Reported in New York Official Reports at Kamara Supplies v GEICO Gen. Ins. Co. (2021 NY Slip Op 01848)
| Kamara Supplies v GEICO Gen. Ins. Co. |
| 2021 NY Slip Op 01848 [192 AD3d 588] |
| March 25, 2021 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| Kamara Supplies, as Assignee of Lisa Sanchez,
Appellant, v GEICO General Ins. Co., Respondent. |
Gary Tsirelman, P.C., Brooklyn (Stefan Belinfanti of counsel), for appellant.
Law Office of Goldstein, Flecker & Hopkins, Melville (Lauren Hirschfeld of counsel), for respondent.
Order, Appellate Term, First Department, entered on or about April 13, 2020, which affirmed an order of the Civil Court, New York County (Judy H. Kim, J.), entered April 18, 2019, granting defendant’s motion to vacate, in effect, so much of a judgment, same court (Carol R. Sharpe, J.), entered May 25, 2018, as awarded plaintiff attorneys’ fees pursuant to Insurance Department Regulations (11 NYCRR) § 65-4.6 (c) (former 11 NYCRR 65-4.6 [d]), unanimously reversed, on the law, with costs, and the matter remanded for further proceedings and an amended judgment in accordance herewith.
The issue before us in this action to recover first-party No-Fault insurance benefits is whether the failure of an eligible injured person (EIP) to attend an independent medical examination (IME) is a “policy issue” for the purpose of the no-fault insurance law denial of claim (NYS NF-10) form, as prescribed by 11 NYCRR Appendix 13, and an award of hourly attorneys’ fees, as provided by 11 NYCRR 65-4.6 (c). We conclude that an EIP’s failure to attend an IME is a “policy issue” and therefore that plaintiff may be awarded attorneys’ fees pursuant to 11 NYCRR 65-4.6 (c). However, we remand the matter to Civil Court for further proceedings, as explained below.
“Eligible Injured Person” is defined in the Mandatory Personal Injury Protection Endorsement (MPIPE) that must be contained in every motor vehicle owner’s policy of liability insurance (11 NYCRR 65-1.1 [d]). The MPIPE also sets forth certain conditions of and exclusions from coverage. For example, under the subheading “Proof of Claim. Medical, Work Loss, and Other Necessary Expenses” (subpara d), the MPIPE says, “The [EIP] shall submit to medical examination by physicians selected by, or acceptable to, the Company, when, and as often as, the Company may reasonably require.”
The NYS NF-10 form lists eight “policy issue” reasons for denial of claim: “Policy not in force on date of accident” (box 3); “Injured person excluded under policy conditions or exclusion” (box 4); “Policy conditions violated” (box 5 [a] and [b]), referring to late notices of claim; “Injured person not an ‘Eligible Injured Person’ ” (box 6); “Injuries did not arise out of use or operation of a motor vehicle” (box 7); and “Claim not within the scope of your election under Optional Basic Economic Loss coverage” (box 8).
We find that “policy conditions or exclusion” under which the injured person is excluded from coverage in the “policy issue” reason in box 4 of the NYS NF-10 form refers to the conditions and exclusions of the MPIPE (11 NYCRR 65-1.1 [d]), which include, as noted above, that an EIP must submit to IMEs as required by the insurer. We therefore conclude that an IME no-show defense is a box 4 reason for denial. An EIP who does not attend an IME fails to satisfy a condition precedent to coverage under the policy, voiding the policy ab initio (PV Holding Corp. v Hank Ross Med., P.C., 188 AD3d 429, 430 [1st Dept 2020]). Thus, an insurer who denies a claim [*2]for first-party No-Fault benefits on the basis of the injured person’s failure to attend an IME properly does so by checking box 4 on the denial of claim form, and therefore an injured person’s failure to attend an IME is a “policy issue” both according to the denial of claim form and for purposes of awarding attorneys’ fees under 11 NYCRR 65-4.6 (c). We are unpersuaded by the reasoning of other courts that have reached the contrary conclusion. We also note that it is unclear to what the terms “policy conditions or exclusion” as used in box 4 of the denial of claim form refer, if not to the policy conditions and exclusions listed in the MPIPE.
Moreover, statutes and regulations must be interpreted in a manner that does not render them meaningless, unreasonable, or absurd (see McKinney’s Cons Laws of NY, Book 1, Statutes § 145; Long v State of New York, 7 NY3d 269, 273 [2006]). For this reason, we also reject the overly restrictive reading of 11 NYCRR 65-4.6 (c) urged by defendant, which would interpret “a policy issue as enumerated on the prescribed denial of claim form” (id.) as referring only to those specific justifications delineated on the form, and only as they are delineated on the form. That interpretation would both render some of the reasons on the denial of claim form meaningless and require the Department of Financial Services effectively to reproduce the MPIPE on the form to capture all the possible reasons for which a No-Fault benefits claim may be denied.
