claim for motor vehicle no-fault benefits, in whole or in part, within 30 days after an applicant’s proof of claim is received. An insurer can extend the 30-day period within which to pay or deny a claim by making a timely demand for further verification of the claim”

(Infinity Health Prods., Ltd. v Eveready Ins. Co., 67 AD3d 862, 864 [2d Dept 2009] [internal citations omitted]).

According to Kathleen McAndrews, a Claims Specialist employed by defendant Nationwide Mutual Insurance Company (Nationwide Mutual) at the claims office in Liverpool, New York, the policy upon which these claims have been presented is a policy underwritten by Nationwide Affinity Insurance Company of America, which is a company of Nationwide Mutual (defendant’s exhibit D in support of motion, McAndrews aff ¶¶ 1-3). McAndrews stated that all New York No-Fault related mail “regardless of where it is addressed is forwarded to P.O. Box 26005, Daphne, AL 36526-1126 for processing” (id. ¶ 10). It is undisputed that the claim forms were sent to “Nationwide Insurance Company” at “P.O. Box 26005, Daphne, AL 36526” (see defendant’s exhibits E-H in support of motion, NF-3 forms).

According to Douglas Taylor, a Vice President employed by Auto Injury Solutions, Inc. (AIS), AIS is defendant’s authorized agent “for receiving bills and/or correspondence at Post Office Box 26005, Daphne, AL 36526” (see defendant’s exhibits E-H in support of motion, Taylor long affs ¶ 2).^[FN4] He stated,

“Upon receipt of a bill . . . via regular mail at Post Office Box 26005, Daphne, AL 36526, or facsimile, the following process is utilized: Once the mail is delivered, the inbound mailroom team sorts all of the mail. Each envelope is opened by an electronic machine and then distributed to the batching team. The batchers take the contents of each envelope out, assign an identifying ID number to the contents of each envelope, and then the contents are given to the scanners to create an electronic image. The scanner machine affixes the receive date that the document was received onto each page of the document, as it is imaged. The hard copies of the records are filed and maintained in the file room for Thirty (30) days. The documents are imaged to Nationwide Affinity Insurance Company of America on the same day that the scanner machines affixes the receive date. The scanner machine affixes the received date to the document the same [*10]date the document is received by AIS”

(Taylor long affs ¶ 4). Defendant also submitted the business records of AIS (see defendant’s exhibits E-H in support of motion), which Taylor established as admissible business records under CPLR 4518 (see Taylor long affs ¶¶ 12-13). Based on the date stamps that appeared at the top of bills submitted to defendant, and based on the business records, defendant established that it received the bills on the following dates shown in Table 1 below:

Table 1. Date of Receipt of Bills

b. Proof of Mailing of Denials

To establish proof of timely mailing of the denials, defendant again relied upon the affidavits of McAndrews and Taylor, and the business records of AIS.

According to McAndrews, NF-10 forms are prepared by Claims Specialists, who then electronically notify AIS that the denials are ready for printing (McAndrews aff ¶¶ 17-18). The NF-10 forms use the address(es) contained on the billing documents provided by the medical provider and/or the medical provider’s attorney (id.¶ 15).

According to Taylor, it is AIS’s practice to mail all Explanations of Review (EORs) and NF-10 forms to the provider in duplicate on the same day that they are generated (see defendant’s exhibits E-H, Taylor long affs ¶ 6). The date that the EOR and NF-10 form are generated is noted in the lower left hand corner of the document (id.). Once an EOR and an NF-[*11]10 form are printed for a particular claim, the documents are then placed into a mail machine by AIS mailroom personnel (Taylor long affs ¶ 13). A notation in the history of the record verifies that the documents have been printed, which is entered automatically in the bill history when the print job is run and cannot be altered (id.). The mail machine reads a unique bar code number generated by the system to separate the documents, places the printed documents into a clear windowed envelope, and then prints first class postage on the envelope (id.). The letters to be mailed are maintained in a secure area in the AIS mailroom until they are picked up by the United States Postal Service, which picks up the mail each business day (id.). Any document processed by the AIS mailroom after 2:00 PM is mailed the next business day (Taylor long affs ¶ 14).

McAndrews’s and Taylor’s affidavits and AIS business records establish proof of mailing of the denials in accordance with a standard office practice or procedure (St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123, 1124 [2d Dept 2008]; Royal Med. Supply, Inc. v Nationwide Gen. Ins. Co., 57 Misc 3d 132[A], 2017 NY Slip Op 51235[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]), either on the dates listed in Table 2 below, or on the next business day:

Table 2. Dates when denials were issued

“[T]o rebut the presumption [of mailing], there must be proof of a material deviation from an aspect of the office procedure that would call into doubt whether the notice was properly mailed, impacting the likelihood of delivery to the intended recipient. Put [*12]another way, the crux of the inquiry is whether the evidence of a defect casts doubt on the reliability of a key aspect of the process such that the inference that the notice was properly prepared and mailed is significantly undermined. Minor deviations of little consequence are insufficient”

(CIT Bank N.A, 36 NY3d at 557).

Contrary to plaintiff’s argument, defendant did submit an affidavit from someone with personal knowledge of the denials, because McAndrews stated that she was the Claims Specialist who issued the denials, and McAndrews also had personal knowledge of the claims procedures and mailing procedures (McAndrews aff ¶¶ 5-7, 22-23).^[FN5] Although plaintiff’s counsel contends that the affidavit of Kelly Weaver, Claims Representative, was insufficient (see Rybak affirmation ¶¶ 317-334), defendant did not submit an affidavit from Kelly Weaver. The affidavit of Linda Arnold was not offered to establish proof of mailing, but rather discussed defendant’s reasons for requesting the EUO of plaintiff (see defendant’s exhibit Y in support of motion).

As plaintiff points out, McAndrews indicated that she had reviewed electronic claim file (McAndrews aff ¶ 23), but defendant did not submit copies or printouts of the electronic claim file. “Evidence of the contents of business records is admissible only where the records themselves are introduced. Without their introduction, a witness’s testimony as to the contents of the records is inadmissible” (Bank of New York Mellon v Gordon, 171 AD3d 197, 205-06 [2d Dept 2019] [internal citations and internal quotation marks omitted]). Thus, any information that McAndrews could only have obtained from the electronic log would not be admissible. However, in this case, McAndrews had personally issued the denials, and had submitted copies of the denials themselves, which McAndrews established as defendant’s business records (see McAndrews aff ¶ 38). Plaintiff does not point to any information in McAndrews’s affidavit relevant to proof of mailing that could only have been derived from a review of the electronic claims file.

Plaintiff’s reliance upon Acupuncture Prima Care, P.C. v State Farm Mutual Auto Ins. Co. (17 Misc 3d 1135[A], 2007 NY Slip Op 52273[U] [Dist Ct, Nassau County 2007]) and Carle Place Chiropractic v New York Cent. Mut. Fire Ins. Co. (19 Misc 3d 1139[A] [Dist Ct, Nassau County 2008]) is misplaced. The same court which decided Carle Place Chiropractic and Acupuncture Prima Care, P.C. acknowledged that its prior cases were no longer good law in light of St. Vincent’s Hospital of Richmond:

“It was the opinion of this court that, when stripped of all of its excess verbiage, the insurance companies’ mailing procedures were simply to place a denial form in an envelope and to have someone subsequently mail same. Carle Place Chiropractic v. New York Central Mutual Fire Insurance Company, 19 Misc 3d 1139(A), Slip Copy, 2008 WL 2228633 (Dist.Ct. Nassau Co. 2008); Acupuncture Prima Care, P.C. v. State Farm Mutual Auto Ins. Co., 17 Misc 3d 1135 (A), 851 NYS2d 67 (Dist.Ct. Nassau Co. 2007); New York Hospital Medical Center of Queens v. Liberty Mutual Insurance Company, 16 [*13]Misc 3d 1104 (A), 841 NYS2d 827 (Dist.Ct. Nassau Co. 2007) Recently, however, the Appellate Division, Second Department has found just such a practice and procedure to adequately describe “a standard office practice[] or procedure[] designed to ensure that items were properly addressed and mailed (citations omitted).” St. Vincent’s Hospital of Richmond v. Government Employees Insurance Company, 50 AD3d 1123, 857 NYS2d 211 (2nd Dept. 2008). This court is now constrained to follow this appellate authority”

(Uniondale Chiropractic Off. v State Farm Mut. Auto. Ins. Co., 20 Misc 3d 1130[A], 2008 NY Slip Op 51687[U] [Dist Ct, Nassau County 2008]).

Contrary to plaintiff’s assertion, boxes #23 through #33 on each of the denials were not blank, and so plaintiff fails to raise a triable issue of fact as to whether the denials were facially defective. Plaintiff also asserts that defendant “fails to use the proper denial of claim form (statutory version of the NF-10 form) (Rybak affirmation ¶ 186). To the extent that plaintiff is arguing that the denial of claim forms were not issued using the most current version of the NF-10 form, defendant’s use of “outdated” denial of claim forms is not a fatal defect, “as they contain substantially the same, pertinent information as prescribed forms” (Sheepshead Bay Med. Supply, Inc. v Erie Ins. Co. of NY, 71 Misc 3d 140[A], 2021 NY Slip Op 50491[U], *1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]).

Contrary to plaintiff’s argument, the denials adequately apprised plaintiff that the bills were denied due to plaintiff’s failure “to submit to the examination under oath scheduled for 11/21/2016, 01/23/2017, 03/21/2017 and 05/19/2017” (see defendant’s exhibits E-H, NF-10 forms). Notably, “a denial of claim form based upon the failure to appear for scheduled EUOs need not set forth the dates of the EUOs” (JYW Med., P.C. v IDS Prop. Ins. Co., 58 Misc 3d 134[A], 2017 NY Slip Op 51800[U], * 1 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]).

c. Timeliness of Denials

Because all the denials were issued more than 30 days after the bills were received, the issue presented is whether the 30-day period for defendant to pay or otherwise deny plaintiff’s claims was properly tolled for each bill. Plaintiff generally asserts that defendant failed to toll the payment period by timely requesting an EUO (Rybak affirmation ¶ 169).

If the insurer requires any additional information to evaluate the proof of claim, such request for verification must be made within 15 business days of receipt of the proof of claim (11 NYCRR 65—3.5[b]; see New York Univ. Hosp.-Tisch Inst. v Government Empls. Ins. Co., 117 AD3d 1012, 1014 [2d Dept 2014]).

“Where there is a timely original request for verification, but no response to the request for verification is received within 30 calendar days thereafter, or the response to the original request for verification is incomplete, then the insurer, within 10 calendar days after the expiration of that 30—day period, must follow up with a second request for verification (see 11 NYCRR 65—3.6 [b])”

(Mount Sinai Hosp. v New York Cent. Mut. Fire Ins. Co., 120 AD3d 561, 563 [2d Dept 2014]).Defendant must demonstrate “that its initial and follow-up requests for verification were timely mailed” (Urban Radiology, P.C. v Clarendon Natl. Ins. Co., 31 Misc 3d 132 [A], 2011 NY Slip Op 50601[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]). “[A] follow-up [*14]request is not premature when sent within 10 days of the failure to appear for the initial scheduled examination” (ARCO Med. NY, P.C. v Lancer Ins. Co., 37 Misc 3d 136[A], 2012 NY Slip Op 52178[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]).

As plaintiff correctly points out, delay letters which inform plaintiff that defendant was investigating the claims and was in the process of obtaining verification, which included examinations under oath, are insufficient to toll the 30-day statutory time period (Parsons Med. Supply, Inc. v Progressive Northeastern Ins. Co., 36 Misc 3d 148[A], 2012 NY Slip Op 51649[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]).

Because defendant requested plaintiff’s EUO prior to its receipt of the bills, the notification requirements for verification requests under 11 NYCRR 65-3.5 and 65-3.6 did not apply to those pre-claim EUO requests (Mapfre Ins. Co. of New York v Manoo, 140 AD3d 468, 469 [1st Dept 2016]; Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 7 Misc 3d 18, 21 [App Term, 2d Dept, 2d & 11th Jud Dists 2004], affd 35 AD3d 720 [2d Dept 2006]). However, once the bills are received, defendant is required to comply with the follow-up provisions of 11 NYCRR 65.36 (b) (Mapfre Ins. Co. of NY, 140 AD3d at 470).

i. Tolling with respect to Bill #1

For bill #1, an EUO was scheduled on January 23, 2017, after receipt of bill #1 on January 20, 2017, and plaintiff failed to appear. A follow-up EUO scheduling letter was timely sent on January 25, 2017, within 10 days of the missed EUO, for another EUO to take place on March 21, 2017, where plaintiff did not appear as well. Another follow-up scheduling letter was timely sent on March 23, 2017, within 10 days of the missed EUO, for an EUO to take place on May 19, 2107. Thus, plaintiff failed to appear at three EUOs scheduled to take place after the receipt of bill #1.

“Where, as here, no other verification request is outstanding, the 30-day period for an insurer to pay or deny a claim based upon a failure to appear for an EUO begins to run on the date of the second EUO nonappearance, when an insurer is permitted to conclude that there was a failure to comply with a condition precedent to coverage”

(Quality Health Supply Corp. v Nationwide Ins., 69 Misc 3d 133[A], 2020 NY Slip Op 51226[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]).

As defendant did not deny bill #1 until June 8, 2017, which was more than 30 days after plaintiff’s second failure to appear, for the EUO scheduled for March 21, 2017, defendant is not entitled to summary judgment dismissing bill#1, because defendant did not demonstrate that it is not precluded from raising its proffered defense as to bill #1 (see id.).

Therefore, summary judgment dismissing the first cause of action is denied.

iii. Tolling with respect to Bills #2-5

For bills #2-5, a pre-claim EUO scheduling letter was sent on January 25, 2017 before the defendant’s receipt of bills #2-5 on February 6, 2017. The only EUO scheduling letter in the record after receipt of bills #2-5 was a follow-up EUO scheduling letter sent on March 23, 2017, more than 30 days after the receipt of bills #2-5.

On the issue of whether pre-claim EUO requests toll the 30-day determination period to pay or otherwise deny a claim, the Appellate Term, Second Department has issued conflicting decisions on that issue.

In Doctor Goldshteyn Chiropractic, P.C., the Appellate Term rejected the argument that pre-claim EUO scheduling letters did not toll the 30-day period for an insurer to pay or deny a [*15]claim. There, the defendant mailed a scheduling letter to plaintiff’s assignor on January 4, 2011, and the defendant received the plaintiff’s bill on January 21, 2011 (Doctor Goldshteyn Chiropractic, P.C., 56 Misc 3d 132[A], 2017 NY Slip Op 50923[U] at *1). The Appellate Term ruled, “defendant’s time to pay or deny these claims, which defendant received on January 21, 2011, was tolled” (id.).

In Vitality Chiropractic, P.C. v Kemper Insurance Company (14 Misc 3d 94, 96 [App Term, 2d Dept, 2d & 11th Jud Dists 2006]), the Appellate Term held, “the tolling provisions of the insurance regulations do not apply” to pre-claim verification requests. There, the defendant had scheduled IMEs of the plaintiff’s assignor by letters dated May 22 and 23, 2002, which pre-dated the receipt of the plaintiff’s claim on May 30, 2002. The Appellate Term ruled that the defendant’s denial of the claim on July 11, 2002 (which was more than 30 days after the receipt of the plaintiff’s bill) was untimely (id. at 96).

Vitality Chiropractic, P.C. and Doctor Goldshteyn Chiropractic, P.C. cannot be reconciled. The logic of Vitality Chiropractic, P.C. has straightforward appeal: the toll is based on outstanding verification requests made pursuant to 11 NYCRR 65-3.5 (see 11 NYCRR 65-3.8 [a][1], [b][3]; see Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556, 563 [2008]). Given that the Appellate Term, Second Department has held that 11 NYCRR 65-3.5 does not apply to pre-claim requests at all, it logically follows that pre-claim requests cannot toll the 30-day period. Vitality Chiropractic, P.C. relied upon the Appellate Term’s prior decision in Stephen Fogel Psychological, P.C. v Progressive Casualty Insurance Company, which held that “the detailed and narrowly construed verification protocols are not amenable to application at a stage prior to submission of the claim form” (7 Misc 3d 18, 21 [App Term, 2d Dept, 2d & 11th Jud Dists 2004], affd 35 AD3d 720 [2d Dept 2006]). Citing Stephen Fogel Psychological, P.C., lower courts therefore concluded that a denial based on a pre-claim IME was proper so long as the insurer mailed the denial within 30 days of its receipt of the claim (see e.g. Lender Med. Supply, Inc. v Hartford Ins. Co., 35 Misc 3d 1226[A], 2012 NY Slip Op 50903[U] [Civ Ct, Kings County 2012]; Prime Psychological Servs., PC v ELRAC, Inc., 25 Misc 3d 1244[A], 2009 NY Slip Op 52579[U] [Civ Ct, Richmond County 2009]; cf. All-Boro Medical Supplies, Inc. v Progressive Northeastern Ins. Co., 20 Misc 3d 554 [Civ Ct, Kings County 2008] [if defendant insisted upon conducting a pre-claim EUO before deciding whether to pay or deny the claim, it had no choice but to reschedule the EUO to a date within 30 calendar days from the date it received the claim]).

By comparison, Doctor Goldshteyn Chiropractic, P.C. did not explain why it ruled that a pre-claim EUO request tolled the defendant’s time to pay or deny the plaintiff’s claim. The court cited ARCO Medical NY, P.C. v Lancer Insurance Company (34 Misc 3d 134[A], 2011 NY Slip Op 52382[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]), which had different facts. In ARCO Medical NY, P.C., the EUO requests were sent within 15 days after the defendant received the plaintiff’s claims (id. at *2). Also, it is not clear that the plaintiff in Doctor Goldshteyn Chiropractic, P.C. had actually argued that pre-claim requests could toll the 30-day period. Rather, the plaintiff apparently argued that there was no toll because an issue of fact arose as to whether the scheduling letters were mailed, which the court rejected (Doctor Goldshteyn Chiropractic, P.C., 56 Misc 3d 132[A], 2017 NY Slip Op 50923[U]). No appellate cases have followed Doctor Goldshteyn Chiropractic, P.C.

In deciding which case this court should follow, the Appellate Division, Second Department’s decision in Sound Shore Medical Center v New York Central Mutual Fire [*16]Insurance Company (106 AD3d 157 [2d Dept 2013]) is instructive. There, the defendant-insurer received a UB-04 form from the plaintiff-hospital, which prompted the insurer to send two “requests for verification” to the hospital (id. at 159). Thereafter, the insurer received a NF-5 form from the hospital, which prompted the insurer to send another verification request, but the insurer neither denied the claim nor sent another verification request (id. at 160).

The insurer argued that the hospital’s claim was premature because the hospital did not respond either to the insurer’s initial verification request following receipt of the UB-04 form, or to the verification request following receipt of the NF-5 form. However, the hospital argued that it was entitled to summary judgment in its favor because the UB-04 form was not the functional equivalent of a NF-5 form. Because the insurer did not send a follow-up verification request after sending an initial verification request when it received the NF-5 form, the hospital argued that the insurer’s time to pay the claim had not been tolled.

The Appellate Division agreed with the hospital, and it held that the hospital’s submission of a UB-04 form was not the functional equivalent of a NF-5 form, which would have triggered the 30-day period for the insurer to pay or deny a claim, or to seek verification of the claim (id. at 162, 163). The Appellate Division also ruled, “a request for verification that precedes a no-fault insurer’s receipt of the prescribed N-F 5 claim form does not trigger the tolling of the 30-day period within which an insurer must determine whether to pay or deny such a claim” (id. at 164 [emphasis supplied]).

Given all the above, this court therefore follows Vitality Chiropractic, P.C. Although Doctor Goldshteyn Chiropractic, P.C. is a more recent decision, Vitality Chiropractic, P.C. is based on the Appellate Term’s rulings in Stephen Fogel Psychological, P.C., which was affirmed by the Appellate Division, Second Department (Stephen Fogel Psychological, P.C., 7 Misc 3d 18 at 21, affd 35 AD3d 72). Additionally, Vitality Chiropractic, P.C. is consistent with the Appellate Division’s ruling in Sound Shore Medical Center, that pre-claim verification requests involving a hospital claim did not toll the 30-day period, and is consistent with the Appellate Term, First Department’s decision in Okslen Acupuncture, P.C. (39 Misc 3d 144[A], 2013 NY Slip Op 50821[U]).

Accordingly, the pre-claim EUO scheduling letter was sent on January 25, 2017 did not toll the 30-day period for defendant to pay or otherwise deny bills #2-5, which ended on March 8, 2017. Although the follow-up EUO scheduling letter was sent within 10 days of missed EUO on March 21, 2017, the follow-up EUO scheduling letter was sent on March 23, 2017, more than 30 days after the receipt of bills #2-5 on February 6, 2017. Thus, defendant failed to demonstrate any tolling with respect to bills #2-5 (see Tsatskis v State Farm Fire & Cas. Co., 36 Misc 3d 129 [A], 2012 NY Slip Op 51268 [U] [App Term, 2d Dept, 9th & 10th Jud Dists 2012]).

Therefore, summary judgment dismissing the second, third, fourth, and fifth causes of action is denied.

For bills #6-8, a pre-claim EUO scheduling letter was sent on January 25, 2017, for an EUO to take place on March 21, 2017, which was within 30 days of the receipt of bills #6-8 on February 25, 2017. A follow-up EUO scheduling letter was sent on March 23, 2017, for an EUO to take place on May 19, 2017.

As discussed above, defendant’s pre-claim EUO scheduling letter sent on January 25, [*17]2017 did not toll the 30-day period to pay or otherwise deny bills #6-8.

The only verification request in the record which was sent after bills #6-8 were received was the follow-up EUO scheduling letter sent on March 23, 2017. Because this verification request was sent within 30 days of the receipt of bills #6-8, and was sent within10 days after the missed EUO on March 21, 2017, the follow-up EUO scheduling letter sent on March 23, 2017 was timely and tolled defendant’s time to pay or otherwise deny bills #6-8 through the EUO scheduled on May 19, 2017. Because defendant issued the denial of bills #6-8 on June 8, 2017, which was within 30 days of the missed EUO on May 19, 2017, defendant demonstrated that the denial of bills #6-8 was timely.

In this court’s view, Quality Health Supply Corp. v Nationwide Insurance (69 Misc 3d 133[A], 2020 NY Slip Op 51226[U]) does not dictate a different result. Although plaintiff failed to appear at the EUOs on January 23, 2017, March 21, 2017, and May 19, 2017, it is this court’s view that defendant’s time to pay or otherwise deny bills #6-8 did not run from missed EUO on March 21, 2017, because the January 23, 2017 EUO was scheduled to take place prior to the receipt of bills #6-8.

As discussed above, the notification requirements for verification requests under 11 NYCRR 65-3.5 and 65-3.6 do not apply to pre-claim EUO requests (Manoo, 140 AD3d at 469; Stephen Fogel Psychological, P.C., 7 Misc 3d 18, 21, affd 35 AD3d 720). Also, as discussed above, pre-claim EUO requests do not toll the 30-day period for an insurer to pay or otherwise deny a claim. Therefore, it would not make sense to consider any pre-claim EUO in determining when the insurer’s toll has ended.

To illustrate, suppose the insurer had scheduled two EUOs of plaintiff to take place on January 23, 2017 and March 21, 2017, prior to receipt of the bills on May 19, 2017, and plaintiff had failed to appear at those pre-claim EUOs. Taking Quality Health Supply Corp. literally, the insurer’s time to pay or otherwise deny the claims would run from the second missed EUO on March 21, 2017, even though the insurer has yet to receive the bills.

Thus, this court interprets Quality Health Supply Corp. to apply to those EUOs that are scheduled to occur after the insurer’s receipt of the bills at issue. In this case, because the only EUOs that were scheduled to occur after the receipt of the bills #6-8 were the EUOs on March 21, 2017 and May 19, 2017, the 30-day period for defendant to pay or otherwise deny bills #6-8 ran from May 19, 2017.

Plaintiff fails to raise a triable issue of fact as to whether the 30-day period was tolled as to bills #6-8.

Therefore, defendant is entitled to summary judgment dismissing the sixth, seventh, and eighth causes of action, based on plaintiff’s failure to appear at EUO scheduled on March 21, 2017 and May 19, 2017.

Although defendant is entitled to judgment dismissing three out of the eight causes of action against it, this court exercises its discretion not to grant any costs to defendant with respect that judgment (see CPLR 8103). As discussed in the next section of this decision, on the issue of costs and disbursements (which was not addressed by either party), plaintiff is the prevailing party in this action. Because much of the elements of defendant’s prima facie burden for the sixth, seven, and eighth causes of action were the same as the elements of the other causes of action on which plaintiff prevailed, this court does not view the sixth, seventh and eighth causes of action being as substantially different for this court to exercise its discretion under CPLR 8103 to award costs to defendant (cf. Gibson v Tsandikos, 23 AD3d 801, 802—03 [*18][3d Dept 2005]).

II. Plaintiff’s Cross Motion (Motion Seq. No. 002)

“A no-fault provider establishes its prima facie entitlement to summary judgment by proof of the submission to the defendant of a claim form, proof of the fact and the amount of the loss sustained, and proof either that the defendant had failed to pay or deny the claim within the requisite 30-day period, or that the defendant had issued a timely denial of claim that was conclusory, vague or without merit as a matter of law”

(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]). Once plaintiff meets its prima facie burden, the burden shifts to defendant “to show that it has a meritorious defense and that such a defense is not precluded” (Urban Radiology, P.C. v GEICO Gen. Ins. Co., 39 Misc 3d 146[A], 2013 NY Slip Op 50850[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013] [internal citation omitted]).

Here, plaintiff established its prima facie entitlement for summary judgment in its favor against defendant as to bills #1-5, based on the denial of claim forms in defendant’s motion papers, which admitted receipt of plaintiff’s bills (see Bob Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co., 53 Misc 3d 135[A], 2016 NY Slip Op 51434[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]; see Oleg Barshay, DC, P.C. v State Farm Ins. Co., 14 Misc 3d 74, 75 [App Term, 2d Dept, 2d & 11th Jud Dists 2006]). The denials also establish that the bills were not paid within 30 days after defendant’s receipt of those bills. As discussed above, the denials themselves were also untimely, and thus were without merit as a matter of law.

Thus, plaintiff is granted summary judgment in its favor against defendant on the first, second, third, fourth, and fifth causes of action against defendant, in the sum of $922.15. Plaintiff is also entitled to prejudgment interest on bills #1 through #5 at the rate of 2% per month from November 2, 2017, the date of the commencement of the action, because plaintiff did not commence a lawsuit within 30 days after those bills became overdue (see 11 NYCRR 65-3.9 [c]; East Acupuncture, P.C. v Allstate Ins. Co., 61 AD3d 202, 205 [2d Dept 2009]).

Plaintiff is also granted summary judgment in its favor on the ninth cause of action against defendant, for attorneys’ fees (11 NYCRR § 65-4.6 [d]). The award of attorneys’ fees is calculated as 20% of the aggregate amount of bills #1 through #5 ($922.15) plus interest, subject to a maximum of $1,360 (id.; LMK Psychological Servs., P.C. v State Farm Mut. Auto. Ins. Co., 12 NY3d 217, 223 [2009]).

On the issue of costs and disbursements (which was not addressed by either party), plaintiff prevailed in obtaining summary judgment in its favor on five out of the eight causes of action against defendant, and plaintiff is entitled to recover exactly half of the total amount sought against defendant (exclusive of interest and attorneys’ fees). Thus, plaintiff is the prevailing party entitled to recover costs of the action from defendant, in the amount of $20.00, as a notice of trial has not been filed and the amount of the judgment is not more than $6,000 (CPLR 8101; NY City Civ Ct Act § 1901 [b] [1]). Having been awarded costs, plaintiff is also therefore entitled to recover any disbursements (CPLR 8301; NY City Civ Ct Act § 1908).

The branch of plaintiff’s motion for summary judgment in its favor on the sixth through eighth causes of action against defendant is denied. As discussed above, defendant demonstrated that it timely denied bills #6-8 based on the failure of plaintiff to appear for duly scheduled [*19]EUOs on March 21, 2017 and May 19, 2017.

The branch of plaintiff’s motion to compel defendant to comply with discovery demands is denied as academic.

CONCLUSION

Upon the foregoing cited papers, it is hereby ORDERED that defendant’s motion for summary judgment dismissing the complaint (Motion Seq. No. 001) is GRANTED IN PART TO THE EXTENT that the sixth, seventh, and eighth causes of action are severed and dismissed, and the remainder of defendant’s motion is otherwise denied; and it is further

ORDERED that the branch of plaintiff’s cross motion for summary judgment in its favor against defendant (Motion Seq. No. 002) is GRANTED IN PART TO THE EXTENT that summary judgment is granted in plaintiff’s favor against defendant on the first, second, third, fourth, and fifth causes of action against defendant, in the sum of $922.15, with prejudgment interest from the date of November 2, 2017; and judgment is granted in plaintiff’s favor on the ninth cause of action for attorneys’ fees in the amount of 20% of the sum of $922.15 plus the accrued prejudgment interest, as calculated by the Clerk, subject to a maximum of $1,360, with costs and disbursements to plaintiff upon submission to the Clerk upon an appropriate bill of costs, and the remainder of plaintiff’s cross motion is denied; and it is further

ORDERED that the Clerk is directed to enter judgment accordingly; and it is further

ORDERED that the prior decision and order dated July 12, 2021 is hereby recalled and vacated.

This constitutes the amended decision and order of the court.

Dated: July 13, 2021
New York, New York
ENTER:
________________________________
RICHARD TSAI, J.
Judge of the Civil Court

Footnotes

Footnote 1: Defendant did not submit a copy of the purported letter from plaintiff’s counsel dated May 18, 2017 or the purported letter from defendant’s counsel dated June 1, 2017.

Footnote 2: Plaintiff also commenced a separate action against defendant to recover assigned first-party no-fault benefits concerning eight bills for dates of service during the period of November 8, 2016 through January 5, 2017, MSB Physical Therapy P.C. a/a/o Bright, Sayquan U v Nationwide Ins., Civ Ct, Kings County, Index No. CV-739338-17/KI.

Footnote 3: In opposition to plaintiff’s cross motion, defendant also argues that, in another action involving the parties for different dates of service from September 9, 2016 through November 3, 2016, another judge of this court determined that plaintiff failed to appeared at EUOs (see defendant’s exhibit A in opposition to plaintiff’s cross motion, MSB Physical Therapy, P.C. a/a/o Sayquan U. Bright v Nationwide Ins., Civ Ct, Kings County, May 8, 2019, Walker-Diallo, J., index No. CV-729770-17/KI).

In light of this court’s determination that defendant’s submissions in its moving papers established plaintiff’s failures to appear at the EUOs on January 23, 2017, March 21, 2017, and May 19, 2017, this court need not reach defendant’s arguments of res judicata and collateral estoppel, which were essentially new arguments raised for the first time in reply in support of summary judgment dismissing this action.

This court notes that the decision in the other action, which ruled that plaintiff had failed to appear at EUOs, appears to concern only the EUOs on November 21, 2016 and January 23, 2017 (see id., at 7-8). The decision did not discuss any proof with respect to the other EUOs scheduled on March 21, 2017 or May 19, 2017.

Defendant also submitted another affidavit from Taylor that is nine paragraphs long and is identical for each bill (see defendant’s exhibits E-H [hereinafter, Taylor short aff]).

CV-35369/10

Counsel for plaintiff: Gary Tsirelman PC

Counsel for defendant: McDonnell Adels & Klestzick PLLC

In this action for the payment of no-fault benefits, defendant seeks an order pursuant to CPLR § 3126, striking the complaint for plaintiff’s failure to provide court-ordered discovery. Defendant contends that despite this Court’s two prior orders, one of which conditionally calls for preclusion, and both requiring responses to defendant’s discovery demands and that plaintiff appear for a deposition, plaintiff has failed to provide the responses requested and has failed to appear for a deposition. Plaintiff opposes the instant motion, asserting that it has fully complied with the prior orders by providing responses to defendant’s discovery demands, that defendant has waived plaintiff’s deposition by refusing to hold and/or attend the same, and that insofar as this Court’s prior order is a self-executing order of preclusion, the instant motion seeks duplicative relief.

For the reasons that follow hereinafter, defendant’s motion is granted, in part.

The instant action is for the payment of medical benefits pursuant to Article 51 of the New York State Insurance Law. It is alleged that secondary to a motor vehicle accident on April 1, 2006, plaintiff provided medical services to PABLO BELLO, who assigned his no-fault benefits under the Insurance Law and defendant’s policy to plaintiff. Plaintiff, upon presenting proof of the foregoing services, requested payment totaling $1,560. Defendant has failed to pay the foregoing amount and thus, plaintiff seeks a judgment in the amount of $1,560.

Within its answer, defendant interposes a legion of affirmative defenses, including number 21, wherein defendant alleges that it is not obligated to pay plaintiff “[b]ecause the services at issue were not conducted and/or supervised by a licensed physician/medical professional.”

Defendant’s motion seeking to strike the complaint based on plaintiff’s failure to provide complete and meaningful responses to defendant’s Demand for Interrogatories and Notice for Discovery and Inspection is granted to the extent of striking the complaint should plaintiff fail to [*2]provide the discovery previously ordered by this Court and reiterated below. As will be discussed hereinafter, plaintiff was required to produce the discovery at issue pursuant to the Court’s two prior orders. Although the last order conditionally ordered sanctions for plaintiff’s noncompliance, such sanction did not accord defendant complete relief and instead incentivized plaintiff’s noncompliance.

In support of the instant motion, defendant submits its Demand for Interrogatories and Notice for Discovery and Inspection dated June 19, 2014 ^[FN1] . To the extent relevant, question six of the Demand for Interrogatories seeks information regarding plaintiff’s owners and shareholders. Question eight seeks salary information for plaintiff’s owners and shareholders. Similarly, many requests in defendant’s Notice for Discovery and Inspection seek information related to the plaintiff’s corporate structure. For example, question two seeks lease information for plaintiff’s office space and questions seven and 12 seek tax information for Oksana Lendel (Lendel), purportedly plaintiff’s owner.

Defendant submits the Court’s (Doherty, J.) prior order dated June 14, 2017, which was issued in response to defendant’s first motion to strike plaintiff’s Notice of Trial, strike the complaint, and/or compel plaintiff to comply with defendant’s discovery demands. Within said order, the Court directed that plaintiff “provide complete and verified responses to defendant’s discovery demands within 60 days.” The Court also ordered that plaintiff was to appear for a deposition within 60 days.

Defendant also submits plaintiff’s first response to defendant’s Demand for Interrogatories and Notice for Discovery Inspection, dated July 12, 2017. A review of the responses evinces that plaintiff objected to disclosure of much of the information sought. For example, plaintiff objected to questions six and eight in the Demand for Interrogatories and questions seven and 12 of defendant’s Notice for Discovery and Inspection, which sought tax and financial records for plaintiff and Lendel.

Defendant submits a letter it sent to plaintiff dated June 29, 2017, wherein defendant scheduled Lendel’s deposition for August 14, 2017. Defendant submits a deposition transcript dated August 14, 2017, wherein defendant’s counsel states that he was present for plaintiff’s deposition but that neither anyone on plaintiff’s behalf, Lendel, nor its counsel appeared.

Defendant submits the Court’s (Semaj, J.) order dated January 7, 2020, wherein in response to defendant’s second motion to strike the complaint and compel discovery, the Court again ordered that plaintiff provide “complete and verified responses to defendant’s discovery demands within 30 days.” The Court also ordered the same with regard to plaintiff’s deposition and indicated that the failure to comply with the foregoing would result in preclusion at trial.

Defendant submits plaintiff’s second response to defendant’s Demand for Interrogatories and Notice for Discovery Inspection, dated January 24, 2020. A review of the responses evinces that they are similar to the responses previously provided in that plaintiff still objected to the disclosure of much of the information sought. For example, plaintiff still objected to question eight in the Demand for Interrogatories, seeking salary information for plaintiff’s owner and its [*3]shareholders and questions seven and 12 of defendant’s Notice for Discovery and Inspection, seeking tax and financial information for plaintiff and Lendel.

Defendant submits an affidavit by Joseph Aterno (Aterno), an Investigator employed by defendant, who states, in pertinent part, as follows. Defendant has been investigating plaintiff with regard to its treatment methods, procedures and billing practices. Defendant suspects that plaintiff is not properly licensed, thereby violating, inter alia, the Business Corporation Law. Defendant also believes that plaintiff has been rendering treatment via independent contractors. Significantly, defendant believes that Lendel, who per documents filed with the Department of Education of the State of New York, is plaintiff’s owner, does not actually own plaintiff, a corporation. Instead, defendant believes that plaintiff is actually owned and controlled by individuals not licensed to practice medicine, which is a violation of New York State Law. Aterno states that plaintiff renders medical treatment in at least eight locations and each location is affiliated with other providers who are under investigation by defendant for illegal incorporation and for ties to management companies, which are owned by unlicensed laypersons.

In addition to plaintiff, Lendel owns JOV Acupuncture PC (JOV). It is defendant’s belief that plaintiff and JOV are reincarnations of prior acupuncture clinics owned by Valentina Anikeyeva (Anikeyeva), which defendant found were controlled and operated by her husband, Andrey Anikeyeva (Andrey). Significantly, on July 28, 2009, at a deposition, Anikeyeva testified that Andrey was responsible for almost every aspect of Anikeyeva’s clinics. On May 4, 2007, at an arbitration, Andrey testified that he was the only person authorized to sell shares of Anikeyeva’s clinic’s shares. Plaintiff was formed in 2004, just as Anikeyeva closed her clinics in 2005. After Lendel incorporated JOV, he then took over Anikeyeva’s practice at the same locations where Anikeyeva’s clinics had previously been. On March 7, 2006, at a deposition, Lendel testified that JOV and plaintiff used the same treatment locations as Anikeyeva’s prior clinics, used the same acupuncturists, employees, billing department, and attorney.

“The purpose of disclosure procedures is to advance the function of a trial, to ascertain truth and to accelerate the disposition of suits” (Rios v Donovan, 21 AD2d 409, 411 [1st Dept. 1964]). Accordingly, our courts possess wide discretion to decide whether information sought is “material and necessary” to the prosecution or defense of an action (Allen v Crowell-Collier Publ. Co., 21 NY2d 403, 406 [1968]). The terms

material and necessary, are, in our view, to be interpreted liberally to require disclosure, upon request, of any facts bearing on the controversy which will assist preparation for trial by sharpening the issues and reducing delay and prolixity. The test is one of usefulness and reason. CPLR 3101 (subd. [a]) should be construed, as the leading text on practice puts it, to permit discovery of testimony which is sufficiently related to the issues in litigation to make the effort to obtain it in preparation for trial reasonable

(id. at 406 [internal quotation marks omitted]). In other words, information that is relevant to an issue in a case is discoverable (Wadolowski v Cohen, 99 AD3d 793, 794 [2d Dept 2012] [“It is incumbent on the party seeking disclosure to demonstrate that the method of discovery sought will result in the disclosure of relevant evidence or is reasonably calculated to lead to the discovery of information bearing on the claims, and unsubstantiated bare allegations of relevancy are insufficient to establish the factual predicate regarding relevancy.”]; Crazytown Furniture, Inc. v Brooklyn Union Gas Co., 150 AD2d 420, 420 [2d Dept 1989]). Whether information is [*4]discoverable does not hinge on whether the information sought is admissible and information is therefore discoverable merely if it “may lead to the disclosure of admissible proof” (Twenty Four Hour Fuel Oil Corp. v Hunter Ambulance, 226 AD2d 175, 175 [1st Dept 1996]). That said, however, “unlimited disclosure is not mandated, and the court may deny, limit, condition, or regulate the use of any disclosure device to prevent unreasonable annoyance, expense, embarrassment, disadvantage, or other prejudice to any person or the courts” (Diaz v City of New York, 117 AD3d 777, 777 [2d Dept 2014]). Thus, the trial court has broad discretion in determining the scope and breadth of discovery, must supervise disclosure and set reasonable terms and conditions therefor (id.). Absent an improvident exercise of discretion, the trial court’s determinations should not be disturbed on appeal (id.).

Pursuant to CPLR § 3126,

[i]f any party, or a person . . . refuses to obey an order for disclosure or wilfully fails to disclose information which the court finds ought to have been disclosed pursuant to this article, the court may make such orders with regard to the failure or refusal as are just, among them . . . an order prohibiting the disobedient party from supporting or opposing designated claims or defenses, from producing in evidence designated things or items of testimony, or from introducing any evidence of the physical, mental or blood condition sought to be determined, or from using certain witnesses; or . . . an order striking out pleadings or parts thereof.

It is well settled that “[t]he nature and degree of a penalty to be imposed under CPLR 3126 for discovery violations is addressed to the court’s discretion” (Zakhidov v Boulevard Tenants Corp., 96 AD3d 737, 738 [2d Dept 2012]). Striking a party’s pleading for failure to provide discovery, however, is an extreme sanction, and warranted only when the failure to disclose is willful and contumacious (Bako v V.T. Trucking Co., 143 AD2d 561, 561 [1st Dept 1999]). Similarly, since the discovery sanction imposed must be commensurate with the disobedience it is designed to punish, the less drastic sanction of preclusion is also only appropriate when there is a clear showing that a party has willfully and contumaciously failed to comply with court-ordered discovery (Zakhido at 739; Assael v Metropolitan Transit Authority, 4 AD3d 443, 444 [2d Dept 2004]; Pryzant v City of New York, 300 AD2d 383, 383 [2d Dept 2002]). Willful and contumacious behavior can be readily inferred upon a party’s repeated non-compliance with court orders mandating discovery (Pryzant at 383). When a party adopts a pattern of willful non-compliance with discovery demands (Gutierrez v Bernard, 267 AD2d 65, 66 [1st Dept 1999]) and repeatedly violates discovery orders, thereby delaying the discovery process, the striking of pleadings is warranted (Moog v City of New York, 30 AD3d 490, 491 [2d Dept 2006]; Helms v Gangemi, 265 AD2d 203, 204 [1st Dept 1999]). Stated differently, discovery sanctions should ensue when there is a willful failure to “disclose information that the court has found should have been disclosed” (Byam v City of New York, 68 AD3d 798, 801 [2d Dept 2009]).

Where the failure to disclose is neither willful nor contumacious, and instead constitutes a single instance of non-compliance for which a reasonable excuse is proffered, the extreme sanction of striking of a party’s pleading is unwarranted (Palmenta v Columbia University, 266 AD2d 90, 91 [1st Dept 1999]). Nor is the striking of a party’s pleading warranted merely by virtue of “imperfect compliance with discovery demands” (Commerce & Industry Insurance [*5]Company v Lib-Com, Ltd, 266 AD2d 142, 144 [1st Dept 1999]).

Under 11 NYCRR 65-3.16(a)(12), a provider need only be licensed for reimbursement. However, it is also settled that in New York, while “a fraudulently incorporated medical company is a provider of health care services within the meaning of the regulation[s]” (State Farm Mut. Auto. Ins. Co. v Robert Mallela, 4 NY3d 313, 321 [2005]), such provider is not entitled to reimbursement under the no-fault laws (id. at 320 [“We accepted the certification and now answer that such corporations are not entitled to reimbursement.”]). Indeed, merely being licensed is not dispositive because “[t]he fact remains that the reimbursement goes to the medical service corporation that exists to receive payment only because of its willfully and materially false filings with state regulators” (id. at 320). Whether a corporation is fraudulently incorporated for purposes of reimbursement turns on whether the corporation runs afoul of BCL § 1508(a), which states that

[n]o individual may be a director or officer of a professional service corporation unless he is authorized by law to practice in this state a profession which such corporation is authorized to practice and is either a shareholder of such corporation or engaged in the practice of his profession in such corporation.

Accordingly, in cases where there is an issue as to whether a medical provider is entitled to reimbursement under the no-fault law for medical services provided to an injured party on grounds that said provider was fraudulently incorporated, in violation of state and local law, disclosure of said provider’s financial records is warranted as they are material and necessary (One Beacon Ins. Group, LLC v Midland Med. Care, P.C., 54 AD3d 738, 740 [2d Dept 2008] [“The Supreme Court properly granted that branch of the plaintiffs’ cross motion which was for disclosure of certain financial documents. Contrary to the appellants’ contention, the plaintiffs were not required to make a showing of “good cause” for such disclosure, as the documents were material and necessary in the prosecution of this action”] [internal citation and quotation marks omitted].). Indeed, in cases where fraudulent incorporation is at issue, broad discovery on that issue, meaning information to determine whether plaintiff was fraudulently incorporated, is warranted (Midborough Acupuncture P.C. v State Farm Ins. Co., 13 Misc 3d 58, 60 [App Term 2006] [“Consequently, we find that discovery requests seeking information to determine whether the owners of a medical service corporation are improperly licensed are germane to the question of whether said corporation is eligible for reimbursement.”]; Lexington Acupuncture, P.C. v State Farm Ins. Co., 12 Misc 3d 90, 93 [App Term 2006]; Val. Physical Medicine and Rehabilitation P.C. v New York Cent. Mut. Ins. Co., 193 Misc 2d 675, 676 [App Term 2002]). Such discovery extends to information related to a provider’s licensing status and corporate structure (Val. Physical Medicine and Rehabilitation P.C. at 676).

Based on the foregoing, defendant’s motion must be granted to the extent of striking the complaint should plaintiff fail to provide the information requested within defendant’s Demand for Interrogatories and Notice for Discovery Inspection, dated June 19, 2014. The same is true should plaintiff fail to appear for a deposition. Here, it is clear that given the Court’s two prior orders requiring plaintiff to produce the information within the aforementioned discovery demands, plaintiff’s failure to respond, by objecting and withholding discovery, constitutes a clear violation of the Court’s orders.

Any contention that plaintiff complied with the Court’s prior orders because it was only [*6]required to respond to the foregoing demands and it reserved its right to object, is without merit. To be sure, while the prior orders facially merely required that plaintiff respond to defendant’s discovery demands, it is clear – given the nature of the motions giving rise to the orders and the submissions therewith – that the Court meant to compel compliance with defendant’s demands such that plaintiff was precluded from interposing objections. This is more true here, where defendant, after receiving plaintiff’s first response to its demands, moved to compel discovery pursuant to CPLR § 3124.

CPLR § 3124 allows a court to compel disclosure “[i]f a person fails to respond to or comply with any request, notice, interrogatory, demand, question, or order.” Thus, when a party responds to discovery demands but provides inadequate responses, the proper remedy is a motion to compel pursuant to CPLR § 3124 as opposed to a motion to strike or preclude pursuant to CPLR § 3126 (Double Fortune Property Investors Corp. v Gordon, 55 AD3d 406, 407 [1st Dept 2008] [“Plaintiff having responded to defendant’s discovery requests, the proper course for defendant, rather than moving to strike the complaint pursuant to CPLR 3126, was first to move to compel further discovery pursuant to CPLR 3124.”]). Thus, by ordering plaintiff to provide further responses to defendant’s demand, it stands to reason that the Court found plaintiff’s objection inappropriate, requiring disclosure of the information to which plaintiff objected.

Notably, although plaintiff previously cross-moved for a protective order pursuant to CPLR § 3103, it did so belatedly and the fact that the prior Court orders are silent on that issue indicates that no such relief was granted. Indeed, when a party fails

to challenge the propriety of a notice for discovery and inspection pursuant to CPLR 3120 within the time prescribed by CPLR 3122 [such failure] forecloses inquiry into the propriety of the information sought, except as to material which is privileged under CPLR 3101 or as to requests which are palpably improper

(Muller v Sorensen, 138 AD2d 683, 684 [2d Dept 1988]). A review of the case law, however, evinces that generally, in order to avoid a waiver of the right to challenge requested discovery, a party must not merely object, but must also timely move for a protective order pursuant to CPLR 3103 (Roman Catholic Church of Good Shepherd v Tempco Sys., 202 AD2d 257, 258 [1st Dept 1994]; Zurich Ins. Co. v State Farm Mut. Auto. Ins. Co., 137 AD2d 401, 401 [1st Dept 1988]; Wood v Sardi’s Rest. Corp., 47 AD2d 870, 871 [1st Dept 1975]).

Pursuant to CPLR §3103, a court, by issuing a protective order, can limit or preclude disclosure. CPLR §3103 reads, in pertinent part,

[t]he court may at anytime on its own initiative, or on motion of any party or any person from whom discovery is sought, make a protective order denying, limiting, conditioning or regulating the use of any disclosure devise. Such order shall be designed to prevent unreasonable annoyance, expense, embarrassment, disadvantage, or other prejudice to any person or the court.

Thus, by issuing a protective order, a court can circumscribe the otherwise liberal scope of discovery, and in the exercise of its discretion, regulate the discovery process (Church & Dwight Co., Inc., v UDDO & Associates, Inc., 159 AD2d 275, 276 [1st Dept 1990]).

While CPLR § 3103 states that a motion for a protective order can be made at any time, a review of the case law indicates that with respect to discovery demands made pursuant to CPLR § 3120 or CPLR § 3121, such motion must be made within the 20 days prescribed by CPLR § [*7]3122, namely the time within which to assert any objections to duly served discovery demands (Roman Catholic Church of Good Shepherd at 258 [citing CPLR § 3122 as prescribing the time period within which to make a timely motion for a protective order]; Haller v North Riverdale Partners, 189 AD2d 615, 616 [1st Dept 1993] [same]). As noted above, the failure to timely move for a protective order within the 20 days prescribed by CPLR § 3122 constitutes a waiver and generally bars a party from obtaining a protective order (Coffey v Orbachs, Inc., 22 AD2d 317, 319-320 [1st Dept 1964]. The exception to this general rule only arises when a discovery demand is palpably improper (Haller at 616; 2 Park Avenue Associates v Cross & Brown Company, 60 AD2d 566, 566-567 [1st Dept 1977]; Wood at 870; Zambelis v Nicholas, 92 AD2d 936, 936-937 [2d Dept 1983]). When the discovery for which a protective order is sought is palpably improper, failure to timely move for a protective order will not constitute a waiver (id.).

Here, aside from the absence of any mention of a protective order – specifically, that one was granted – in the Court’s prior order, insofar as plaintiff made its prior cross-motion on or about February 8, 2016 and defendant’s demands are dated June 19, 2014, it is clear that the plaintiff sought such relief almost two years after 20 days within which to make a timely motion pursuant to CPLR § 3103 had expired. As such, plaintiff cannot object to any of the discovery demands sought.

Indeed, in order to foreclose all doubt about plaintiff’s obligation to produce all of the information requested in defendant’s discovery demand and because this Court’s two prior orders were very brief short form orders, bereft of any discussion of the law and how it applies to the facts in the record, the Court will now endeavor to detail why the discovery sought is both material and necessary, thereby requiring plaintiff to produce the same.

As noted above, when a party adopts a pattern of willful non-compliance with discovery demands (Gutierrez at 66) and repeatedly violates discovery orders, thereby delaying the discovery process, the striking of pleadings is warranted (Moog at 491; Helms at 204). Stated differently, discovery sanctions should ensue when there is a willful failure to “disclose information that the court has found should have been disclosed” (Byam at 801). With respect to discovery and what information can be discovered, the test is whether the information sought is material and necessary in that it bears “on the controversy which will assist preparation for trial by sharpening the issues” (Allen at 406). Stated differently, if the information sought is relevant to the issues raised by a party, it ought to be discovered (Wadolowski at 794; Crazytown Furniture, Inc. at 420). In cases where fraudulent incorporation is at issue, broad discovery on that issue, meaning information to determine whether plaintiff was fraudulently incorporated, is warranted (Midborough Acupuncture P.C. at 60; Lexington Acupuncture, P.C. at 93; Val. Physical Medicine and Rehabilitation P.C. at 676). Such discovery extends to information related to a provider’s licensing status and corporate structure (Val. Physical Medicine and Rehabilitation P.C. at 676).

Here, given defendant’s affirmative defense, sounding in fraudulent incorporation and Aterno’s affidavit, which in discussing facts which call into question whether plaintiff was fraudulent incorporated in violation of applicable laws, it is clear that the discovery sought by defendant, which seeks to discover plaintiff’s corporate structure by way of corporate, tax, and financial records, is relevant – material and necessary – and thus, discoverable. To be sure, if plaintiff was fraudulently incorporated, in that it is owned by non-medical laypersons, then [*8]plaintiff would not be entitled to no-fault payments for any treatment rendered. Indeed, it is precisely because of this very finding that the Court previously granted defendant’s two applications seeking to compel the very disclosure which plaintiff has sought to shield.

To the extent that plaintiff avers that it has already been sanctioned for its noncompliance – in that the Court (Semaj, J.) already issued a self-executing order of preclusion – such argument is without merit. To be sure, a defendant bears the burden of establishing all affirmative defenses (Flatau v Fairchild Camera & Instrument Corp., 40 AD2d 990, 990 [2d Dept 1972] [“The burden of such proof was on defendant in connection with its affirmative defense that procurement of Workmen’s Compensation benefits was plaintiff’s exclusive remedy.”]; Averbuck v Becher, 134 NYS 1112, 1113 [App Term 1912] [“The burden was on defendant to prove the affirmative defense.”]). Accordingly, here, where the information necessary to establish defendant’s defense is squarely in plaintiff’s possession, the remedy of preclusion only serves to shield that information from defendant, and incentivizes plaintiff from producing the same. As such, the appropriate remedy is dismissal of the action – meaning the striking of the complaint – should plaintiff fail to provide the discovery requested.

Contrary to plaintiff’s assertion, defendant’s decision to cancel the deposition scheduled for March 23, 2020 did not constitute a waiver of the same. As urged by defendant, in the absence of the document discovery sought by defendant, plaintiff’s deposition would have been relatively fruitless. Thus, defendant is entitled to plaintiff’s deposition once plaintiff complies with the Court’s two prior orders and this one. It is hereby

ORDERED that the plaintiff provide defendant with all of the information requested in defendant’s Demand for Interrogatories and Notice for Discovery and Inspection, dated June 19, 2014, within 60 days hereof. It is further

ORDERED that plaintiff is precluded from interposing objections to any of the foregoing discovery demands and unless it does not posses the information requested, it must provide the same. It is further

ORDERED that should plaintiff fail to comply with the foregoing directives, the complaint is automatically stricken and this case is dismissed, without further leave of court. It is further

ORDERED that plaintiff appear for a deposition at a date and time mutually convenient to all parties within 90 days hereof. It is further

ORDERED that defendant serve a copy of this Decision and Order with Notice of Entry upon plaintiff within thirty (30) days hereof.

This constitutes this Court’s decision and Order.

Dated: July 9, 2021

Bronx, New York
FIDEL E. GOMEZ, JCC

Footnotes

Footnote 1:Defendant’s submissions primarily consist of its prior two motions seeking discovery sanctions and the Court discusses only those documents contained therein, which are pertinent to the instant decision.

CV-740154-19/KI

Attorney for Plaintiff: Oleg Rybak, Esq. The Rybak Firm, PLLC1810 Voorhies Ave., 3rd Floor, Ste. 7, Brooklyn, NY 11235

Attorney for Defendant: Alisa Burns, Esq., McDonnell Adels & Klestzick, PLLC 401 Franklin Ave., 2nd Floor, Garden City, NY 11530

The court’s Decision and Order is based upon consideration of the following papers:

CPLR 2219(a) Recitation

NOTICE OF MOTION & AFFIDAVITS ANNEXED 1

OPPOSITION/CROSS-MOTION 2

REPLY/OPPOSITION TO CROSS-MOTION 3

EXHIBITS

In this No-Fault action, Plaintiff medical provider seeks reimbursement for seven bills which cover a period of medical services provided from October 2, 2018 through January 24, 2019. Defendant acknowledges timely receipt of Plaintiff’s seven bills and now moves for summary judgment on its outstanding verification request defense. Plaintiff cross moves for summary judgment pursuant to CPLR 3212 and to dismiss Defendant’s affirmative defenses pursuant to CPLR 3211(b).

“The proponent of a summary judgment motion must make a prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to eliminate any material issues of fact from the case” (Winegrad v. New York Univ. Med. Ctr., 64 NY2d 851, 853 [1985]). “The failure to make such prima facie showing requires a denial of the motion, regardless of the sufficiency of the opposing papers” (id.). In order to prevail on a motion based on an outstanding additional verification request defense, the movant must establish that the plaintiff failed to comply with its additional verification requests (Compas Medical, P.C. v. New [*2]York Cent. Mut. Fire Ins. Co., 50 Misc 3d 146[A] [App Term, 2d Dept., 11th & 13th Jud. Dists. 2016]; Compas Med., P.C. v Farm Family Cas. Ins. Co., 38 Misc 3d 142[A] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists. 2013]; TAM Medical Supply Corp. v. Tri State Consumers Ins. Co., 57 Misc 3d 133[A] [App Term, 2d Dept., 2d, 11th & 13th Jud. Dists. 2017]).

As an initial matter, the court finds that Defendant established timely mailing of its verification requests pursuant to 11 NYCRR 65-3.5(b) for each of the seven bills at issue through the affidavit of claims specialist Timothy Dacey. However, the proper denial of the bills remains an issue of fact as Defendant failed to establish its outstanding verification request defense.

Defendant mailed post-EUO requests for additional verification to Plaintiff on December 4, 2018, January 18, 2019, February 7, 2019 and March 5, 2019 wherein it requested the following documents:

1. Burke’s federal and state tax returns for 2017 to the present, including any W-2s, 1099’s, and quarterly payroll tax returns.

2. Burke’s bank records for the period December 1, 2017 to the present, including any statements, deposits slips and cancelled checks.

3. Burke’s general ledgers for the period December 1, 2017 to the present, or such other documents as reflect its financial condition, payments made and payments received.

4. Any documents relating to or reflecting any agreement, contract, lease, deal, arrangement or understanding with any person or entity providing management, billing, collection, consulting, or administrative services to Burke during the period December 1, 2017 to the present, including Expert Billing Solutions and Streamline Services.

5. Any documents relating to or reflecting any payment to or received from any person or entity providing management, billing, collection, consulting, or administrative services to Burke during the period December 1, 2017 to the present, including Expert Billing Solutions and Streamline Services.

6. All contracts, leases, subleases and agreements concerning Burke’s operations at 941 Burke Avenue, Bronx, New York, including the written agreement with Seo Han Medical, P.C.

7. All contracts, leases, subleases and agreements concerning Burke’s operations at 764 Elmont Road, Elmont, New York, including the written agreement with Starmed Group, Inc.

8. All contracts, leases, subleases and agreements concerning Burke’s operations at 2625 Atlantic Avenue, Brooklyn, New York, including the written agreement with 2625 Group, Inc.

9. All contracts, leases, subleases and agreements concerning Burke’s operations at 152-180 Rockaway Boulevard, Jamaica, New York.

10. All contracts, leases, subleases and agreements concerning Burke’s operations at 80-12 Jamaica Avenue, Woodhaven, New York, including the written with 19413 Northern Boulevard, Inc.

11. All contracts, leases, subleases and agreements concerning Burke’s operations 424 East 147th Street, Bronx, New York, including the written agreement with 19413 Northern Boulevard, Inc.

12. All contracts, leases, subleases and agreements concerning Burke’s operations at 5037 Broadway, New York, New York, including the written agreement with 19413 Northern Boulevard, Inc.

13. All contracts, leases, subleases and agreements concerning Burke’s operations at 2510 Westchester Avenue, Bronx, New York, including the written agreement with 19413 Northern Boulevard, Inc.

14. All contracts, leases, subleases and agreements concerning Burke’s operations 90-04 Merrick Road, Merrick, New York, including any written agreement with Life Health Care Medical, P.C.

15. All contracts, leases, subleases and agreements concerning Burke’s operations at 2025 Davidson Avenue, Bronx, New York, including any written agreement with Seasoned Chiropractic P.C.

16. All contracts, leases, subleases and agreements concerning Burke’s operations at 550 Remsen Avenue, Brooklyn, New York.

17. All contracts, leases, subleases and agreements concerning Burke’s operations at 1122A Coney Island Avenue, Brooklyn, New York, including the written agreement with Marina Gadaborshev/MG Chiropractic, P.C.^[FN1]

Defendant states that it properly denied all seven bills due to Plaintiff’s failure to provide the requested documentation within 120 days or “written proof providing a reasonable justification for the failure to comply” (Defendant 1, ¶17). However, in the following paragraph, Defendant acknowledges receipt of Plaintiff’s written responses, by letters dated February 26, 2019 and April 16, 2019. Defendant attaches these letters and two of State Farms’ response letters dated March 11, 2019 and April 24, 2019 as an exhibit to its motion papers (Def. 1, exh. 4).

In Plaintiff’s four-page letter dated February 26, 2019, Plaintiff objects to Defendant’s verification request on both procedural and substantive grounds, citing case law and the No-Fault statutes in support of its arguments. The letter further demonstrates that Plaintiff provided similar written objections in previous correspondences along with specific responses to each of the items on Defendant’s list:

“State Farm has now received from Burke Physical all documents in its possession that are responsive to State Farm’s verification requests. As noted in previous correspondences with regards to State Farm’s unduly burdensome, improper and illegal request for additional documents/information listed in paragraphs 1-17 on page 4-5 of your Letter, it should be stated again for the record that the carrier has already been provided with the items in paragraphs 4, 5, 6, 7, 8, 10, 11, 12, 13 and 17 during the EUO. Meanwhile, the items in paragraphs 9, 14, 15 and 16 cannot be provided due to their verbal/oral nature. As for items in paragraphs 1, 2 and 3, they are improper to be requested by the carrier in the first place for the reasons supra.”

In cases where a medical provider sent a similar response to a verification request, courts have denied an insurer summary judgment based on an outstanding verification request defense. In Mount Sinai Hosp. v. Auto One Ins. Co., the Second Department found that the defendant insurer failed to demonstrate its prima facie entitlement to summary judgment as the record [*3]revealed that the medical provider hospital replied to the verification requests with respect to the records in its possession that it was authorized to release. However, the court did find triable issues of fact regarding the “propriety” of the defendant’s verification requests and whether the documents requested existed or were in the possession of the hospital (Mount Sinai Hosp. v. Auto One Ins. Co., 121 AD3d 869 [2d Dept. 2014]; Pro-Align Chiropractic, P.C. v. Travelers Property Casualty Ins. Co., 58 Misc 3d 857 [Dist Ct, Suffolk County 2017]).

Further, the No-Fault rules do not require a medical provider to provide each and every document requested by the insurer. New York Insurance Law Section 65-3.5(o) states that the applicant must provide “all such verification under the applicant’s control or possession or written proof providing reasonable justification for the failure to comply.” (11 NYCRR 65-3.5[o] [emphasis added]). Just as Defendant asserts its right to request all information necessary to verify a claim, Plaintiff’s right to object to such requests is codified in the no fault statute as noted in each of Defendant’s verification request letters:

“Please be advised that pursuant to 11 NYCRR 65-3.5(o), State Farm may deny the claim if Burke Physical Therapy does not provide within 120 calendar days from the date of this initial verification request all of the documents identified above under Burke Physical Therapy control or possession or written proof providing reasonable justification for the failure to comply” [emphasis added].

This principle is affirmed by the caselaw Defendant directly quotes in its opposition affirmation: “If a plaintiff deems a verification request to be defective and or unreasonable, it is incumbent on that plaintiff to convey that information to the defendant and to state the reasons thereof, thereby giving the defendant the opportunity to respond accordingly” (Canarsie Chiropractic P.C. a/a/o Day v. Adirondack Mut. Auto. Ins., 27 Misc 3d 1228[A] [Civ. Ct. Kings Cty., 2010]).

Here, Plaintiff objected to Defendant’s requests with strong and detailed arguments in its February 26, 2019 and April 16, 2019 letters. In its response letters dated March 11, 2019 and April 24, 2019, Defendant argued that its requests were proper and repeated its demand for all seventeen items listed in its original request, including those items which Plaintiff stated did not exist. In the instant motion, Defendant disregards these correspondences and either denies Plaintiff’s response altogether or characterizes Plaintiff’s response as a “generic refusal to provide any of the requested verification” (Def. 3, ¶16). Defendant also fails to properly address the arguments and issues raised in Plaintiff’s objection letters. Rather, Defendant argues that Plaintiff is barred from objecting to the propriety of the requests because of its failure to respond. This argument is without merit under the circumstances and wholly inconsistent with the documents provided in Defendant’s motion papers. Further, the objection letters raise an issue of fact regarding Plaintiff’s compliance with 11 NYCRR 65-3.5(o). Based on the foregoing, Defendant failed to meet its summary judgment burden on its outstanding verification defense.

The timely mailing of Plaintiff’s bills is established as Defendant acknowledged timely receipt of those bills. However, in its cross motion, Plaintiff failed to establish its full compliance with Defendant’s verification requests or that the requests themselves were improper. It is well settled that summary judgment is appropriate when sufficient evidence in admissible form is presented to demonstrate the absence of any material issues of fact (Alvarez v. Prospect Hosp., 68 NY2d 320 [1986]; Zuckerman v. City of New York, 49 NY2d 557 [1980]). In support of its cross-motion, Plaintiff attaches the December 8, 2020 affidavit of John Nasrinpay, wherein he avers the following: “I personally responded and mailed on 01/18/2019, 03/07/2019, [*4]04/05/2019 and 05/07/2019 the verification response in issue in this case to the address designated by defendant on the verification requests, to the extent that such response was proper and in my possession.” The affiant provides no further details as to which documents constituted the “verification response in issue” that were “proper” and in his “possession.” Further, while the affidavit refers to the responses provided, there is no admissible documentation to that effect as Plaintiff fails to attach copies of the allegedly mailed responses to its motion. The arguments within Plaintiff’s motion objecting to the propriety of Defendant’s verification requests are equally vague and conclusory. Accordingly, Plaintiff’s request for summary judgment is denied.

Likewise, Plaintiff failed to provide the court with any legal or factual grounds to dismiss Defendant’s affirmative defenses. To prevail on a motion to dismiss an affirmative defense pursuant to CPLR 3211(b), ” the plaintiff bears the burden of demonstrating that the affirmative defense is ‘without merit as a matter of law'” (Bank of New York v. Penalver, 125 AD3d 796, 797 [2d Dept. 2015] quoting Vita v. New York Waste Servs., LLC, 34 AD3d 559, 559 [2d Dept. 2006]). Plaintiff cites no legal authority and provides no substantive or even intelligible argument to support dismissal of Defendant’s affirmative defenses. The bulk of Plaintiff’s arguments against Defendant’s verification requests are conclusory, vague and repetitive. They are also intertwined with Plaintiff’s arguments against Defendant’s discovery demands, a matter which Plaintiff improperly raises in its motion. Further, as both Plaintiff’s arguments and supporting papers fail to establish, in evidentiary form, Plaintiff’s allegations of having mailed verification in compliance with Defendant’s request, this court will not hear Plaintiff’s objections regarding the substance of those requests (see Westchester County Med. Ctr. v. New York Cent. Mut. Fire Ins. Co., 262 AD2d 553 [2d Dept. 1999]; Compas Medical, P.C. v. New York Cent. Mut. Fire Ins. Co., 50 Misc 3d 146[A]).

Further, Defendant’s fraudulent incorporation defense is a non-precludable affirmative defense (State Farm Mut. Auto. Ins. Co. v. Mallela, 4 NY3d 313 [2005]; 11 NYCRR 65-3.16[a]). An insurance carrier may, at any time, assert a non-precludable “Mallela defense” and deny payment based on the medical provider’s fraudulent incorporation (Matter of Acuhealth Acupuncture, P.C. v. Country-Wide Ins. Co., 149 AD3d 828 [2d Dept. 2017]; Lexington Acupuncture, P.C. v. General Assur. Co., 35 Misc 3d 42, 44, [App. Term, 2d, 11th & 13th Jud. Dists 2012]). “Inasmuch as the defense of ‘fraudulent incorporation’ is not subject to the preclusion rule, the defendant may raise this defense in its answer, even if not asserted in the claim denial” (Island Chiropractic Testing, P.C. v Nationwide Ins. Co., 35 Misc 3d 1235[A] [Dist Ct, Suffolk County 2012]). Accordingly, Plaintiff failed to establish that dismissal of any of Defendant’s affirmative defenses, including its outstanding verification defense, is warranted under CPLR 3211 (b).

Finally, in its opposition, Plaintiff objects to the discovery demands served with Defendant’s Answer. However, as noted above, the matter is not properly before the court as Plaintiff does not move for relief based on the discovery demands. Plaintiff states, “Defendant has failed to demonstrate its entitlement to the discovery demanded in these matters. In light of that fact, Defendant cannot possibly be entitled to an Order compelling responses to improper discovery demands.” Yet, Defendant has not moved to compel discovery demands.

Based on the foregoing, Defendant’s motion for summary judgment is granted solely to the extent that it established timely mailing of its verification requests. Plaintiff’s cross-motion for summary judgment is granted to the extent that timely receipt of the bills has also been [*5]established. The remainder of Plaintiff’s cross-motion is denied. Defendant’s outstanding verification defense remains an issue of fact for trial.

This constitutes the decision and order of this court.

ENTER.

June 30, 2021

Brooklyn, NY

Hon. Consuelo Mallafre Melendez

Judge, Civil Court

Footnotes

Footnote 1:In its letter dated February 26, 2019, intra, Plaintiff claims that items 4, 5, 6, 7, 8, 10, 11, 12, 13 and 17 were provided during the EUO and items 9, 14, 15 and 16 could not be provided due to their verbal nature. Plaintiff objected to the propriety of Defendant’s request for items 1, 2 and 3.

Index No. CV-716670-16/KI

Attorney for Plaintiff:
Oleg Rybak, Esq.
The Rybak Firm, PLLC
1810 Voorhies Avenue, 3rd Floor, Suite 7
Brooklyn, New York 11235

This action seeks to recover first-party no-fault benefits, assigned by Souleyman Diallo, for services rendered. Plaintiff moves to amend to add a new party, Knightbrook Insurance Company, to the action pursuant to CPLR 305(c), CPLR 2001, and CPLR 3025(b), and to remove Grange Mutual Casualty Ins. Co. as a defendant under claim number 14982012. Plaintiff claims that in reviewing the Summons and Complaint it noticed there was a clerical error, in that the name of the defendant was not properly printed. Plaintiff thus seeks leave to re-serve the Amended Summons and Complaint upon Knightbrook Ins. Co. No opposition papers to this motion were submitted by the defendant, Grange Mutual Casualty Ins. Co.

After oral argument, the Decision/Order on plaintiff’s Motion to Amend is as follows:

The accident giving rise to this case occurred on May 5, 2012. Claims were allegedly submitted [*2]to the carrier on December 20, 2013. According to the court files and the plaintiff’s motion, no answer was filed in response to the Summons and Complaint dated May 6, 2016, and filed May 9, 2016. The six-year statute of limitations applies to first-party no-fault claims which begins to run from the date the cause of action accrues, not from the date of the insurer’s belated denial of claim form (DJS Med. Supplies, Inc. v. Clarendon Natl Ins. Co., 32 Misc 3d 129(a) (App Term 2d, 11th & 13th Judicial Dists, 2011)). An amendment to add a party at this juncture falls clearly outside of the statute of limitations.

Plaintiff’s counsel argues Knightbrook Ins. Co. will not suffer any prejudice should the court grant leave to amend. It will merely be called to defend against current claim amounts that remain unpaid and are overdue (Plaintiff Affirmation, Paragraph 10). Plaintiff’s counsel maintains that failure to permit an amendment of the Summons and Complaint would result in additional time, effort, and costs, to all parties, as well as unnecessary waste of judicial resources, as plaintiff would be forced to discontinue the instant action and commence a second lawsuit (id.). Plaintiff’s counsel further asserts, in the discontinuance of this action, there would be no prejudice to Grange Mutual Ins. Co., because no orders have been issued by the Court nor have the parties engaged in substantial litigation (Plaintiff Affirmation, Paragraphs 11, 16). Finally, plaintiff claims this application is not an attempt to circumvent an adverse ruling or otherwise derive underhanded advantage through discontinuing the action against Grange (Plaintiff Affirmation, Paragraph 16).

Relief pursuant to CPLR 305 (c) may be granted only where there is evidence that the correct defendant was served, albeit misnamed, in the original process, and that the correct defendant would not be prejudiced by the granting of the amendment (Nossov v. Hunter Mountain, 185 AD3d 948-949 (2nd Dept, 2020). Though “CPLR 305 (c) may be used to cure a misnomer in the description of a party defendant, it cannot be used after the expiration of the statute of limitations as a device to add or substitute an entirely new defendant who was not properly served” (Tokhmakhova v. H.S. Bros. II Corp., 132 AD3d 662, 662 (2nd Dept. 2015); Smith v. Garo Enters., Inc., 60 AD3d 751,752 (2d Dept. 2009); see also Nossov v Hunter Mountain, 185 AD3d 948, 949 (2nd Dept. 2020). Under CPLR 305 (c), “an amendment to correct a misnomer will be permitted ‘if the court has acquired jurisdiction over the intended but misnamed defendant provided that … the intended but misnamed defendant was fairly apprised that [it] was the party the action was intended to affect … [and] would not be prejudiced’ by allowing the amendment” (Honeyman v. Curiosity Works, Inc., 120 A.D3d 1302, (2d Dept. 2014) [internal citations omitted]).

CPLR 2001 allows a party to correct mistakes, omissions, defects, or irregularities, at any stage of an action. Courts freely grant leave to amend a pleading under CPLR 3025 (b), unless the opposing party can show that the delay causes prejudice or surprise (O’Halloran v. Metropolitan Transp. Auth., 154 AD3d 83, 86 (1st Dept 2017)). If the statute of limitations has expired, a plaintiff may add a claim if it relates back to the incident alleged in the complaint (id.). However, “allowing the relation back of amendments adding new defendants implicates more seriously due process policy concerns than simply the relation back of new causes of action since, in the latter situation, the defendant is already before the court” (Buran v. Coupal, 87 NY2d 173, 178 [1995]).

Here, there is no indication Grange was served with the original summons and complaint or that Knightbrook Ins. Co. was served with the current motion or any other documents related to this incident. To bring a claim for no-fault benefits, statutory prerequisites must be met. The [*3]plaintiff must show claim forms were timely and properly sent to the carrier and that those claims were not paid or properly denied within the statutory period. In the proposed amended pleading, plaintiff merely switches the names of the party and retains the same claim number with the same allegations of timely mailing, albeit to a different address. Plaintiff fails to demonstrate notice to, nor that the statutory prerequisites have been met with the new party. By now moving to add a new party, the plaintiff is requesting this court extend the statute of limitations and resurrect a claim that is otherwise time barred.

According to CPLR 203 (f), “[a] claim asserted in an amended pleading is deemed to have been interposed at the time the claims in the original pleading were interposed, unless the original pleading does not give notice of the transactions, occurrences, or series of transactions or occurrences, to be proved pursuant to the amended pleading.” The relation-back doctrine “enables a plaintiff to correct a pleading error—by adding either a new claim or a new party—after the statutory limitations period has expired,” and gives courts the “sound judicial discretion to identify cases that justify relaxation of limitations strictures … to facilitate decisions on the merits if the correction will not cause undue prejudice to the plaintiff’s adversary” (Buran v. Coupal, 87 NY2d 173, 177-178, [citation and internal quotation marks omitted]; see O’Halloran v. Metropolitan Transp. Auth., 154 AD3d 83, 86); Catnap, LLC v. Cammeby’s Mgmt. Co., LLC, 170 AD3d 1103, 1106 (2019)).

A court could entertain the amendment of the pleading if plaintiff shows that (1) the claims arise out of the same occurrence, (2) the proposed new defendant is “united in interest” with the original defendant and, due to this relationship, the proposed new party is chargeable with notice of the of the action such that there is no prejudice, and (3) the proposed new defendant, Knightbrook Ins. Co., “knew or should have known that, but for an excusable mistake by plaintiff as to the identity of the proper parties, the action would have been brought against him as well.” (id. [internal quotation marks and citation omitted]; see CPLR 203 [c]).

In arguing there would be no prejudice to Grange Mutual, the plaintiff misdirects the focus of the prejudice analysis. The dictates of due process require the court to consider prejudice to the new defendant, Knightbrook, where a belated amendment is requested. Additionally, where, as here, the statute of limitations has expired, plaintiff has the burden of showing that the relation-back doctrine applies (Garcia v. New York-Presbyt. Hosp., 114 AD3d 615, 615 [1st Dept 2014]). Plaintiff has not offered any arguments to satisfy this three-part test for the application of the relation-back doctrine. Finally, “[t]he moving party … has the added burden of establishing that diligent efforts were made to ascertain the unknown party’s identity prior to the expiration of the statute of limitations” (Bumpus v. New York City Tr. Auth., 66 AD3d 26, 35 [2d Dept 2009]). In this case, plaintiff has not provided the court with a factual basis to engage in an analysis and has failed to meet its burden. Given these failures, the court does not reach the question of prejudice to the new party.

Accordingly, the Motion to Amend is denied. This constitutes the decision and order of the court.

CV-723175-16/KI

Plaintiff’s Firm
Richard Rozhik
The Rybak Firm, PLLC
1810 Voorhies Avenue, Suite 7
Brooklyn, New York 11235
Telephone: (718) 975 – 2035
Facsimile: (718) 975 – 2037
rrozhik@rybakfirm.com

Defendant’s Firm:
Christin M. Brown
Attorney at Law
Wilson Elser Moskowitz Edelman & Dicker LLP
1133 Westchester Avenue
White Plains, NY 10604 914.872.7158 (Direct)
914.323.7000 (Main)
914.323.7001 (Fax)
christin.brown@wilsonelser.com

Recitation, as required by Civil Procedure Law and Rules (CPLR) §2219(a), of the papers considered on the review of these Motions for Summary Judgment and Cross-Motions for Summary Judgment.

Papers submitted for each above listed case and corresponding Index number: Numbered: ^[FN1]

1. CV-723175-16/KI

Plaintiff NYS Acupuncture, P.C., a/a/o Patrick Howard Notice of Motion, Affirmation and Annexed Exhibits BCYXMB

Defendant’s Cross-Motion and Annexed Exhibits 3ETAHL

2. CV-723178-16/KI

Plaintiff NYS Acupuncture, P.C., a/a/o Miguel Quinn Notice of Motion, Affirmation and Annexed Exhibits VEZUPK

Defendant’s Cross-Motion and Annexed Exhibits 9L2X9X

3. CV-723183-16/KI

Plaintiff Elmont Rehab, P.T., P.C., a/a/o Karen Cutler Notice of Motion, Affirmation and Annexed Exhibits SMQGV7

Defendant’s Cross-Motion and Annexed Exhibits X9J24W

4. CV-723185-16/KI

Plaintiff NYS Acupuncture, P.C., a/a/o Karen Cutler Notice of Motion, Affirmation and Annexed Exhibits HLHQKX

Defendant’s Cross-Motion and Annexed Exhibits HLCISL

5. CV-723177-16/KI

Plaintiff Elmont Rehab, P.T., P.C., a/a/o Miguel Quinn Notice of Motion, Affirmation and Annexed Exhibits EG9PNE

Defendant’s Cross-Motion and Annexed Exhibits JMEEDJ

6. CV-723180-16/KI

Plaintiff Uzma Nasir Physician, P.C., a/a/o Miguel Quinn Notice of Motion, Affirmation and Annexed Exhibits S9SATO

Defendant’s Cross-Motion and Annexed Exhibits 4MT2ST

7. CV-707439-17/KI

Plaintiff Solution Bridge, Inc., a/a/o Jennifer Schaum Notice of Motion, Affirmation and Annexed Exhibits L1TAWA

Defendant’s Cross-Motion and Annexed Exhibits 3C3RI6

8. CV-704429-18/KI

Plaintiff Metro Pain Specialist, P.C., a/a/o Eileen Kilbane Notice of Motion, Affirmation and Annexed Exhibits SV5FHT

Defendant’s Cross-Motion and Annexed Exhibits GCMFWC

9. CV-706460-19/KI

Plaintiff Gentlecare Ambulatory Anesthesia Services; Lyonel F. Paul, M.D., a/a/o Maglorie Bueno Notice of Motion, Affirmation and Annexed Exhibits P59UM6

Defendant’s Cross-Motion and Annexed Exhibits FSJMGT

10. CV-707274-19/KI

Plaintiff Right Aid Medical Supply Corp., a/a/o Enrique Alexander Notice of Motion, Affirmation and Annexed Exhibits TB0A9I

Defendant’s Cross-Motion and Annexed Exhibits LQADFZ

Upon the foregoing cited papers, the Decision and Order on these motions is as follows:

The New York State Insurance Fund (NYSIF/the Fund/Defendant), appearing by its attorney in these breach of contract no-fault proceedings, moves this Court pursuant to CPLR §§2221 and 5015(a) for an Order (a) vacating each default judgment entered against the Defendant in each of the above referenced matters; (b) dismissing each Complaint because this Court lacks subject matter jurisdiction; (c) dismissing each Complaint because Plaintiffs failed to state a claim upon which relief can be granted; (d) imposing sanctions against Plaintiffs’ counsel pursuant to CPLR §8303 and 22 NYCRR §130-1.1(c) for commencing frivolous actions; and (e) for any further relief that seems just, proper and equitable to the Court. Plaintiffs, appearing by their attorney, oppose Defendant’s motions to dismiss the complaints, claiming that this Court does have subject matter jurisdiction over Defendant. Plaintiffs also oppose vacatur of the default judgements on the grounds that Defendant failed to raise a reasonable excuse for defaulting, and they further oppose Defendant’s motions on the grounds that they are fatally defective pursuant to CPLR §2214(c) because Defendant failed to serve the motion with exhibits referenced in the attorney’s affirmations. Finally, Plaintiffs assert that their filings of the summons, complaints and motions for summary judgment were made in good faith and that this Court should not impose sanctions.

For the reasons discussed below, Defendant’s Motions to Vacate the Default Judgment and to Dismiss each of the above-captioned ten (10) actions are GRANTED WITHOUT PREJUDICE in case any of the Plaintiffs decide to seek relief in the Court of Claims. Defendant’s application for sanctions against Plaintiffs’ counsel is DENIED. Finally, Plaintiffs’ [*2]and their counsel are enjoined from commencing any future similar actions or proceedings seeking relief from this Defendant in Kings County Civil Court without a determination from the Appellate Term, that it is appropriate for Plaintiffs to do so.^[FN2]

Procedural History for Index Nos. CV-723175-16/KI; CV-723178-16/KI; CV-723183-16/KI; CV-723185-16/KI

#1 — Plaintiff NYS Acupuncture, P.C., (CV-723175-16/KI)

Plaintiff claims that Assignor Patrick Howard was allegedly involved in a motor vehicle accident on or about February 1, 2011, that Defendant was timely notified of Assignor Howard’s accident and injuries and was subsequently assigned a claim number by Defendant.^[FN3] On or about June 27, 2016, Plaintiff filed a Summons and Complaint with the Kings County Civil Court seeking judgment against Defendant for breach of contract based on its alleged failure to either timely pay or deny payment for services rendered to Assignor Howard, as well as statutory interest and attorney’s fees, and served it on Defendant on or about July 6, 2016.^[FN4] On or about October 3, 2016, Defendant served and filed its answer which listed affirmative defenses, including but not limited to that the Civil Court “lacked subject matter jurisdiction to the extent that plaintiff is seeking monetary relief against the STATE INSURANCE FUND, a New York State agency [and that] [r]elief must be sought in the Court of Claims.”^[FN5] On or about October 11, 2016, Kings County Chief Clerk entered a default judgment against Defendant.^[FN6]

#2 — Plaintiff NYS Acupuncture, P.C., (CV-723178-16/KI)

Plaintiff claims that Assignor Miguel Quinn was allegedly in a motor vehicle accident occurring on or about February 12, 2012, that Defendant was timely notified of Quinn’s accident and injuries and was subsequently assigned a claim number by Defendant.^[FN7] On or about June 27, 2016, Plaintiff filed a Summons and Complaint with the Kings County Civil Court seeking judgment against Defendant for breach of contract based on its alleged failure to either timely pay or deny payment for services rendered to Assignor Quinn, as well as statutory interest and attorney’s fees, and served it on Defendant on or about July 6, 2016.^[FN8] On or about October 3, 2016, Defendant served and filed its answer which listed affirmative defenses, including but not limited to that Plaintiff failed to properly serve Defendant, and the Civil Court lacked subject matter jurisdiction as the relief sought against NYSIF, a state agency, must be sought in the Court of Claims.^[FN9] On or about October 11, 2016 a default judgment was entered against the Defendant.^[FN10]

#3 — Plaintiff Elmont Rehab, P.T., P.C. (CV-723183-16/KI)

Plaintiff claims that Assignor Karen Cutler was allegedly in a motor vehicle accident occurring on or about January 26, 2011, that Defendant was timely notified of Cutler’s accident and injuries and was subsequently assigned a claim number by Defendant.^[FN11] On or about June 27, 2016, Plaintiff filed a Summons and Complaint with the Kings County Civil Court seeking judgment against Defendant for breach of contract based on its alleged failure to either timely pay or deny payment for services rendered to Assignor Cutler, as well as statutory interest and attorney’s fees, and served it on Defendant on or about July 6, 2016.^[FN12] In its Answer, Defendant listed affirmative defenses, including but not limited to that Plaintiff failed to properly serve the Defendant and that the Civil Court lacked subject matter jurisdiction as the relief sought against NYSIF, a state agency, must be sought in the Court of Claims.^[FN13] On or about October 11, 2016 a default judgment was entered against the Defendant.^[FN14]

[*3]#4 — Plaintiff NYS Acupuncture, P.C., (CV-723185-16/KI)

Plaintiff claims that Assignor Karen Cutler was allegedly in a motor vehicle accident occurring on or about January 26, 2011, that Defendant was timely notified of Cutler’s accident and injuries and was subsequently assigned a claim number by Defendant.^[FN15] On or about June 27, 2016, Plaintiff filed a Summons and Complaint with the Kings County Civil Court seeking judgment against Defendant for breach of contract based on its alleged failure to either timely pay or deny payment for services rendered to Assignor Cutler, as well as statutory interest and attorney’s fees, and served it on Defendant on or about July 6, 2016.^[FN16] On or about October 3, 2016, Defendant served and filed its answer which listed affirmative defenses, including but not limited to improper service of the summons and complaint in violation of CPLR § 307, and that the Civil Court lacked subject matter jurisdiction because Defendant was a state agency and, as such, monetary relief had to be pursued in the Court of Claims.^[FN17] On or about October 11, 2016, a default judgment was entered against the Defendant.^[FN18]

On or about March 15, 2019, the Plaintiffs on the four cases summarized above filed and served motions seeking summary judgment pursuant to CPLR §§3211(c) or 3212(a) and dismissal of Defendant’s affirmative defenses pursuant to CPLR §3211(b). Defendant subsequently filed notices of cross-motion in each case for summary judgment seeking an order granting its cross-motions for summary judgment and dismissing the cases on multiple grounds, including but not limited to that the Civil Court lacked subject matter jurisdiction. Defendant also sought sanctions on Plaintiffs’ counsel, pursuant to CPLR §8303 and 22 NYCRR §130-1.1(c) for commencing frivolous actions.

After a series of adjournments, on January 5, 2021, these four cases (index numbers CV-723175-16, CV-723178-16, CV-723183-16 and CV-723185-16) were called and argued from the Parts 40 and 41 Special 1 calendars in Kings County Civil Court. The same counsel represented Plaintiffs NYS Acupuncture, P.C. and Elmont Rehab, P.T., P.C. and Defendant had the same counsel in all four cases. This Court denied Plaintiffs’ motions for summary judgment. This Court further stated that it was inclined to grant Defendant’s cross-motion to dismiss the actions on the grounds that the Court lacked subject matter jurisdiction, and that it would be drafting its Decision and Order on the summary judgment and sanctions issues.

On or about January 25, 2021, via email to chambers, Plaintiffs’ counsel suggested instead that one of the four cases be decided on the merits instead of being dismissed for lack of subject matter jurisdiction, and the remaining three cases be stayed pending an appeal to and a decision from the Appellate Term. Defendant’s counsel objected to that, reiterating that the cases had to be dismissed because this Court did not have jurisdiction. Further, Defendant again [*4]urged that the Court impose sanctions against Plaintiffs’ counsel for continuing to commence actions against Defendant in the Civil Court despite Plaintiffs’ counsel’s knowledge of prior decisions holding consistently that only the Court of Claims had jurisdiction of the type of cases being litigated before this Court.

While drafting its Decision and Order, this Court found that the New York State Unified Court System Universal Case Management System (UCMS) listed all four cases as having had default judgments entered in favor of the Plaintiffs on October 11, 2016. As a result, on April 6, 2021, during a status conference on the four cases, this Court informed counsel that in the course of its review of UCMS and the Unified Court System public online case-tracking e-Courts information service, it not only found that the four instant cases had default judgments filed, but this Court had found additional no-fault insurance cases filed against Defendant by Plaintiffs’ counsel.

This Court further informed counsel that it was still drafting a Decision and Order dismissing the four cases for lack of subject matter jurisdiction. In addition, this Court directed Defendant’s counsel to review its records to identify any other no-fault insurance cases filed by Plaintiffs’ counsel in Kings County Civil Court that resulted in default judgments issued against it. The Court established a motion and conference schedule for both sides to file the appropriate motions. In addition, this Court urged counsel to review all their cases that had been filed in Kings County Civil Court involving this Defendant where default judgments had not been filed and to seek possible resolutions on those cases for review and approval by this Court.

On April 19, 2021, Defendant’s counsel, after apparently identifying six additional no-fault cases in which default judgments had been issued against it stemming from filings in Kings County Civil by Plaintiffs’ counsel, filed Motions to Dismiss in the ten (10) instant captioned matters pursuant to the motion schedule maintaining that the Civil Court does not have jurisdiction to hear said matters and moved this Court to vacate the default judgments, dismiss the summons and complaint and to impose sanctions on Plaintiffs’ Counsel. On or about April 22, 2021, Plaintiffs’ Counsel opposed said Motions to Dismiss asserting that Defendant’s motions were defective and its defects prejudicial to Plaintiffs given Defendant’s failure to annex all the exhibits it referenced in its motion, which Plaintiffs assert is a fatal defect warranting denial of Defendant’s motion. Plaintiffs also assert that Defendant lacks a reasonable excuse to support vacating the default judgements entered against it and the Court should not vacate the same. Plaintiffs’ counsel did not seek to revive the Motions for Summary Judgment in these submissions for the first four cases heard by this Court, Index Numbers CV-723175-16, CV-723178-16, CV-723183-16 and CV-723185-16.

The six additional cases identified by Defendant’s counsel and subsequently the subject of the moving and opposing papers filed by the parties on or about April 19, 2021 and April 22, 2021, respectively, and addressed in this Decision and Order, along with the first four captioned in this Decision and Order,^[FN19] are summarized procedurally below:

[*5]Procedural History regarding Index Nos. CV-723177-16/KI; CV-723180-16/KI; CV-707439-17/KI; CV-704429-18/KI; CV-706460-19/KI; CV-707274-19/KI

#5 — Plaintiff Elmont Rehab, P.T., P.C. (CV-723177-16/KI)

Plaintiff claims that Assignor Miguel Quinn was allegedly in a motor vehicle accident occurring on or about February 12, 2011, that Defendant was timely notified of Quinn’s accident and injuries and was subsequently assigned a claim number by Defendant.^[FN20] On or about June 27, 2016, Plaintiff filed a Summons and Complaint with the Kings County Civil Court seeking judgment against Defendant for breach of contract based on its alleged failure to either timely pay or deny payment for services rendered to Assignor Quinn, as well as statutory interest and attorney’s fees.^[FN21] Defendant answered the complaint posing affirmative defenses,^[FN22] but on October 11, 2016 a default judgment was entered against the Defendant.^[FN23]

#6 — Plaintiff Uzma Nasir Physician, P.C. (CV-723180-16/KI)

Plaintiff claims that Assignor Miguel Quinn was allegedly in a motor vehicle accident occurring on or about February 1, 2011, that Defendant was timely notified of Quinn’s accident [*6]and injuries and was subsequently assigned a claim number by Defendant.^[FN24] As a result of Defendant’s alleged failure to either timely pay or deny payment for services rendered to Assignor Quinn, Plaintiff filed a Summons and Complaint in Kings Civil Court on or about July 6, 2016,^[FN25] seeking payment, statutory interest and attorney’s fees from Defendant.^[FN26] On October 11, 2016 a default judgement was entered against Defendant.^[FN27]

#7 — Plaintiff Solution Bridge, Inc. (CV-707439-17/KI)

Plaintiff claims that Assignor Jennifer Schaum was allegedly in a motor vehicle accident occurring on or about January 7, 2012, that Defendant was timely notified of Schaum’s accident and injuries and was subsequently assigned a claim number by Defendant.^[FN28] On or about March 8, 2017, Plaintiff filed a Summons and Complaint with the Kings County Civil Court seeking judgment against Defendant for breach of contract based on its alleged failure to either timely pay or deny payment for services rendered to Assignor Schaum, as well as statutory interest and attorney’s fees.^[FN29] In its Answer, Defendant listed affirmative defenses.^[FN30] On or about September 8, 2017, Plaintiff rejected Defendant’s Answer as untimely.^[FN31] On or about September 8, 2017 a default judgement was entered against Defendant.^[FN32] The April 19, 2021 Affidavit of Rosanne [*7]Nichols, an Associate Attorney for the Defendant, listed affirmative defenses, including that Plaintiff failed to properly serve the Defendant and filed its action in the wrong court, service against the Defendant was improper, and that since Defendant is a state agency, relief could only be sought in the New York State Court of Claims and thus the Civil Court lacked subject matter jurisdiction.^[FN33]

#8 — Plaintiff Metro Pain Specialist, P.C. (CV-704429-18/KI)

Plaintiff claims that Assignor Eileen Kilbane was allegedly in a motor vehicle accident occurring on or about July 7, 2016, that Defendant was timely notified of Kilbane’s accident and injuries and was subsequently assigned a claim number by Defendant.^[FN34] On or about January 30, 2018, Plaintiff filed a Summons and Complaint with the Kings County Civil Court seeking judgment against Defendant for breach of contract based on its alleged failure to either timely pay or deny payment for services rendered to Assignor Kilbane, as well as statutory interest and attorney’s fees.^[FN35] On or about November 14, 2018 a default judgment was entered against Defendant.^[FN36] The April 19, 2021 Affidavit of Rosanne Nichols, an Associate Attorney for the Defendant, listed affirmative defenses, including that Plaintiff failed to properly serve the Defendant, and that since Defendant is a state agency, relief could only be sought in the New York State Court of Claims and thus the Civil Court lacked subject matter jurisdiction.^[FN37]

#9 — Plaintiff Gentlecare Ambulatory Anesthesia Services; Lyonel F. Paul, MD (CV-706460-19/KI)

Plaintiff claims that Assignor Maglorie Bueno was allegedly in a motor vehicle accident occurring on or about September 11, 2012, that Defendant was timely notified of Bueno’s accident and injuries and was subsequently assigned a claim number by Defendant.^[FN38] On or about February 13, 2019, Plaintiff filed a Summons and Complaint in the Kings County Civil Court seeking judgment against Defendant for breach of contract based on its alleged failure to either timely pay or deny payment for services rendered to Assignor Bueno, as well as statutory [*8]interest and attorney’s fees.^[FN39] On or about April 13, 2019, Defendant listed affirmative defenses, including but not limited to that Plaintiff filed its action in the wrong court since Defendant, a state agency, could only be sued in the New York State Court of Claims and thus the Civil Court lacked subject matter jurisdiction.^[FN40] On or about May 29, 2019 Plaintiff rejected Defendant’s Answer as untimely.^[FN41] On or about June 26, 2019 a default judgment was entered against Defendant.^[FN42]

#10 — Plaintiff Right Aid Medical Supply Corp. (CV-707274-19/KI)

Plaintiff claims that Assignor Enrique Alexander was allegedly in a motor vehicle accident occurring on or about January 19, 2016, that Defendant was timely notified of Alexander’s accident and injuries and was subsequently assigned a claim number by Defendant.^[FN43] On or about February 20, 2019, Plaintiff filed a Summons and Complaint in the Kings County Civil Court seeking judgment against Defendant for breach of contract based on its alleged failure to either timely pay or deny payment for services rendered to Assignor Alexander, as well as statutory interest and attorney’s fees.^[FN44] In its Answer, Defendant listed affirmative defenses, including that service against the Defendant was improper and Plaintiff filed its action in the wrong court, i.e., since Defendant is a state agency, relief could only be sought in the New York State Court of Claims and thus the Civil Court lacked subject matter jurisdiction.^[FN45] On or about June 26, 2019 a default judgment was entered against Defendant.

Issues Presented:

The threshold and dispositive issue is whether this Court has subject matter jurisdiction to entertain the Plaintiffs’ actions against this Defendant. A secondary issue is whether Defendant’s request for sanctions against the Plaintiffs and/or their counsel should be granted.

Positions of the Parties:

The Defendant moves this Court to vacate the default judgements entered against it and [*9]to dismiss the attendant breach of contract matters against the Defendant because the Civil Court did not have subject matter jurisdiction to render the judgments. The Defendant points to Nash v. Port Authority of NY and N.J., 22 NY3d 220, 229 (2013) to support the axiom that “a judgment rendered without subject matter jurisdiction is void, and that the defect may be raised at any time and may not be waived.”^[FN46] Defendant cites additional cases supporting its argument that a court cannot assert jurisdiction over a matter in which it does not have subject matter jurisdiction. See, e.g., Defendant’s Affirmation under Index number CV-723175-16, paragraphs 19, 21 (citing, e.g., Gager v. White, 53 NY2d 475, 488 [1981] [“Unlike subject matter jurisdiction, which limits the power of a particular court rather than the judicial jurisdiction of the State en gros, a defect in basis jurisdiction is waivable.”]; Morrison v. Budget Rent a Car Sys., 230 AD3d 253, 258, 260 [2d Dept 1997] [“If, however, a court lacks subject matter jurisdiction, the parties may not confer it on the court…and it may not be conferred by laches or estoppel…. More importantly in the case before us, we recognize that that when a court lacks subject matter jurisdiction it may not acquire it by waiver.”]).

Defendant claims that it is a state agency ^[FN47] and that, as such, Article VI, Section 9 of the [*10]New York State Constitution, Court of Claims Act Section 9 proscribes that the Court of Claims has exclusive jurisdiction to hear and determine actions for money damages against it and accordingly the Civil Court does not have subject matter jurisdiction over the instant matters. See, e.g., Defendant’s Affirmation dated April 19, 2021, Index number CV-723175-16, at paragraphs 21, 25 (citing, e.g., D’Angelo v. State Ins. Fund, 48 AD3d 400 [2nd Dept 2008]; Comm’rs of the State Ins. Fund v. Photocircuits Corp., [20 AD3d at 176]).^[FN48]

Plaintiffs’ counter with CPLR §2214(c) to stress to this Court that Defendant’s motions are fatally defective and should not be considered. Plaintiffs’ counsel confirms that Defendant failed to serve all of the exhibits referenced in Defendant’s affidavits and said failure was prohibitive and prejudicial to the Plaintiffs’ ability to properly defend the motions.

Plaintiffs further cite numerous sections of the CPLR, the NYCRR, the No-Fault Insurance Law and Regulations as well as cases to support their proposition that a Defendant’s failure to raise a reasonable excuse for defaulting is reason enough to deny vacatur of the same. Plaintiffs point to Defendant’s untimely filing of its answers to support their position that the Court deny Defendant’s motion.^[FN49] Finally, Plaintiffs assert that Defendant’s failure to raise improper service as a defense ^[FN50] is a waiver of its defense of personal jurisdiction ^[FN51] and vacatur of [*11]the default judgment must be denied.^[FN52]

Plaintiffs also urge the Court to deny vacatur of the default judgments because Defendant’s assertion that it is a state agency is an inadequate defense to Plaintiffs’ position that Defendant is still fully subject to the jurisdiction of this Court.^[FN53] In support of its argument, Plaintiffs’ cite Commissioners of State Insurance Fund v. Low, 3 NY2d 590 (1958), Carney v. Newburgh Park, 84 AD2d 599 (3d Dept 1981), State Ins. Fund v. State, 212 AD2d 98 (4th Dept 1995), Royal Ins. Co. of Am. v. Comm’rs of State Ins. Fund, 289 AD2d 807 (3rd Dept 2001); Matter of Central NY Workers’ Compensation Bar Assn v. State of NY Workers’ Compensation Bd., 16 AD3d 1066 (3d Dept 2005), Matter of Progressive Cas. Ins. Co. v. New York State Ins. Fund, 47 AD3d 633 (2d Dept 2008) and Merchants Mut. Ins. Co. v. New York State Ins. Fund, 85 AD3d 1686 (4th Dept 2011).^[FN54]

Defendant seeks sanctions against Plaintiffs and their counsel as well as costs and reasonable attorneys’ fees, alleging that Plaintiffs, by their counsel, have engaged in frivolous conduct by continuing to file actions against it that are completely without merit in the law and which cannot be supported by a reasonable argument for an extension, modification or reversal of existing law, and that doing so is a “continued and deliberate waste of judicial resources.”^[FN55] Defendant cited three cases to support its motion for sanctions and/or the awarding of costs and legal fees.^[FN56]

Plaintiffs’ counsel maintains that he acted in good faith and that the Court must consider such good-faith to modify existing case law through “common law jurisprudence.”^[FN57] Plaintiffs rely on cases holding that unpersuasive legal arguments do not rise to the level of frivolity to [*12]require the imposition of sanctions.^[FN58]

Discussion:

The Issues of Subject Matter Jurisdiction and Vacatur of the Default Judgments

The New York State Constitution Article VI, Section 9, Court of Claims Act Section 9 states in relevant part, “The Court [of Claims] shall have jurisdiction:… 2. To hear and determine a claim of any person, corporation…against the state for the appropriation of any real or personal property…, for the breach of contract, express or implied….” While it is uncontroverted that New York State statutory and case law prove that Defendant NYSIF is a State agency within the Department of Labor,^[FN59] the federal courts have likewise reached that conclusion. See Lipofsky v. The State Insurance Fund, 86 F.3d 15 (2nd Cir.), cert. denied, 519 U.S. 971 (1996). In Lipofsky, the plaintiff claimant unsuccessfully challenged the federal district court’s finding that NYSIF was a state agency and thus was entitled to immunity from suit in federal court under the U.S. Const. amend. XI.^[FN60]

The status of NYSIF as a state agency is only being mentioned briefly as it is the predicate to the dispositive question of subject matter jurisdiction, the answer to which is that New York courts have consistently held that claims for money damages against NYSIF, whether based on an alleged breach of contract or couched as an action for a declaratory judgment, if the remedy sought is financial recovery, must be litigated in the Court of Claims. See, e.g., GuideOne Specialty Mut. Ins. Co. v. State Ins. Fund, 94 AD3d at 700-01 (claim denominated as one for a declaratory judgment was really for money damages and thus belonged in the Court of Claims); Twin City Fire Ins. Co. v. State Ins. Fund, 65 AD3d 945, 946 (1st Dept 2009) (claim disguised as one for declaratory relief was actually for money damages and thus belonged in the Court of Claims); D’Angelo v. State Ins. Fund, 48 AD3d at 402 (Supreme Court erred in granting Plaintiffs’ cross-motion to add breach of contract claim to recover damages as such a claim must be litigated against the Fund in the Court of Claims); Commissioners of State Ins. Fund v. M. [*13]Mathews & Sons Co., 131 AD2d 301 (counter-claim for actual and punitive damages for wrongful policy cancellation could only be heard in the Court of Claims); Miraglia v. State Ins. Fund, 32 Misc 2d at 473-474 (Article 78 proceeding to compel payment could only be heard in the Court of Claims); Ultimate Care Chiropractic, P.C. v. State Ins. Fund, Civ. Ct., Kings County, Index No. 716668/2016 (Dec. 10, 2018, Gerstein, J.) (Civil Court lacked jurisdiction over State Insurance Fund in no-fault benefit action).^[FN61]

Attempts to recover money damages from the Fund in courts other than the Court of Claims have resulted in dismissals. See, e.g., GuideOne Specialty Mut. Ins. Co. v. State Ins. Fund, 94 AD3d at 700 (claim for money damages against State Insurance Fund in State Supreme Court rather than Court of Claims mandated dismissal). Accordingly, since this Court does not have subject matter jurisdiction over the claims at issue, the Court does not have the power to impose the money judgment relief sought by Plaintiffs. Further, while a claimant may subsequently seek to file the action in the Court of Claims,^[FN62] that is not an automatic fallback option.^[FN63]

Plaintiffs also urge the Court to deny vacatur of the default judgment citing to Defendant’s failure to establish a meritorious defense that this Court lacks subject matter jurisdiction over these matters.^[FN64] To support its argument, Plaintiffs’ attorney relies on Commissioners of State Insurance Fund v. Low, 3 NY2d 590 (1958); Carney v. Newburgh Park, 84 AD2d 599 (3d Dept 1981); State Ins. Fund v. State, 212 AD2d 98; Royal Ins. Co. of Am. v. Comm’rs of State Ins. Fund, 289 AD2d 807; Matter of Central NY Workers’ Compensation Bar Assn v. State of NY Workers’ Compensation Bd., 16 AD3d 1066; Matter of Progressive Cas. Ins. Co. v. New York State Ins. Fund, 47 AD3d 633 (2d Dept 2008) and Merchants Mut. Ins. Co. v. New York State Ins. Fund, 85 AD3d 1686). The Plaintiffs’ reliance on these cases to support their suing this Defendant in this court for money damages is misplaced, factually and/or legally.

The primary issue in Commissioners of State Insurance Fund v. Low, 3 NY2d 590 (1958) was a question of collateral estoppel and res judicata. Low involved a state trooper who died after the state car he was riding in collided with a private passenger car and whose widow received Workers’ Compensation benefits via a policy issued to the State by the State Insurance Fund. Id. at 593. After Mr. Low, the operator of the other car, successfully sued New York [*14]State, not the State Insurance Fund, in the Court of Claims, alleging negligence by the operator of the state car, the Fund, which had not been a party in Low’s suit but was the statutory assignee of the deceased trooper for Workers’ Compensation purposes, subsequently sued Low for negligence in State Supreme Court. Id. at 593-594. The Supreme Court agreed with Low that the matter was res judicata and that the Fund was collaterally estopped from pursuing its action, but the Court of Appeals affirmed the Appellate Division’s reversal of the Supreme Court’s decision, noting that while the Fund was a state agency, for purposes of litigation, it was a separate entity and as it was not a party in Mr. Low’s prior suit and thus had no opportunity to litigate the matter, neither res judicata nor collateral estoppel applied. Id. at 595-96. Accordingly, this case does not support Plaintiffs’ position that their cases can, in fact, be adjudicated in Civil Court. While Low does say that for purposes of applying res judicata and collateral estoppel in litigation, the Fund can be treated as a separate entity from the State, it does not say that the Court of Claims Act does not apply to the Fund. At most, the Low case shows that the legislature may enact a specific statute, e.g., the Workers’ Compensation Law Section 81, to allow the Fund to sue or be sued in courts other than the Court of Claims. Id. at 594.

A subsequent Court of Appeals case to Low not cited by Plaintiffs’ counsel provides further clarification about circumstances upon which a particular court may have jurisdiction is Koerner v. State, 62 NY3d 442 (1984). Koerner concerned whether a Plaintiff must, when seeking monetary damages pursuant to New York’s Human Rights Law, pursue the action only in the Court of Claims. Id. at 444. In Koerner, an employee terminated from Pilgrim State Psychiatric Hospital Plaintiff filed suit in Supreme Court. Id. at 444-45. The Defendants, including among others, Pilgrim State Psychiatric as well as the State itself, moved successfully to dismiss the complaint on multiple grounds, including that the court was without subject matter jurisdiction. See 62 NY2d at 445, 448. The Court of Appeals reversed, opining that while “[f]or the most part, the State’s waiver of immunity as to actions for money damages is limited to actions commenced in the Court of Claims”, the Legislature, in statutory language permitting the State Division of Human Rights to award damages administratively without recourse to the Court of Claims, “must be deemed to have waived both the State’s immunity to suit and the requirement that it be sued in the Court of Claims.” See 62 NY2d at 448-49. Koerner confirms that, barring specific legislation to the contrary, e.g. Workers’ Compensation Law §81 or the Human Rights Law, money-damage actions against New York State and its agencies lay in the Court of Claims.

Low is also referenced in Commissioners of State Ins. Fund v. M. Mathews & Sons Co., 131 AD2d 301 (1st Dept 1987), where the Fund instituted an action in Supreme Court pursuant to Workers’ Compensation Law §93 to recover unpaid premiums on a cancelled insurance policy and respondent had counter-claimed for actual and punitive damages. Id. at 301. When the Fund moved to dismiss the counterclaim on the grounds that the Supreme Court lacked subject matter jurisdiction, that Court rejected the argument, citing Commissioners of State Insurance Fund v. Low. Id. The Appellate Division reversed and dismissed the counter-claim on the grounds that as the Fund was a State agency, it was cloaked with sovereign immunities, one of which was that it could not be sued for money damages in courts other than the Court of Claims. Id. (also citing Methodist Hosp. of Brooklyn v. State Ins. Fund, 64 NY2d 365, 375 [1985] [holding that a counterclaim against the Fund for actual and punitive damages for wrongful policy cancellation can be heard only in the Court of Claims). Akin to Koerner, the Appellate Division in Mathews interpreted Low as allowing the Fund to consider itself a separate entity [*15]from the State itself for the purposes of instituting litigation (and thus unbound from the doctrines of collateral estoppel and res judicata by judgments rendered only against the State), but that status did not strip the Fund of its immunity as a State agency, including the requirement that it be sued for money damages in the Court of Claims absent any statute to the contrary. See 131 AD2d at 301-02.

Plaintiffs also rely on Carney v. Newburgh Park, 84 AD2d 599 to support their claim that Civil Court has jurisdiction over their cases. However, the Court’s reading of M. Mathews and Carney proves that in the absence of legislation to the contrary, claims against the Fund for money damages must be heard in the Court of Claims. Carney involved an arbitration hearing before the Workers’ Compensation Board which the Fund lost. The Fund then appealed the arbitration decision to the Appellate Division. Id. at 600. Plaintiffs argue that the Fund is deemed like any other litigant and is not afforded special treatment that an instrumentality of the state would enjoy to divest the Court of Claims of jurisdiction over this issue.^[FN65] Carney is another reminder that Workers’ Compensation proceedings are statutorily bound to arbitration, unlike automotive insurance claims. Because Carney involved the Fund as the actual insurer for these Workers’ Compensation policies (as well as many others in New York, where the Fund actually competes on the market for business), the Fund occupies a different position than it does in auto insurance No-Fault proceedings.

Plaintiffs also rely on State Ins. Fund v. State, 212 AD2d 98, as a basis for his filings in this Court. But, like Carney, the facts and applicable law in State Ins. Fund v. State were different from the Plaintiffs’ no-fault auto insurance cases, and do not establish grounds for this Court to have jurisdiction herein. State Ins. Fund v. State involved a trucking company employee who was injured by a garbage truck owned and operated by New York State. Id. at 99. As the insurance carrier for the company’s Workers’ Compensation policy, the Fund paid benefits on the employee’s behalf. Id. The Fund then sought reimbursement from New York State, which had self-insured its garbage truck. Id. at 99-100. When the State’s authorized no-fault adjuster, Continental Loss Adjusting Services Inc., denied the Fund the full amount sought, the Fund filed for mandatory arbitration against the State under Workers’ Compensation Law §29 and Insurance Law §5105. Id. at 100. After the arbitrator held the Fund failed to show that the State was the proper party to the arbitration, the Fund filed a petition in State Supreme Court pursuant to CPLR §7511 seeking to vacate the arbitrator’s decision. Id. at 100. The Supreme Court dismissed the petition, agreeing with the State that the latter could only be sued in the Court of Claims. Id. The Fourth Department reversed the Supreme Court, holding that Insurance Law §5105 stated that the sole remedy to recover on this type of claim was to submit it to mandatory arbitration. Id. at 100-101. The Appellate Court noted that as the State had chosen to self-insure its own vehicles, for the purpose of auto accident claims involving the State, it stood in the same position as any other insurer under the No-Fault Law, making it [*16]subject to mandatory arbitration. Id. at 101-102. Thus, State Ins. Fund v. State does not mean that any or all no-fault insurance cases can be litigated against the Fund or the State outside the Court of Claims, but is permissible under certain facts and applicable laws such as when a no-fault claim arises from an accident with a state-owned, operated and self-insured vehicle. Id. at 100-102.

Plaintiffs’ reliance on Royal Ins. Co. of Am. v. Comm’rs of State Ins. Fund, 289 AD2d 807 is similarly misplaced. This Court finds that this case does not support the proposition that filings against the NYSIF for money judgments can lie in the Civil Court. The Royal case involved an appeal from an underlying Court of Claims decision and the issue of Court of Claims jurisdiction was not addressed by the Third Department in its decision here. Id. at 807.

Plaintiffs’ reliance on Matter of Central NY Workers’ Compensation Bar Assn v. State of NY Workers’ Compensation Bd., 16 AD3d 1066 in support of their position that this Court has jurisdiction on Plaintiffs’ claims against the Fund is likewise unavailing. In Matter of Central NY Workers’ Compensation Bar Assn, the Fund was not a party to the action. Rather, the Defendant in this Article 78 filing, which pursuant to CPLR §7804, is required to be brought in the State Supreme Court, was the Workers’ Compensation Board (“WCB”), which was accused of showing favoritism toward Fund attorneys by allowing them to have wireless internet access during WCB proceedings. Id. at 1066-67. Aside from the statutory requirement that an Article 78 proceeding must be filed in Supreme Court, thus implicitly undercutting the relevance of this case to the issue of this Court’s jurisdiction, no issue of Court of Claims was explicitly raised in Matter of Central NY Workers’ Compensation Bar Assn. The Third Department noted that in the context of its dealings with the WCB, the Fund “is merely one of the insurers appearing in proceedings” and to provide one litigant, the Fund, with internet access while denying it to the Fund’s adversaries was arbitrary and capricious and could not stand. Id. Further, it was implicit that the relief sought was equitable, not monetary, further distinguishing this case from counsel’s list of cases. Id. at 1067.

Plaintiffs’ reliance on Merchants Mut. Ins. Co. v. New York State Ins. Fund, 85 AD3d 1686 does not address this Court’s ability to exercise of jurisdiction over these cases. Merchants Mut. Ins. Co. centered on whether the Fund was required to pay-out on a Workers’ Compensation insurance policy issued by the Fund in its capacity as a competitive, private insurer (see 85 AD3d at 1686-1687). That Merchants Mut. applied Workers’ Compensation Law to a case in which the Fund had contracted to provide insurance distinguished the case from the instant Plaintiffs’ No-Fault actions. See M. Mathews, 131 AD2d at 301-302; Carney, 84 AD2d at 600. Accordingly, the issue of whether the Supreme Court had subject matter jurisdiction was not raised here.

Matter of Progressive Cas. Ins. Co. v. New York State Ins. Fund, 47 AD3d 633 (2d Dept 2008), also relied on by Plaintiffs, involved Insurance Law §5105. In this case, the Fund, after paying Workers’ Compensation to and on behalf of an individual who was injured while employed by a company insured by the Fund, won an arbitration hearing pursuant to the statute, and then the Plaintiff moved, via an Article 75 proceeding, to vacate the award. See 47 AD3d at 633. This case further supports that the statute controls the venue since arbitration was required by statute, the Fund was the claimant as opposed to the Defendant, and the case involved Workers’ Compensation. CPLR §7502 permits the Supreme Court to hear Plaintiff’s Article 75 to vacate the award since it was not a monetary award. Progressive cannot be stretched to permit a basis for this Court’s jurisdiction in Plaintiffs’ current cases.

Further, the court’s lack of subject matter jurisdiction is not waivable and can be raised at any time,^[FN66] which this Defendant has done repeatedly. This Court finds that Kings County Civil Court does not have subject matter jurisdiction over Plaintiffs’ claims seeking money judgment against the Fund. Accordingly, as a judgment or order issued without subject matter jurisdiction is void, and that defect may be raised be raised at any time and may not be waived, this Court is vacating all of the default judgments issued in favor of Plaintiffs in the cases captioned in this Decision and Order. See, e.g., Editorial Photocopier Archives v. Granger Collection, 61 NY2d 517, 523 (1984). As the Civil Court did not have subject matter jurisdiction over the above-captioned ten (10) actions, this Court is compelled to dismiss the actions, but without prejudice in case any of the Plaintiffs decide to seek relief in the Court of Claims.

The Issue of Sanctions

With respect to Defendant’s request for sanctions, the Court observes patterns in Plaintiffs’ counsel’s conduct that are troubling. First, in Compass Med., P.C. v. New York State Ins. Fund, 2020 NY Misc. LEXIS 7010 (Civ. Ct., Kings County, Sept. 30, 2020), Judge Roper noted that Plaintiff’s counsel, namely Oleg Rybak of the Rybak firm, received a decision in December 2018 wherein another Civil Court judge had held that the Civil Court lacked jurisdiction over the State Insurance Fund.^[FN67] In Compass Med., P.C. v. State Ins. Fund, 2020 NY Misc. LEXIS 7010, the Plaintiff commenced an action against Defendant State Insurance Fund, alleging Defendant’s failure to pay first party No-Fault benefits for medical services Plaintiff rendered to its assigned eligible injured party. There, the Summons and Complaint were filed in 2015 and answered more than four months later. In 2018, the Plaintiff then filed for summary judgment pursuant to CPLR §3211(c) or §3212(a) and dismissal of Defendant’s affirmative defenses pursuant to CPLR §3211(b). Defendant then filed its cross-motion for summary judgment on the grounds that the Civil Court did not have jurisdiction to hear the case against a state agency and that jurisdiction rested in the Court of Claims. During oral argument held in 2019, Defendant argued, inter alia, that the jurisdictional argument had previously been decided in Defendant’s favor in Ultimate Care Chiropractic, P.C. v. State Ins. Fund, Civ. Ct., Kings County Index No. CV-716668-16, December 10, 2018 by Hon. Michael Gerstein, a case also brought by Plaintiff’s counsel. The Defendant also brought to Judge Roper’s attention twenty other first party No-fault actions that Plaintiff’s counsel filed in 2019, after the decision in Ultimate Care Chiropractic, P.C. v. State Ins. Fund. In Compass Med., P.C. v. State Ins. Fund, the Court noted that Plaintiff’s counsel, “with full knowledge and admittedly conced[ed] that [the] Court of Claims is the court of competent jurisdiction…”, counsel continued to seek relief in Civil Court. While Judge Roper did not find that Plaintiff was collaterally estopped from bringing the action since the Plaintiff and the specific facts of said case were different from Ultimate Care, the Court agreed that jurisdiction lay in the Court of Claims.^[FN68] That Court [*17]rejected Plaintiff’s claim that the Civil Court should retain jurisdiction because the matter would be time-barred if brought in the Court of Claims. Judge Roper reasoned that “[t]his Court’s jurisdiction is not a fail-safe, not a fallback and not a court of contingent jurisdiction.”^[FN69]

This Court’s review of UCMS on April 6, 2021 indicates that the Rybak Firm is listed as counsel for Plaintiffs on at least 118 matters in the Kings Civil Court against this Defendant, reflecting filings between the beginning of 2008 and the end of 2020. Even if Plaintiffs attempted to argue that Compass Med and Ultimate Care cases are distinguishable from the instant cases because there are different facts and different Plaintiffs, such assertions are without merit since it is irrefutable that the Defendant is a state agency and as a state agency, the Court of Claims is the proper court to hear their claims.

When actions are brought where there is incontrovertible proof that undercut their filing in the first place,^[FN70] much less cases where there existed conclusive defenses to the asserted claims,^[FN71] courts have the discretion, on their own initiative or upon a party’s motion, to impose sanctions on a party for commencing a frivolous proceeding. See 22 NYCRR §130-1.1;^[FN72] see also Ram v. Torto, 111 AD3d 814 (2nd Dept 2013), lv. dismissed, 22 NY3d 860 (2014) (court upheld Defendant’s motions for attorney’s fees as well as injunctive relief prohibiting self-represented Plaintiff from filing further actions related to the case without court approval and also imposed, on its own initiative, a fine for frivolous conduct); Flushing Expo, Inc. v. New World Mall, LLC, 116 AD3d 826 (2d Dept 2014) (defendant’s motions for sanctions and attorney’s fees granted); cf. CPLR §8303(a) (where a personal injury action is commenced or continued and is found by the court to be, at any point in the proceedings, frivolous, the court [*18]shall award costs and reasonable attorney’s fees up to $10,000).

In Ram, the Appellate Division noted that the self-represented Plaintiff commenced various proceedings relating to the same matter, all of which had been dismissed by lower courts, which were subsequently affirmed by the Appellate Division.^[FN73] The Ram Defendants moved to dismiss the complaint pursuant to CPLR §3211(a)(7) because the Plaintiff failed to state a cause of action, for injunctive relief, and for an award of costs pursuant to 22 NYCRR §130-1.1.^[FN74] The Appellate Division upheld the lower court’s dismissal of the complaint and further found that the lower court “acted providently in enjoining the Plaintiff ‘from commencing any action or proceeding seeking relief from [Defendants] or from anyone else, in any form or fashion, related to or arising from the [underlying money judgment] without prior permission from this court or from the Appellate Division, Second Department.'”^[FN75] The Appellate Division also upheld the lower court’s award of costs pursuant to 22 NYCRR §130-1.1.^[FN76] in the amount of $6,000 for attorney’s fees, payable by the Plaintiff.^[FN77] The Appellate Division in Ram also held that the Plaintiff’s appeal was frivolous as it had no legal merit and was not supported by any reasonable argument, and ordered him to pay $2,500 to the court clerk to be forwarded in turn to the State Department of Taxation and Finance.^[FN78] See also Greene v. Rachlin, 154 AD3d 818 (2d Dept 2017) (attorney’s fees awarded as sanction against Plaintiff for its frivolous conduct in commencing action that was without merit in law and could not be supported by a reasonable argument for extension or modification of existing law); Mosab Constr. Corp. v. Prospect Park Yeshiva, Inc., 124 AD3d at 733 (attorney’s fees of $500 awarded as sanction against Plaintiff for its frivolous conduct in commencing time-barred lawsuit); Flushing Expo, Inc. v. New World Mall, LLC, 116 AD3d at 827-28 (sanction and attorney’s fee warranted where Plaintiff and counsel filed new action after Plaintiff’s previous action, with same counsel, had been dismissed, and new action had no merit in law nor any reasonable argument). Similarly, sanctions may be considered where a party continues to file actions despite knowing that it has no basis for doing so.^[FN79]

When the Plaintiffs appealed in all of the Omni cases listed in footnote 79, which included not only the 34 cases decided on December 21, 2018, but a few more decided the same day, the Appellate Term affirmed each dismissal and, on the Appellate Term’s own motion, directed the parties to show cause as to whether the Court should impose sanctions and costs against Plaintiffs’ counsel. See, e.g., Natural Therapy Acupuncture, P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6469, 62 Misc 3d 136(A); see also Mosab Constr. Corp. v. Prospect Park Yeshiva, Inc., 124 AD3d at 733 (sanctions and attorney’s fees against Plaintiff warranted where Defendant not only showed debt claims were time-barred by a wide margin and Plaintiff, when asked for proof of debt, failed to provide it but rather discussed Defendant’s defenses). In the Appellate Term’s Omni Indemnity decisions, all of which were issued on December 21, 2018, the Court held that sanctions could be considered because Plaintiffs’ counsel’s conduct appeared not only to meet the definition of frivolous conduct as stated in 22 NYCRR §130-1.1, but that “[s]ince 2013, Plaintiff and/or other providers represented by Plaintiffs’ counsel have been before this court more than 20 times in similar actions wherein these providers, while represented by Plaintiffs’ counsel, have made the same or essentially the same arguments which Plaintiff raises in the instant appeal.” See, e.g., Natural Therapy Acupuncture, P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6469, 62 Misc 3d 136(A) (citations omitted); see also Greene v. Rachlin, 154 AD3d at 819) (Plaintiffs’ continued pursuit on appeal of the same claims that were previously found meritless and barren of any reasonable argument as well as the advancing of other meritless arguments warranted an additional consideration as to whether the appeal was frivolous and could result in additional sanctions); Flushing Expo, Inc. v. New World Mall, LLC, 116 AD3d at 827-28 (judicial record of a prior case involving the Plaintiff and a related party constituted documentary evidence that warranted summary dismissal as well as sanctions and attorney’s fees). The Appellate Term further stated that “Plaintiff’s counsel continues to advance [*19]essentially the same arguments notwithstanding the fact that Defendant’s appellate brief expressly notes that this court has previously considered and rejected the arguments put forth by Plaintiff’s counsel…”. See, e.g., Natural Therapy Acupuncture, P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6469, 62 Misc 3d 136(A) (citations omitted).

The Court is also troubled by Plaintiffs’ counsel’s insistence that it has proceeded in “good faith and with the support of binding authority on the matter as discussed above”^[FN80] , i.e., whether the Civil Court has subject matter jurisdiction. Rather, it appears to this Court that Plaintiffs’ citations to cases in support of jurisdiction are replete with either misunderstood and/or incomplete recitations of pertinent facts (e.g., Carney v. Newburgh Park [specific workers compensation legislation requires NYSIF to appear at arbitration hearings in matters in which NYSIF is actually providing the policy and acting as a competitor in the market]; Royal Ins. Co. of Am. v. Comm’rs of State Ins. Fund [underlying case actually was litigated in the Court of Claims]. Accordingly, this Court is stressed to give the Plaintiffs and their counsel the benefit of the doubt that they have cited “binding authority” in favor of subject matter jurisdiction over the Defendant in the instant cases. Last, this Court has been further tested about Plaintiffs’ counsel’s “good faith” due to the latter’s interpretation of the last series of communications with this Court that it would not be issuing this Decision and Order as stipulations of discontinuances on all of the cases would render the issues resolved (for now, or until the cycle repeated with more no-fault filings against Defendant in Civil Court). It is a close call whether this Court should impose monetary sanctions and/or costs and attorneys’ fees upon Plaintiffs’ counsel.

Conclusion:

Defendant established that the New York Constitution’s Court of Claims Act requires this Court to summarily dismiss the Plaintiffs’ complaints against this Defendant state agency.^[FN81] The [*20]Court is unpersuaded by Plaintiffs’ arguments, including the cases it cited that are immaterial to the issue presented and seek to unjustifiably expand this Court’s jurisdiction to adjudicate actions seeking money judgments against the Fund. This Court lacks subject matter jurisdiction over the ten (10) captioned matters above, wherein jurisdiction lies only with the Court of Claims, as the Plaintiffs are attempting to collect money damages from a State agency. The Defendant’s motions to dismiss are therefore granted in part and denied in part. Granted to the extent that all actions are dismissed and denied to the extent that neither monetary sanctions nor costs and attorney fees will not be issued against Plaintiffs or their counsel although this Court has the discretion to so issue given the facts and circumstances herein. However, Plaintiffs’ counsel, namely the Rybak Firm as well as Oleg Rybak, Esq. and the Plaintiffs are enjoined from commencing any action or proceeding seeking relief in the form of a money judgment from this Defendant, in any Civil Court, without prior approval from this Court or the Appellate Term. To do so otherwise, could warrant monetary sanctions, as well as costs and attorney fees.

This constitutes the Decision and Order of the Court.

Dated: June 24, 2021
Brooklyn, New York
Hon. Patria Frias-Colón
Civil Court, Kings County

Footnotes

Footnote 1: The “Numbered” column represents the electronic filing via the “Electronic Document Delivery System” (EDDS), which at the time of this decision was the method afforded New York State attorneys and other authorized persons to file legal papers by electronic means. This method of E-filing via EDDS is authorized for these proceedings in Kings County Civil Court. These identifying numbers represent the confirmation provided to each counsel upon uploading their respective legal documents under each Index number.

Footnote 2: The Motions for these ten cases involve the same attorneys and the same dispositive issues of law. For the sake of judicial economy, the Decision and Order for each matter will be combined into this single decision. To further minimize confusion for the reader in identifying the cases, Plaintiff NYS Acupuncture Inc. is on three of the cases (Number 1 [a/a/o Patrick Howard], Number 2 [a/a/o Miguel Quinn] and Number 4 [a/a/o Karen Cutler] in the captioned Decision and Order above; Plaintiff Elmont Rehab, P.T., P.C. is on two of the cases (Number 3 [a/a/o Karen Cutler] and Number 5 [a/a/o Miguel Quinn]) in the captioned order above, Plaintiff Uzma Nasir Physician, P.C. is on one case (Number 6 [a/a/o Miguel Quinn]), Plaintiff Solution Bridge, Inc. is on one case (Number 7 [a/a/o Jennifer Schaum]); Plaintiff Metro Pain Specialist, P.C. is on one case (Number 8 [a/a/o Eileen Kilbane]), Plaintiff Gentlecare Ambulatory Anesthesia Services is on one case (Number 9 [a/a/o Maglorie Bueno]), and Plaintiff Right-Aid Medical Supply Corp. is on one case (Number 10 [a/a/o Enrique Alexander]).

Footnote 3: See Exhibit B of Defendant’s motion under Index number CV-723175-16/KI — Defendant’s Answer.

Footnote 4: See Exhibit A of Defendant’s motion under Index number CV-723175-16/KI — Summons and Complaint for Plaintiff.

Footnote 5: See Exhibit B of Defendant’s motion under Index number CV-723175-16/KI — Defendant’s Answer.

Footnote 6: See Exhibit C of Defendant’s motion under Index number CV-723175-16/KI — Kings County Civil Court Judgment dated October 11, 2016.

Footnote 7: See Exhibit A of Defendant’s motion under Index number CV-723178-16/KI — Summons and Complaint.

Footnote 8: Id.

Footnote 9: See Exhibit B of Defendant’s motion under Index number CV-723178-16/KI — Answer.

Footnote 10: See Exhibit C of Defendant’s motion under Index number CV-723178-16/KI — Kings County Civil Court Judgment dated October 11, 2016.

Footnote 11: See Exhibit A of Defendant’s motion under Index number CV-723183-16/KI — Summons and Complaint.

Footnote 12: Id.

Footnote 13: See Exhibit B of Defendant’s motion under Index number CV-723183-16/KI — Defendant’s Answer.

Footnote 14: See Exhibit C of Defendant’s motion under Index number CV-723183-16/KI — Kings County Civil Court Judgment dated October 11, 2016.

Footnote 15: See Exhibit A of motion under Index number Defendant’s CV-723185-16/KI — Summons and Complaint Plaintiff.

Footnote 16: Id.

Footnote 17: See Exhibit B of Defendant’s motion under Index number CV-723185-16/KI — Answer for Plaintiff.

Footnote 18: See Exhibit C of Defendant’s motion under Index number CV-723185-16/KI — Kings County Civil Court Judgment dated October 11, 2016.

Footnote 19: Subsequent to the conference held on April 6, 2021, Stipulations of Discontinuances were submitted to this Court for 98 no-fault insurance cases filed in Kings County Civil Court against Defendant NYSIF in which Plaintiffs were all represented by the Rybak Firm, who is also representing the instant Plaintiffs. To this Court’s dismay, it found that of the 98 stipulations, 97 of which were dated May 13, 2021 and one which was dated May 19, 2021, ten of the stipulations were for the ten cases captioned above that this Court had previously emphasized to both sides that it intended to render a Decision and Order. In an email dated June 9, 2021, Plaintiffs’ counsel told this Court that it disagreed with this Court’s recollection of the multiple “discussions” held and that “your Honor made it abundantly clear that you intended to vacate years old defaults and permit the NYSIF to dismiss the 10 cases. Based on these prior discussions, it is Plaintiffs and their counsel’s position that they would like to dismiss all cases between the Providers represented by The Rybak Firm, PLLC and the NYSIF. Based of [sic] that, if possible, since there is no need to issue any orders and the cases can be dismissed on the previously submitted and executed stipulations.” Defendant’s counsel objected to Plaintiffs’ email. This Court rejects Plaintiffs’ counsel misinterpretation and accordingly, 88 of the 98 stipulations of discontinuances will be filed in Kings County Civil Court. For the reasons set forth, this Court renders this decision on the ten instant cases herein. This Court is troubled by the lack of discernible order the 98 stipulations were sent; there was no chronological or alphabetical order. This may be because either the ten stipulations for the instant cases were mixed-in deliberately with the other 88 in an attempt to preempt this Court from issuing its intended Decision and Order and any possible subsequent consequence to counsel, or the random insertion of these ten cases was an inadvertent error or a misinterpreted and innocent attempt to clear the Civil Court of all the cases between these parties.

Footnote 20: See Exhibit A of Defendant’s motion under Index number CV-723177-16/KI — Summons and Complaint for Plaintiff.

Footnote 21: Id.

Footnote 22: See Exhibit B of Defendant’s motion under Index number CV-723177-16/KI — Defendant’s Answer.

Footnote 23: See Exhibit C of Defendant’s motion under Index number CV-723177-16/KI — Kings County Civil Court Judgment dated October 11, 2016 for Plaintiff.

Footnote 24: See Plaintiff’s Affidavit at paragraph 9 and Exhibit 1 under Index number CV-723180-16/KI — Affidavit of Service dated July 6, 2016.

Footnote 25: See Exhibit 1 of Plaintiff’s Affidavit of Service of Summons and Complaint under Index number CV-723180-16/KI. The Summons and Complaint are missing from this Exhibit and not included elsewhere in Plaintiff’s Opposition; see also Affidavit of Roseanne Nichols, Esq., Defendant’s Exhibit K, dated April 19, 2021 (claiming, inter alia, no affidavit of service of the summons and complaint was filed with the Court, and there was improper service of the summons and complaint and entry of default judgment upon Defendant.no notice of leave to enter the default judgment was motion for default was served, and that the Civil Court did not have subject matter jurisdiction).

Footnote 26: See UCMS records regarding the Summons and Complaint for Plaintiff under Index number CV-723180-16/KI.

Footnote 27: See Exhibit A of Defendant’s motion under Index number CV-723180-16/KI — Kings County Civil Court Judgment dated October 11, 2016.

Footnote 28: See Exhibit A of Defendant’s motion under Index number CV-707439-17/KI — Plaintiff’s Summons and Complaint.

Footnote 29: Id.

Footnote 30: See Exhibit 2 of Plaintiff’s motion under Index number CV-707439-17/KI — Defendant’s Answer.

Footnote 31: See Exhibit 3 of Plaintiff’s motion under Index number CV-707439-17/KI — Plaintiff’s Rejection of Defendant’s Answer.

Footnote 32: See Exhibit B of Defendant’s motion under Index number CV-707439-17/KI — Kings County Civil Court Judgment dated October 11, 2016 for Plaintiff.

Footnote 33: See Exhibit C of Defendant’s motion under Index number CV-707439-17/KI.

Footnote 34: See Exhibit A of Defendant’s motion under Index number CV-704429-18/KI — Plaintiff’s Summons and Complaint.

Footnote 35: Id.

Footnote 36: See Exhibit C of Defendant’s motion, Index number CV-704429-18/KI.

Footnote 37: See Exhibit B of Defendant’s motion, Index number CV-704429-18/KI.

Footnote 38: See Exhibit A of Defendant’s motion, Index number CV-706460-19/KI — Summons and Complaint.

Footnote 39: Id.

Footnote 40: See Exhibit B of Defendant’s motion under Index number CV-706460-19/KI.

Footnote 41: See Exhibit C of Defendant’s motion under Index number CV-706460-19/KI.

Footnote 42: See Exhibit D of Defendant’s motion under Index number CV-706460-19/KI.

Footnote 43: See Exhibit A of Defendant’s motion under Index number CV-707274-19/KI — Plaintiff’s Summons and Complaint.

Footnote 44: Id.

Footnote 45: See Exhibit 4 of Plaintiff’s motion under Index number CV-707274-19/KI.

Footnote 46: See, e.g., Defendant’s Affirmation under Index number CV-723175-16, paragraphs 18-20. Defendant’s citation to Nash is from an opinion that dissented in part, on other grounds, from the majority decision which did not touch on subject matter jurisdiction. The Nash case involved the Court of Appeals review of the Port Authority’s successful motion in Supreme Court to vacate a tortious liability judgment against it after it had previously failed to appeal from an order of the Appellate Division affirming the judgment, contending that there had been a post-judgment change in the law immunizing the Port Authority. See 22 NY3d at 223. The Court of Appeals reversed the lower’s court vacatur of the judgment, finding that the lower court was wrong when it found that it had no discretion other than to vacate the judgment. See 22 NY3d at 225-226. The Nash case turned on the interplay between CPLR §5015(a)(5) (vacating a judgment because of reversal, modification or vacatur of a prior judgment) and whether the underlying court had the discretion to consider whether the Port Authority had waited too long to make its motion, rather than the question as to whether the underlying court even had jurisdiction to hear the case (see CPLR §5015[a][(4]), which is the issue before this Court. See 22 NY3d at 225-226, 229. The dissenting opinion, while agreeing with the majority on the vacatur of the judgment, emphasized that “unlike subject matter jurisdiction—an issue that is nonwaivable and can be raised by any party at any time in any forum—the Port Authority sought vacatur of the Nash judgment based on an issue that was waivable.” See 22 NY3d at 225-226, 229. Defendant subsequently cited to support its argument that the instant default judgments must be vacated because subject matter jurisdiction cannot be waived with case more on point than Nash. See 22 NY3d 220 (order vacating judgment reversed and remitted to Supreme Court for further proceedings), on remitter 131 AD3d 164, 165 (1st Dept 2015) (the motion court, which upon remand from the Court of Appeals, again vacated the judgment, which the Appellate Division reversed as an improvident exercise of discretion).

Footnote 47: See, e.g., Defendant’s Affirmation, Index number CV-723175-16, paragraph 20 (citing, e.g., Workers’ Compensation Law § 76; Comm’rs of the State Ins. Fund v. Photocircuits Corp., 20 AD3d 173, 176 [1st Dept 2005].

Footnote 48: Defendant asserts additional arguments, e.g., that Defendant was not made aware of the prior default judgments, that the default judgments were entered in error, that some Plaintiffs should have first filed their claims with the Worker’s Compensation Board before any further resolution could occur in the Court of Claims. See, e.g., Defendant’s Affirmation, Index number CV-723175-16 at paragraphs 16, 17, 27, 54, 58. Defendant cites several persuasive cases supporting the position that this Court would be providently exercising its discretion in vacating the judgments. See, e.g., Defendant’s Affirmation, Index number CV-723175-16 (citing Bunch v. Dollar Budget, Inc., 12 AD3d 391 [2d Dept 2004] [defendant’s delay in answering was brief, the default was not willful, and there was no evidence that the plaintiff was prejudiced]); Anamdi v. Anugo, 229 AD2d 408 [2d Dept 1996] [court exercised sound discretion in granting vacatur of default judgment where defendant was unaware that the action had commenced and presented an affidavit showing a meritorious defense]). Because this Court’s resolution of the subject matter jurisdiction issue is dispositive in the instant cases, this Court need not reach any of the parties’ arguments other than the jurisdictional one. E.g., c.f., Matter of Regina Metro Co., LLC. v. New York State Div. of Hous. & Community Renewal, 35 NY3d 332, 382 n. 27 (2020) (Court did not reach claim as to whether there was an unconstitutional taking because issue was resolved on other grounds); Matter of Adirondack Wild Friends of the Forest Preserve v. New York State Adirondack Park Agency, 34 NY3d 184, 194 (2019) (for purposes of rendering decision, Court did not need to address whether Department of Conservation plan triggered a provision); Braunstein v. Day, 2021 NY App. Div. LEXIS 3548 (2nd Dept 2021) (As Appellate Division granted the defendant’s motion for summary judgment, it was unnecessary for it to reach the defendant’s remaining contention).

Footnote 49: See, e.g., Plaintiff’s Affirmation, Index number CV-723175-16, at paragraph 6.

Footnote 50: See, e.g., Plaintiff’s Affirmation, Index number CV-723175-16, at paragraph 10.

Footnote 51: See, e.g., Plaintiff’s Affirmation, Index number CV-723175-16, at paragraph 13.

Footnote 52: See, e.g., Plaintiff’s Affirmation, Index number CV-723175-16, at paragraphs 20-23.

Footnote 53: See, e.g., Plaintiff’s Affirmation, Index number CV-723175-16, at paragraph 30.

Footnote 54: See, e.g., Plaintiff’s Affirmation, Index number CV-723175-16, at paragraphs 31-38.

Footnote 55: See, e.g., Defendant’s Affirmation, Index No. 723175/16, at paragraphs 76, 78-79 (citing 22 NYCRR § 130-1.1).

Footnote 56: See, e.g., Defendant’s Affirmation, Index No. 723175/16, at paragraph 77 (citing Transaero, Inc. v. Biri Associates, Corp,. 39 AD3d 738 [2d Dept 2007] [sanctions imposed, on the court’s own motion, against plaintiff and plaintiff’s attorney for filing a lawsuit that attempted to skirt the statute of limitations by falsely claiming that the plaintiff and/or attorney had only recently become aware that they had a cause of action]; Yan v. Klein, 35 AD3d 729, 826 N.Y.S2d 669 [2d Dept 2006] [sanctions warranted where Plaintiff’s attorney repeatedly continued to advance cases that were barred by the doctrines of res judicata and collateral estoppel]); Weinstock v. Weinstock, 253 AD3d 873 [2d Dept 1998] [plaintiff attorney representing self in divorce proceeding ordered to pay $3000 in costs to ex-wife defendant and $10,000 to Lawyers Fund for Client Protection for pursuing an appeal that was meritless in that there was no identifiable relief being sought other than forcing defendant to incur unnecessary counsel fees]); see also CPLR § 8303-a (where a personal injury action is commenced or continued and is found by the court to be, at any point in the proceedings, frivolous, the court shall award costs and reasonable attorney’s fees up to $10,000).

Footnote 57: See, e.g., Plaintiff’s Affirmation, Index No. 723175/16, at paragraphs 40 and 43.

Footnote 58: W.J. Nolan & Co. v. Daly, 170 AD2d 320 (1st Dept 1991) vacated an order imposing sanctions on an attorney because the attorney did know that claims arising from Plaintiff utilizing confidential records of Defendant’s employment was subject to arbitration. Lewis v. Stiles, 158 A.D.2d589 (2d Dept 1992) rejected Defendant’s request to impose sanction in Plaintiff’s nuisance cause of action because counsel’s arguments about the alleged disturbances of children frolicking and dogs barking created by Defendant’s installation of a pool and building a pool house are unpersuasive but do not rise to the level of frivolous.

Footnote 59: See Workers’ Compensation Law §76[1]; Methodist Hosp. of Brooklyn v. State Ins. Fund, 64 NY2d at 375 ; D’Angelo v. State Ins. Fund, 48 AD3d 400, 402 (2d Dept 2008); GuideOne Specialty Mut. Ins. Co. v. State Ins. Fund, 94 AD3d 700 (2nd Dept 2012); Commissioners of State Ins. Fund v. M. Mathews & Sons Co., 131 AD2d 301 (1st Dept 1987); Miraglia v. State Ins. Fund, 32 Misc 2d 471, 473-74 (Sup. Ct. Bx. County 2011).

Footnote 60: See Lipofsky v The State Insurance Fund, 86 F.3d 15.

Footnote 61: This case, also cited as Ultimate Care Chiropractic, P.C. v. State Ins. Fund, Index No. CV-71668-16, was discussed in Compass Med., P.C. v. State Ins. Fund, 2020 NY Misc. LEXIS 7010 (Civ. Ct., Kings County, Sept. 30, 2020), wherein Judge Sandra Roper noted therein that Plaintiffs’ counsel in both cases was the Rybak Firm, who is also counsel in the instant cases.

Footnote 62: See GuideOne Specialty Mut. Ins. Co. v. New York State Ins. Fund, 2015 NY Misc. LEXIS 4345 (NY Ct. Cl., Nov. 12, 2015) where permission was granted to file late claim.

Footnote 63: See Compass Med., P.C. v. State Ins. Fund, 2020 NY Misc. LEXIS 7010 (citing Ultimate Care Chiropractic, P.C. v. State Ins. Fund, Index No. CV-716668-16 [Civil Court improperly granted Plaintiff leave to transfer case to Court of Claims because that court does not accept transfers and the matter was time-barred]).

Footnote 64: See, e.g., Plaintiff’s Affirmation, Index number CV-723175-16, at paragraphs 30-39.

Footnote 65: See, e.g., Plaintiff’s Affidavit, Index No. 723175/16 dated April 22, 2021, paragraph 36. The additional cases that Plaintiffs cite in paragraphs 36—38, are likewise distinguishable from the instant cases because subject matter jurisdiction was not an issue in Plaintiffs’ cited cases where NYSIF was acting like a private insurer in the competitive market collecting premiums and in that context may bring actions in other state courts.

Footnote 66: See GuideOne Specialty Mut. Ins. Co. v. State Ins. Fund, 94 AD3d at 700; D’Angelo v. State Ins. Fund, 48 AD3d at 402.

Footnote 67: Ultimate Care Chiropractic, P.C. v. State Ins. Fund, Index No. CV-716668-16.

Footnote 68: See Compass Med., P.C. v. New York State Ins. Fund, 2020 NY Misc. LEXIS 7010.

Footnote 69: Id.

Footnote 70: See GuideOne Specialty Mut. Ins. Co. v. State Ins. Fund, 94 AD3d 700; D’Angelo v. State Ins. Fund, 48 AD3d 400; Miraglia v. State Ins. Fund, 32 Misc 2d 471.

Footnote 71: See Mosab Constr. Corp. v. Prospect Park Yeshiva, Inc., 124 AD3d 732, 733 (2d Dept 2015) (summary dismissal granted where case was time-barred after being filed eleven years after alleged breach of contract) and Flushing Expo, Inc. v. New World Mall, LLC, 116 AD3d 826, 827 (2d Dept 2014) (summary dismissal granted when Defendant’s evidence conclusively showed no contract existed between the parties).

Footnote 72: 22 NYCRR §130-1.1(a) authorizes a court to award to any party or attorney reasonable expenses incurred and reasonable attorney’s fees, resulting from frivolous conduct and, in addition to or in lieu of awarding costs, to impose financial sanctions upon any party or attorney for said conduct. Pursuant to 22 NYCRR §130-1.1(b), these sanctions can be imposed against the attorney personally or upon a partnership, firm or corporation with whom the attorney is associated and has appeared as attorney of record. In addition, 22 NYCRR §130-1.1(c) states, in part, that “conduct is frivolous if: (1) it is completely without merit in law and cannot be supported by a reasonable argument for an extension, modification or reversal of existing law….Frivolous conduct shall include the making of a frivolous motion….In determining whether the conduct undertaken was frivolous, the court shall consider…the (1) circumstances under which the conduct took place, including the time available for investigating the legal or factual basis of the conduct; and (2) whether or not the conduct was continued when its lack of legal or factual basis was apparent, should have been apparent, or was brought to the attention of counsel or the party.” 22 NYCRR §130-1.1(d) states, in part, “[a]n award of costs or the imposition of sanctions may be made either upon motion in compliance with CPLR §2214 or §2215 or upon the court’s own initiative, after a reasonable opportunity to be heard. The form of the hearing shall depend upon the nature of the conduct and the circumstances of the case.”

Footnote 73: Id. at 815.

Footnote 74: Id.

Footnote 75: Id. at 815-816 (citing Spremo v. Babchik, 216 AD2d 382 [2nd Dept 1995]).

Footnote 76: 22 NYCRR §130-1.2 authorizes a court to award costs, or impose sanctions, or both, up to $10,000 for any single occurrence of frivolous conduct, but the court can only do so “upon a written decision setting forth the conduct on which the award or imposition is based, the reasons why the court found the conduct to be frivolous, and the reasons why the court found the amount awarded or imposed to be appropriate.”

Footnote 77: Id. at 816.

Footnote 78: Id.

Footnote 79: In all the below-cited cases filed against Omni Indemnity Co., which were heard by various Kings County Civil Court judges, several medical providers sought to recover assigned first party no-fault benefits. Each Plaintiff was represented by the Rybak Firm. Except for an award to a Plaintiff by one judge which was subsequently reversed by the Appellate Term (see Charles Deng Acupuncture, P.C., v. Omni Indem. Co., 62 Misc 3d 134[A]), all were summarily dismissed because the Defendant showed that Plaintiff sued the wrong insurance company and the Plaintiff failed to raise an issue of fact in response. See T & S Med. Supply Corp. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6494, 62 Misc 3d 131(A).See, e.g., Charles Deng Acupuncture, P.C., v. Omni Indem. Co., 2018 NY Misc. LEXIS 6482, 62 Misc 3d 134(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Charles Deng Acupuncture, P.C., v. Omni Indem. Co., 2018 NY Misc. LEXIS 6487, 62 Misc 3d 135(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Charles Deng Acupuncture, P.C., v. Omni Indem. Co., 2018 NY Misc. LEXIS 6496, 62 Misc 3d 139(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); T & S Med. Supply Corp. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6494, 62 Misc 3d 131(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Maiga Prods. Corp. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6462, 62 Misc 3d 131(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6474, 62 Misc 3d 131(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6497, 62 Misc 3d 132(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6466, 62 Misc 3d 132(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6456, 62 Misc 3d 133(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6478, 62 Misc 3d 133(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6481, 62 Misc 3d 133(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6490, 62 Misc 3d 134(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6483, 62 Misc 3d 135(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6457, 62 Misc 3d 136(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Masigla v. Omni Indem. Co., 2018 NY Misc. LEXIS 6456, 62 Misc 3d 136(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Natural Therapy Acupuncture, P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6475, 62 Misc 3d 132(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Natural Therapy Acupuncture, P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6467, 62 Misc 3d 133(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Natural Therapy Acupuncture, P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6479, 62 Misc 3d 134(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Natural Therapy Acupuncture, P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6452, 62 Misc 3d 135(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Natural Therapy Acupuncture, P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6469, 62 Misc 3d 136(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas v. Omni Indem. Co., 2018 NY Misc. LEXIS 6454, 62 Misc 3d 132(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas v. Omni Indem. Co., 2018 NY Misc. LEXIS 6465, 62 Misc 3d 132(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas v. Omni Indem. Co., 2018 NY Misc. LEXIS 6450, 62 Misc 3d 135(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas v. Omni Indem. Co., 2018 NY Misc. LEXIS 6455, 62 Misc 3d 135(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas v. Omni Indem. Co., 2018 NY Misc. LEXIS 6486, 62 Misc 3d 135(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas Med., P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6451, 62 Misc 3d 131(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas Med., P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6492, 62 Misc 3d 131(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas Med., P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6472, 62 Misc 3d 131(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas Med., P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6471, 62 Misc 3d 132(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas Med., P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6491, 62 Misc 3d 133(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas Med., P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6461, 62 Misc 3d 134(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas Med., P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6495, 62 Misc 3d 134(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018); Compas Med., P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6915, 62 Misc 3d 134(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018) Compas Med., P.C. v. Omni Indem. Co., 2018 NY Misc. LEXIS 6470, 62 Misc 3d 136(A) (App. Term 2d Dept 2d, 11th & 13th Jud. Dists. Dec. 21, 2018).

Footnote 80: See, e.g., Plaintiff’s Affirmation, Index No. 723175/16, at paragraph 40 (emphasis supplied). Plaintiffs misplaced reliance on other cited cases to support their position that Defendant failed to move to dismiss the complaint for lack of personal jurisdiction or refute the presumption of valid service of process is unpersuasive. See, e.g., Plaintiff’s Opposition, CV-723175-16 at paragraphs 13 and 15 citing US Consults v. APG, Inc., 82 AD3d 753 (2d Dept 2011]) and paragraph 13. Plaintiffs’ counsel also cited US Consults case in Ultra Ortho Prods., Inc. v. North Carolina Farm Bur. Ins. Group, 2018 18 NY Misc. LEXIS 5076, 61 Misc 3d [Civ Ct, Kings County, Nov. 9, 2018, Kennedy, J]. The Court in Ultra Ortho Prods. found that “the cases cited by plaintiff’s counsel [Oleg Rybak Esq., The Rybak Firm] are distinguished from the facts of the instant action” rejecting the plaintiff’s claim that personal jurisdiction was acquired and dismissed the complaint.

Footnote 81: See, e.g., GuideOne Specialty Mut. Ins. Co. v. State Ins. Fund, 94 AD3d 700; Twin City Fire Ins. Co. v. State Ins. Fund, 65 AD3d 945; D’Angelo v. State Ins. Fund, 48 AD3d 400, 402; Commissioners of State Ins. Fund v. Mathews & Sons Co., 131 AD2d 301; Miraglia v. State Ins. Fund, 32 Misc 2d 471; Compass Med., P.C. v. New York State Ins. Fund, 2020 NY Misc. LEXIS 7010; Ultimate Care Chiropractic, P.C. v. State Ins. Fund, Index No. 716668/2016; see also NY Const. art. VI, § 9; Workers’ Compensation Law § 76[1]; Methodist Hosp. of Brooklyn v. State Ins. Fund, 64 NY2d at 375.

CV-702946-18/KI

Attorney for Plaintiff: Allen Tsirelman, Esq., Gary Tsirelman P.C., 129 Livingston Street Brooklyn, Brooklyn, New York 11201

Attorney for Defendant: Michael Philippou, Esq., Rubin, Fiorella, Friedman & Mercante LLP, 630 Thrid Ave. 3rd Floor, New York, NY 10017

The court’s Decision and Order is based upon consideration of the following papers:

NOTICE OF MOTION & AFFIDAVITS ANNEXED 1

OPPOSITION/CROSS-MOTION 2

REPLY/OPPOSITION TO CROSS-MOTION 3

EXHIBITS

CPLR 2219(a) Recitation

Upon the foregoing cited papers, after oral argument, on June 4, 2021, the Decision and Order on Defendant’s Motion to Dismiss pursuant to CPLR 3211(A)(5) and 3212 on the grounds that it is barred by res judicata and collateral estoppel is as follows:

This action to seeking reimbursement of No-Fault benefits, was commenced on or about January 19, 2018. Issue was joined on or about February 21, 2018 with the service of Defendant’s Answer. The Answer contained numerous affirmative defenses including the defense that the action was barred by res judicata and/or collateral estoppel. On May 2, 2018 Defendant filed a summary judgment motion claiming that the underlying accident was staged and that there was fraud in the procurement of the policy. The motion was denied on April 16, 2019 as the court preserved these claims as questions of fact for trial. Plaintiff filed a Notice of Trial on or about May 7, 2019 that Defendant claims they received on May 20, 2019. The court file indicates that Defendant filed a motion to strike the notice of trial on June 18, 2019 and that after a number of adjournments due to COVID quarantine and/or requests by the parties, the motion will appear on the No-Fault motion calendar for argument on August 22, 2022. Thus, the motion to strike is not before this court.

On or about April 19, 2018, State Farm commenced a declaratory action in New York Supreme Court. On September 11, 2019, the Supreme Court issued an order declaring that State Farm has no obligation to cover No-Fault claims for the plaintiff, date of loss and claim number herein. “‘Under the doctrine of res judicata, a final adjudication of a claim on the merits precludes re-litigation of that claim and all claims arising out of the same transaction or series of transactions by a party or those in privity with a party'” (Milton v. Subraj, et al, 67 Misc 3d 140[A] [App Term, 2d Dept., 11th & 13th Jud. Dists. 2020] quoting Ciraldo v. JP Morgan Chase Bank, N.A.,140 AD3d 912 at 913 [2d Dept. 2016]; see Schuylkill Fuel Corp. v. Nieberg Realty Corp., 250 NY 304 [1929]). Defendant now seeks dismissal of this action based upon that Supreme Court order.

Plaintiff opposes the instant motion claiming that it is procedurally defective. Specifically, Plaintiff claims that Defendant improperly seeks relief under CPLR 3211(a)(5) because such a motion must be made before issue is joined, which was not done here. Additionally, Plaintiff argues that Defendant cannot move pursuant to CPLR 3212 because this motion was filed more than one hundred twenty (120) days after the filing of the Notice of Trial. Notably, Plaintiff does not oppose the motion on substantive grounds.

It is well established that CPLR 3212(a) provides that if no date is set by the court, a motion for summary judgment shall be made no later than one hundred twenty (120) days after the filing of the note of issue, except with leave of court on good cause shown (Brill v. City of New York, 2 NY3d 648 [2004]). Good cause has been defined as “a satisfactory explanation for the untimeliness” (Brill v. City of New York, 2 NY3d 648, 652). In this matter, Plaintiff correctly claims that this motion was filed beyond the one hundred and twenty (120) day period of the filing of the notice of trial. It is also noted that Defendant’s motion to strike the notice of trial has been adjourned well into next year and is not before the court at this time. Consequently, the May 7, 2019 filing of the notice of trial remains and the summary judgment motion is late.

Notwithstanding the above, the circumstances surrounding this case present good cause for the court to entertain a late summary judgment motion. Here summary judgment is sought based upon an order of the Supreme Court order which holds that as between the parties, Defendant bears no obligation to provide no fault coverage to Plaintiff stemming from the subject collision. In Armentano v Broadway Mall Properties, Inc., the Second Department found that the lower court had good cause to entertain a late summary judgment motion because it was based upon an order of the Appellate Department in a prior appeal of the matter which dismissed the case (Armentano v Broadway Mall Properties, Inc., 48 AD3d 493 [2d Dept 2008]). Similarly, in the instant action, the September 11, 2019 Supreme Court order is dispositive as to the merits of this matter and warrants dismissal of the case.

Further, Defendant could not have moved based on those defenses prior to joinder of issue as required by CPLR 3211(a)(5) because the declaratory judgment order did not exist at the time (see generally Renelique v State Wide Ins. Co., 50 Misc 3d 137[A] [App Term, 2d Dept., 11th & 13th Jud. Dists. 2016]; Metro Health Products, Inc. v. Nationwide Ins., 52 Misc 3d 138[A] [App Term, 2d Dept., 11th & 13th Jud. Dists. 2016]; see Atlantic Chiropractic, P.C., 62 Misc 3d 145[A] [App Term, 2d Dept.,11th & 13th Jud. Dists. 2019]; Milton v. Subraj, 67 Misc 3d 140 [A]). Likewise, when the first summary judgment motion was filed, the declaratory judgment order had not been issued; the only grounds for the initial summary judgment motion at that time were Defendant’s claims of fraud and staged accident.

Furthermore, to deny relief based on the untimeliness of the summary judgment motion under these facts would result in a disregard of a Supreme Court order and lead to an unjust result. Any judgment issued in favor of Plaintiff would destroy or impair rights or interests established by the judgment in the declaratory action. (see Active Chiropractic, P.C. v. Allstate Ins., 58 Misc 3d 156[A] [App Term, 2d Dept.,11th & 13th Jud. Dists. 2018]; Metro Health Products, Inc. v. Nationwide Ins., 52 Misc 3d 138 [A] [App Term, 2d Dept.,11th & 13th Jud. Dists. 2016]).

It is further noted that Plaintiff cannot now claim prejudice or surprise. Plaintiff was on notice of these defenses since early 2018, when Defendant raised its res judicata and collateral estoppel affirmative defenses in its Answer.

Although this is Defendant’s second summary judgment motion, the court will entertain the motion as it is based on the new evidence: the subsequently issued order of the Supreme Court which directly affects this action. “Multiple summary judgment motions in the same action should be discouraged in the absence of a showing of newly discovered evidence or other sufficient cause (Burbige v. Siben & Ferber, 152 AD3d 641,642 [2d Dept 2017]; see Valley Natl. Bank v. INI Holding, LLC, 95 AD3d 1108 [2d Dept 2012]).

Lastly, Plaintiff’s assertion that the declaratory judgment has no merit because it was granted on default is erroneous. It is well settled that “res judicata applies ‘to an order or judgment taken by default which has not been vacated, as well as to issues which were or could have been raised in the prior [action]'” (Lazides v. P & G Enters., 58 AD3d 607, 609 [2d Dept 2009] [internal citation omitted]). “[A] Supreme Court’s order is a conclusive final determination, notwithstanding that it was entered on default, and res judicata applies to an order or judgment taken by default” (Ava Acupuncture, P.C. v. NY Central Mut. Fire Ins. Co., 34 Misc 3d 149 [A] [App Term, 2d Dept. 2d, 11th and 13th Jud Dists 2012]; Atlantic Chiropractic, P.C. v. Utica Mutual Ins. Co., 62 Misc 3d 145[A]).

Based on the foregoing, Defendant’s motion is Granted. Defendant established that it properly preserved its res judicata and collateral estoppel defenses; that a declaratory judgment order was issued regarding this claim; and that the order has preclusive effect given the identity of issues and parties. Accordingly, the complaint is dismissed with prejudice.

This constitutes the Decision and Order of the Court.

ENTER.
June 24, 2021
Brooklyn, NY
Hon. Consuelo Mallafre Melendez
Judge, Civil Court

CV-702880-19/QU

Plaintiff’s Counsel:
Gabriel Law Firm, P.C.
100 Merrick Road, 430W
Rockville Centre, NY 11570

Defendant’s Counsel:
Callinan & Smith, LLP
3361 Park Avenue, Suite 104
Wantagh, NY 11793

I. Papers

Papers Numbered

Defendant’s Notice of Motion and Affirmation in Support dated October 24, 2019 (“Motion”) [*2]and file stamped by the court on October 31, 2019. 1

Plaintiff’s Notice of Cross-Motion and Affirmation in Support dated October 1, 2020 (“Cross-Motion”) and electronically filed with the court on the same date. 2

Defendant’s Affirmation in Opposition to Plaintiff’s Cross Motion and in Support of Defendant’s Motion dated October 9, 2020 (“Opposition to Cross-Motion”) and electronically filed with the court on October 12, 2020. 3

Plaintiff’s Reply Affirmation dated November 30, 2020 (“Reply”) and electronically filed with the court on the same date. 4

In a summons and complaint filed February 15, 2019, Plaintiff sued Defendant insurance company to recover a total of $2,330.56 in unpaid first party No-Fault benefits for medical services provided to Plaintiff’s assignor Pierre, plus attorneys’ fees and statutory interest (see Motion, Aff. of Levy, Ex. A).

Defendant moved for summary judgment dismissing Plaintiff’s complaint on the ground that Plaintiff failed to attend scheduled Examinations Under Oath (“EUO“). Plaintiff cross-moved for summary judgment on its claims against Defendant. Both parties orally argued the motions before this Court on April 30 and May 6, 2021 respectively.

III. Discussion and Decision

CPLR 3212 provides that “a motion for summary judgment shall be supported by affidavit, by a copy of the pleadings and by other available proof, such as depositions and written admissions” (CPLR 3212[b]). “Mere conclusions, expressions of hope or unsubstantiated allegations or assertions are insufficient” (Zuckerman v. City of New York, 49 NY2d 557, 562 [1980]). “A defendant moving for summary judgment [seeking an order dismissing plaintiff’s complaint] has the initial burden of coming forward with admissible evidence, such as affidavits by persons having knowledge of the facts, reciting the material facts and showing that the cause of action has no merit” (GTF Mktg. v Colonial Aluminum Sales, 66 NY2d 965, 967 [1985]; Anghel v Ruskin Moscou Faltischek, P.C., 190 AD3d 906, 907 [2d Dept 2021], see Jacobsen v. New York City Health & Hosps. Corp., 22 NY3d 824, 833 [2014]). A motion for summary judgment “shall be granted if, upon all the papers and proof submitted, the cause of action or defense shall be established sufficiently to warrant the court as a matter of law in directing judgment in favor of any party” (CPLR 3212[b]; Zuckerman v. City of New York, at 562, see GTF Mktg. v Colonial Aluminum Sales, 66 NY2d at 968).

Insurers must pay or deny No-Fault benefit claims “within thirty (30) calendar days after receipt of the proof of the claim” (Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498, 501 [2015]; Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556, 563 [2008]; Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 317 [2007]; see Insurance Law § 5106[a]; 11 NYCRR § 65-3.8[c]; Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90 NY2d 274, 278 [1997]). Failure to establish timely payment or denial of the claim precludes the insurer from offering evidence of its defense to non-payment (Viviane [*3]Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d at 506; Fair Price Med. Supply Corp. v. Travelers Indem. Co., 10 NY3d at 563; Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d at 318; Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90 NY2d at 281-86). Noncompliance with an insurance policy provision requiring disclosure through an EUO is a failure of a condition precedent to an insurer’s duty to indemnify (IDS Prop. Cas. Ins. Co. v Stracar Med. Servs., P.C., 116 AD3d 1005, 1007 [2d Dept 2014]; National Med. & Surgical Supply, Inc. v ELRAC, Inc., 54 Misc 3d 131[A], 2017 NY Slip Op 50028[U] *1 [App Term 2d Dept 2017]) and is a material policy breach precluding recovery of proceeds under the insurance policy (Nationwide Affinity Ins. Co. of Am. v George, 183 AD3d 755, 756 [2d Dept 2020]; Interboro Ins. Co. v Clennon, 113 AD3d 596, 597 [2d Dept 2014]).

Here, the undisputed facts as fully addressed hereinafter, are (i) that Plaintiff submitted its claim to Defendant, (ii) that Defendant received Plaintiff’s claims, (iii) that Defendant first requested EUO on the 17th business days after it received Plaintiff’s claims, (iv) that Plaintiff failed to attend any of the scheduled EUOs, and (v) that Defendant denied Plaintiff’s claims on the seventh (7th) day after Plaintiff’s failure to appear for the third scheduled EUO. The legal issues argued by the parties, however, before this Court, are:

First, whether an EUO scheduling letter is a request for additional verification, subject to the fifteen (15) business day requirement (11 NYCRR § 65-3.5[b]).

Second, whether an insurer’s transmission of an EUO request letter within thirty (30) calendar days of receiving a claim for No Fault benefits tolls an insurer’s time to pay or deny such claim.

Third, the effect of an insurer’s late transmission of request for an EUO, if such lateness defense is not precluded.

This Court will address the above issues in the context of Defendant’s Motion for summary judgment and Plaintiff’s opposition. Plaintiff’s Cross-Motion will be analyzed separately.

A. Defendant’s Motion

Legal Issue One: whether an EUO scheduling letter is a request for additional verification, subject to the fifteen (15) business day requirement (11 NYCRR § 65-3.5[b]).

Initially, parties disputed whether an EUO constitutes “additional verification.” Plaintiff contended that an EUO request was additional verification, which required Defendant to request an EUO within fifteen (15) business days of receipt of Plaintiff’s claims (11 NYCRR 65-3.5[b]). Defendant maintained that an EUO was not an additional verification.

Pursuant to Regulation 68-C of the Insurance Department of the State of New York, “(a) [w]ithin 10 business days after receipt of the completed application for motor vehicle no-fault benefits (NYS form NF-2) or other substantially equivalent written notice, the insurer shall forward, to the parties required to complete them, those prescribed verification forms it will require prior to payment of the initial claim. (b) Subsequent to the receipt of one or more of the completed verification forms, any additional verification required by the insurer to establish proof of claim shall be requested within 15 business days of receipt of the prescribed verification [*4]forms (d) [i]f the additional verification required by the insurer is a medical examination, the insurer shall schedule the examination to be held within 30 calendar days from the date of receipt of the prescribed verification forms” (11 NYCRR 65-3.5).

Here, Regulation 68-C requires additional verification request to be sent within fifteen (15) business days of receipts of claims by insurer, except that medical examination shall be scheduled within thirty (30) calendar days of receipts of claims. However, statutes are silent as to whether an EUO constitutes “additional verification” subject to the fifteen (15) business day requirements. Although prior courts have not expressly found that EUO scheduling letters were requests for additional verification, pursuant to case law, EUO scheduling letters have been effectively treated as requests for additional verification (Urban Radiology, P.C. v Clarendon Natl. Ins. Co., 31 Misc 3d 132[A], 2011 NY Slip Op 50601[U] * 1 [App Term 2d Dept 2011]; Infinity Health Prods., Ltd. v Progressive Ins. Co., 28 Misc 3d 133[A], 2010 NY Slip Op 51334[U] *1 [App Term 2d Dept 2010]; Advanced Med., P.C. v Utica Mut. Ins. Co., 23 Misc 3d 141[A], 2009 NY Slip Op 51023[U] * 1-2 [App Term 2d Dept 2009]). Ultimately, determining whether an EUO request is or is not additional verification is irrelevant because courts have traditionally applied the fifteen (15) business day time requirement for additional verification to any request scheduling EUOs (see Great Health Care Chiropractic, P.C. v Travelers Ins. Co., 49 Misc 3d 145[A], 2015 NY Slip Op 51665[U] *1 [App Term 2d Dept 2015]; O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134[A], 2015 NY Slip Op 50476[U] *1 [App Term 2d Dept 2015]; Longevity Med. Supply, Inc. v IDS Prop. & Cas. Ins. Co., 44 Misc 3d 137[A], 2014 NY Slip Op 51244[U] *2 [App Term 2d Dept 2014]). Nevertheless, this Court adopts the tradition of viewing the EUO scheduling letter as an “additional verification” request, therefore subject to the fifteen (15) business day requirement.

Legal Issue Two, whether an insurer’s transmission of an EUO request letter within thirty (30) calendar days of receiving a claim for No Fault benefits tolls an insurer’s time to pay or deny such claim.

It is well established that in order to establish a defense that an insured failed to attend a duly scheduled EUO, an insurer must present evidence of the timely and proper mailing of the EUO scheduling letters (Nationwide Affinity Ins. Co. of Am. v George, 183 AD3d at 757; Progressive Cas. Ins. Co. v Metro Psychological Servs., P.C., 139 AD3d 693, 694 [2d Dept 2016]). This may be established with evidence of the actual mailing or by an affidavit of a person “with personal knowledge of the standard office practice for ensuring that the letters are properly addressed and mailed” (Nationwide Affinity Ins. Co. of Am. v George, 183 AD3d at 757; Progressive Cas. Ins. Co. v Metro Psychological Servs., P.C., 139 AD3d at 694).

At oral argument on April 30, 2021, Plaintiff’s counsel contended that Defendant’s initial EUO scheduling letter was untimely. Defendant’s counsel countered that the untimeliness of the EUO scheduling letter was not fatal to Defendant’s defense of Plaintiff’s nonappearance at scheduled EUOs. This Court invited counsels to submit memoranda regarding their respective positions on the timeliness of the EUO scheduling and the calculation of the times pursuant to relevant statutes.

Here, Defendant’s Explanation of Benefits to Plaintiff dated September 5, 2018 indicated receipt of Plaintiff’s bill on July 24, 2018 (see Motion, Levy Aff. Ex. P). Defendant must request additional verification “within 15 business days of receipt of the prescribed verification forms” (11 NYCRR § 65-3.5[b]; A.C. Med., P.C. v Ameriprise Ins. Co., 54 Misc 3d 127[A], 2016 NY Slip Op 51787[U] *1 [App Term 2d Dept 2016]; Great Health Care Chiropractic, P.C. v Travelers Ins. Co., 2015 NY Slip Op 51665[U] *1; Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins., 48 Misc 3d 139[A], 2015 NY Slip Op 51220[U] *1 [App Term 2d Dept 2015]; O & M Med., P.C. v Travelers Indem. Co., 2015 NY Slip Op 50476[U] *1. As Plaintiff correctly pointed out, Defendant’s first EUO scheduling letter dated August 16, 2018, which set September 18, 2018 as the date for the EUO, was two (2) business days late (see Motion, Levy Aff. Ex. E). It is noted, however, Defendant’s first EUO request was made within thirty (30) calendar days of Defendant’s receipt of Plaintiff’s claims.

Obviously, scheduling an initial EUO in excess of thirty (30) calendar days precludes Defendant from denying a claim for failure to attend an EUO (see A.C. Med., P.C. v Ameriprise Ins. Co., 2016 NY Slip Op 51787[U] *1 [more than 30 days]; Great Health Care Chiropractic, P.C. v Travelers Ins. Co., 2015 NY Slip Op 51665[U] *1 [about 50 days]; Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins., 2015 NY Sip Op 51220[U] *1 [more than 30 days]; O & M Med., P.C. v Travelers Indem. Co., 2015 NY Slip Op 50476[U] *1 [nearly 3 months]; Optimal Well-Being Chiropractic, P.C. v Ameriprise Auto & Home, 40 Misc 3d 129[A], 2013 NY Slip Op 51106[U] *2 [App Term 2d Dept 2013] [more than 70 days]). Here, although Defendant’s initial EUO scheduling letter was untimely for being two (2) business day late, its untimeliness did not exceed the thirty (30) days in which Defendant was required to pay or deny the claim, so was sufficient to toll Defendant’s time to pay or deny the claim (see A.C. Med., P.C. v Ameriprise Ins. Co., 2016 NY Slip Op 51787[U] *1; Optimal Well-Being Chiropractic, P.C. v Ameriprise Auto & Home, 2013 NY Slip Op 51106[U] *2; St. Vincent Med. Care, P.C. v Travelers Ins. Co., 26 Misc 3d 144[A], 2010 NY Slip Op 50446[U] *1 [App Term 2d Dept 2010]). Although letters that do not request verification from a plaintiff are insufficient to delay an insurer’s time to pay or deny such plaintiff’s claim (Mount Sinai Hosp. v Triboro Coach, 263 AD2d 11, 17 [2d Dept 1999]; Parsons Med. Supply Inc. v Progressive Northeastern Ins. Co., 36 Misc 3d 148[A], 2012 NY Slip Op 51649[U] *2 [App Term 2d Dept 2012]; Points of Health Acupuncture, P.C. v Lancer Ins. Co., 28 Misc 3d 133[A], 2010 NY Slip Op 51338[U] *2 [App Term 2d Dept 2010]; Alur Med. Supply, Inc. v Progressive Ins. Co., 21 Misc 3d 134[A], 2008 NY Slip Op 52191[U] *1 [App Term 2d Dept 2008]), in our instant matter, Defendant’s initial EUO scheduling letter, which requested Plaintiff’s EUO, tolled Defendant’s time to pay or deny Plaintiff’s claim (J.C. Healing Touch Rehab, P.C. v Nationwide Ins., 41 Misc 3d 141[U], 2013 NY Slip Op 52011[U] *2 [App Term 2d Dept 2013]).

Legal Issue Three: the effect of an insurer’s late transmission of request for an EUO, if such lateness defense is not precluded.

As discussed above, Defendant sent out its initial EUO scheduling letter two (2) business days late, but within thirty (30) calendar days of its receipt of Plaintiff’s claim. Such delay is not fatal to Defendant’s defense that Plaintiff did not appear for the scheduled EUO, rather, such EUO request tolled Defendant’s time to pay or deny Plaintiff’s claims.

“For the purposes of counting the 30 calendar days after proof of claim, wherein the claim becomes overdue pursuant to section 5106 of the Insurance Law, with the exception of section 65-3.6 of this Subpart, any deviation from the rules set out in this section shall reduce the 30 calendar days allowed” (11 NYCRR § 65-3.8[l]). In the context scheduling an initial EUO, as Defendant’s counsel correctly maintained during the oral argument and in his email memorandum dated May 3, 2021, any lateness of scheduling the initial EUO merely reduces the thirty (30) calendar days within which an insurer must pay or deny a claim. In our instant case, since Defendant’s initial EUO scheduling letter was two (2) business days late, Defendant’s time to pay or deny Plaintiff’s claim was reduced to twenty-eight (28) days (see Longevity Med. Supply, Inc. v IDS Prop. & Cas. Ins. Co., 2014 NY Slip Op 51244[U] *2; Eagle Surgical Supply, Inc. v Allstate Indem. Co., 41 Misc 3d 141[A], 2013 NY Slip Op 52012[U] *2 [App Term 2d Dept 2013]).

After Plaintiff failed to appear for the September 18, 2018 first EUO, Defendant timely mailed a second scheduling letter dated September 24, 2018, which scheduled the EUO for November 8, 2018 (see Motion, Levy Aff. Ex. F) (11 NYCRR § 65-3.6[b]; see Active Care Med. Supply Corp. v Ameriprise Auto & Home, 58 Misc 3d 138[A], 2017 NY Slip Op 51835[U] *2 [App Term 2d Dept 2017]; ARCO Med. NY, P.C. v Lancer Ins. Co., 34 Misc 3d 134[A], 2011 NY Slip Op 52382[U] *2 [App Term 2d Dept 2011]). By letter dated November 12, 2018, Defendant scheduled a third EUO for December 4, 2018 (see Motion, Levy Aff. Ex. G). The transcripts of the EUO proceedings (see Motion, Levy Aff. Ex. I, M and O) and affidavits of counsel assigned to conduct the EUOs appended to the motion established Plaintiff’s nonappearance at the scheduled EUOs (Nationwide Affinity Ins. Co. of Am. v George, 183 AD3d at 757; TAM Med. Supply Corp. v 21st Century Ins. Co., 57 Misc 3d 149[A], 2017 NY Slip Op 51510[U] *1 [App Term 2d Dept 2017]; First Class Med., P.C. v State Farm Mut. Auto. Ins. Co., 55 Misc 3d 141[A], 2017 NY Slip Op 50593[U] *2; National Med. & Surgical Supply, Inc. v ELRAC, Inc., 2017 NY Slip Op 50028[U] *1).

In an affidavit sworn June 11, 2019, which was appended to the Motion, Overly, Defendant’s litigation examiner, established Defendant’s claim processing and standard mailing procedures designed to ensure timely mailing of Defendant’s denial of Plaintiff’s claims after the last EUO at which Plaintiff failed to appear (Nationwide Affinity Ins. Co. of Am. v George, 183 AD3d at 757; TAM Med. Supply Corp. v 21st Century Ins. Co., 2017 NY Slip Op 51510[U] *1; First Class Med., P.C. v State Farm Mut. Auto. Ins. Co., 2017 NY Slip Op 50593[U] *2; National Med. & Surgical Supply, Inc. v ELRAC, Inc., 2017 NY Slip Op 50028[U] *1). Defendant denied Plaintiff’s claim on December 11, 2018, just seven (7) days after Plaintiff’s failure to appear for the third scheduled EUO on December 4, 2018 (see Motion, Levy Aff. Ex. Q).

As Defendant’s counsel correctly stated in its email memorandum dated May 3, 2021, even though Defendant had only twenty-eight (28) days to pay or deny Plaintiff’s claim because the initial EUO request was mailed two (2) days late, Defendant nevertheless timely denied Plaintiff’s claim, seven (7) days after Plaintiff’s non-appearance to the third scheduled EUO (Longevity Med. Supply, Inc. v IDS Prop & Cas. Ins. Co., 2014 NY Slip Op 51244[U] *2; Eagle Surgical Supply, Inc. v Allstate Indem. Co., 2013 NY Slip Op 52012[U] *2, see [*5]Nationwide Affinity Ins. Co. of Am. v George, 183 AD3d at 757).

Here, Defendant’s evidence that it requested Plaintiff’s appearance at EUOs three times, that Plaintiff failed to appear three times and that Defendant denied Plaintiff’s claim on that basis satisfied Defendant’s burden of establishing a material policy breach by Plaintiff (Nationwide Affinity Ins. Co. of Am. v George, 183 AD3d at 757; IDS Prop. Cas. Ins. Co. v Stracar Med. Servs., P.C., 116 AD3d at 1007; Interboro Ins. Co. v Clennon, 113 AD3d at 597).

Plaintiff’s Opposition to Defendant’s Motion

In opposition, Plaintiff contended that factual issues existed precluding Defendant’s motion for summary judgment, that Defendant failed to establish an objective basis for requesting an EUO, and that Defendant did not respond to Plaintiff’s objections to the EUO.

It is well established that the No-Fault regulations do not require “an insurer’s notice of scheduling an EUO to specify the reason[s] why the insurer is requiring the EUOs” (City Chiropractic, P.C. v State Farm Ins., 64 Misc 3d 134[A], 2019 NY Slip Op 51102[U] *1 [App Term 2d Dept 2019]; Bronx Chiropractic Care, P.C. v State Farm Ins., 63 Misc 3d 132[A], 2019 NY Slip Op 50423[U] *1 [App Term 2d Dept 2019]; Flow Chiropractic, P.C. v Travelers Home & Mar. Ins. Co., 44 Misc 3d 132[A], 2014 NY Slip Op 51142[U] *1 [App Term 2d Dept 2014], see Longevity Med. Supply, Inc. v Praetorian Ins. Co., 47 Misc 3d 144[A], 2015 NY Slip Op 50685[U] *1 [App Term 2d Dept 2015]). Contrary to Plaintiff’s position, Defendant responded to Plaintiff’s letters objecting to the EUOs (see Motion, Levy Aff. Ex. K and L) even though no such response is required to establish noncompliance with a scheduled EUO (see Interboro v Clennon, 113 AD3d at 597; 21st Century Pharm., Inc. v Integon Natl. Ins. Co., 69 Misc 3d 142[A], 2020 NY Slip Op 51364[U] *1 [App Term 2d Dept 2020]; Dynamic Balance Acupuncture, P.C. v State Farm Ins., 62 Misc 3d 145[A], 2019 NY Slip Op 50171[U] *1 [App Term 2d Dept 2019]). Also, contrary to Plaintiff’s argument, Defendant was not required to provide “objective reasons for requesting [an] EUO” (21st Century Pharm., Inc. v Integon Natl. Ins. Co., 2020 NY Slip Op 51364[U] *1; Gentlecare Ambulatory Anesthesia Servs. v Geico Ins. Co., 57 Misc 3d 150[A], 2017 NY Slip Op 51518[U] *1 [App Term 2d Dept 2017], see New Way Med. Supply Corp. v State Farm Mut. Auto. Ins. Co., 64 Misc 3d 136[A], 2019 NY Slip Op 51158[U]*2 [App Term 2d Dept 2019]; Dynamic Balance Acupuncture, P.C. v State Farm Ins., 2019 NY Slip Op 50171[U] *2).

Here, Plaintiff failed to raise factual issues regarding Defendant’s defense of Plaintiff’s failure to attend an EUO. This Court finds that Defendant has presented prima facie admissible evidence proving that there is no material issue of fact, that the controversy regarding Plaintiff’s claims can be decided as a matter of law (CPLR 3212 [b]; Jacobsen v New York City Health and Hosps. Corp., 22 NY3d 824 [2014]; Brill v City of New York, 2 NY3d 648 [2004]), that Plaintiff has failed to raise factual issues requiring a trial (Nationwide Affinity Ins. Co. of Am. v George, 183 AD3d at 757; Nova Chiropractic Servs., P.C. v Ameriprise Auto & Home, 58 Misc 3d 142[A], 2017 NY Slip Op 51882[U] *1 [App Term 2d Dept 2017]; K.O. Med., P.C. v IDS Prop. Cas. Ins. Co., 57 Misc 3d 145[A], 2017 NY Slip Op 51454[U] *1 [App Term 2d Dept 2017]), and that Defendant is entitled to a dismissal of Plaintiff’s claims.

B. Plaintiff’s Cross-Motion

Regarding the Cross-Motion, Plaintiff bore the burden to show it submitted the statutory claim forms indicating the fact and amount of the loss sustained and “that payment of no-fault benefits was overdue” (Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d at 501; New York Hosp. Med. Ctr. of Queens v QBE Ins. Corp., 114 AD3d 648, 648 [2d Dept 2014]; NYU-Hospital for Joint Diseases v Esurance Ins. Co., 84 AD3d 1190, 1191 [2d Dept 2011]; Fair Price Med. Supply Corp. v ELRAC Inc., 12 Misc 3d 119, 120 [App Term 2d Dept 2006]). Here, Defendant’s denial of claim forms dated December 11, 2018, acknowledging receipt of Plaintiff’s claims on July 24, 2018 (see Motion, Levy Aff. Ex. Q) constituted prima facie evidence that Defendant received Plaintiff’s claims and that the denial was overdue (see Lopes v Liberty Mut. Ins. Co., 24 Misc 3d 127[A], 2009 NY Slip Op 51279[U] *2 [App Term 2d Dept 2009]). As discussed above, however, Defendant demonstrated that Plaintiff failed to appear for scheduled EUOs which mandates a denial of Plaintiff’s Cross-Motion for summary judgment on its claims against Defendant (Actual Chiropractic, P.C. v Mercury Cas. Co., 53 Misc 3d 135[A], 2016 NY Slip Op 51435[U] *1 [App Term 2d Dept 2016]; Professional Health Imaging, P.C. v State Farm Mut. Auto. Ins. Co., 52 Misc 3d 134[A], 2016 NY Slip Op 51026[U] *1 [App Term 2d Dept 2016]; Arco Med. NY, P.C. v Lancer Ins. Co., 37 Misc 3d 90, 93 [App Term 2d Dept 2012]).

IV. Order

Accordingly, it is

ORDERED that Defendant’s Motion for summary judgment is granted and Plaintiff’s complaint is dismissed, and it is further

ORDERED that the part clerk is directed to update the court system to reflect Plaintiff’s Cross-Motion as motion seq. No.2, and it is further

ORDERED that Plaintiff’s Cross-Motion for summary judgement is denied.

This constitutes the DECISION and ORDER of the Court.

Dated: June 24, 2021
Queens County Civil Court
_____________________________________
Honorable WENDY CHANGYONG LI, J.C.C.