Although we conclude, for the foregoing reasons, that plaintiff may be awarded attorneys’ fees in this case under 11 NYCRR 65-4.6 (c), it is entirely unclear from the record whether the amount that was awarded was calculated correctly. There is no documentation supporting plaintiff’s claim for attorneys’ fees, the parties’ calculations as to the amount of attorneys’ fees owed and due differ irreconcilably, and it is uncertain whether the unpaid amount of the judgment was, in fact, unpaid attorneys’ fees in the first place. Accordingly, upon remittal, Civil Court should ascertain the amount of attorneys’ fees owed to plaintiff under 11 NYCRR 65-4.6 (c) and whether any amount either thereof or of the judgment as a whole remains outstanding, crediting defendant for the payments that it has already made. Concur—Renwick, J.P., Mazzarelli, Singh, González, JJ. [Prior Case History: 67 Misc 3d 129(A), 2020 NY Slip Op 50414(U).]
Reported in New York Official Reports at Matter of Country-Wide Ins. Co. v TC Acupuncture, P.C. (2021 NY Slip Op 01120)
| Matter of Country-Wide Ins. Co. v TC Acupuncture, P.C. |
| 2021 NY Slip Op 01120 [191 AD3d 557] |
| February 18, 2021 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| In the Matter of Country-Wide Insurance Company,
Respondent, v TC Acupuncture, P.C., as Assignee of Darrius Williams, Appellant. |
Gary Tsirelman, P.C., Brooklyn (Gary Tsirelman of counsel), for appellant.
Jaffe & Velazquez LLP, New York (Thomas Torto of counsel), for respondent.
Order, Supreme Court, New York County (Lynn R. Kotler, J.), entered June 8, 2018, which, in effect, granted reargument and adhered to the original determination, which granted the petition to vacate a master arbitrator’s award in favor of respondent, unanimously reversed, on the law, without costs, the petition denied, the master arbitrator’s award confirmed, and the matter remanded for a determination of respondent’s attorneys’ fees.
Although the motion court purported to deny respondent’s motion for reargument, it effectively granted the motion by addressing the merits. Accordingly, the order is appealable (CPLR 5701 [a] [2] [viii]; Castillo v Mount Sinai Hosp., 140 AD3d 619, 620 [1st Dept 2016], lv denied 28 NY3d 913 [2017]).
As respondent argued, the court overlooked existing authority confirming that CPLR 7511 (b) limits courts’ vacatur of arbitration awards to circumstances not present in this case (see Matter of New York State Correctional Officers & Police Benevolent Assn. v State of New York, 94 NY2d 321, 326 [1999] [“(E)ven in circumstances where an arbitrator makes errors of law or fact, courts will not assume the role of overseers to conform the award to their sense of justice”]).
The order that vacated the arbitration award cited no basis for vacatur under CPLR 7511 (b), finding only that the arbitrator and master arbitrator applied the wrong burden of proof to plaintiff’s fraudulent incorporation defense. Although on reargument the motion court determined that this Court’s decision in Country-Wide Ins. Co. v TC Acupuncture, P.C. (140 AD3d 643 [1st Dept 2016]), decided June 28, 2016, could not apply to the petition decided on June 9, 2016, Country-Wide did not state a new proposition of law, but merely cited existing authority (id. at 643-644 [“Even assuming, without deciding, that the master arbitrator applied the wrong burden of proof, the award is not subject to vacatur on that ground”], citing New York State Correctional Officers, 94 NY2d at 326).
Respondent is entitled to its reasonable attorneys’ fees on appeal (11 NYCRR 65-4.10 [j] [4]; Matter of Country-Wide Ins. Co. v TC Acupuncture P.C., 179 AD3d 414, 415 [1st Dept 2020]). We therefore remand the matter to Supreme Court for the calculation of those fees. Concur—Renwick, J.P., Kern, Singh, Shulman, JJ.
Reported in New York Official Reports at Unitrin Direct Ins. Co. v Beckles (2020 NY Slip Op 06974)
| Unitrin Direct Ins. Co. v Beckles |
| 2020 NY Slip Op 06974 [188 AD3d 620] |
| November 24, 2020 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| Unitrin Direct Insurance Company, Appellant, v Alan Dennis Beckles, M.D., et al., Defendants, and Jules Francois Parisien, M.D., et al., Respondents. |
Goldberg, Miller & Rubin P.C., New York (Eli Shmulik and Harlan R. Schreiber of counsel), for appellant.
The Rybak Firm PLLC, Brooklyn (Maksim Leyvi of counsel), for respondents.
Order, Supreme Court, New York County (Melissa A. Crane, J.), entered on or about November 1, 2019, which denied summary judgment on plaintiff’s first cause of action for a declaration disclaiming coverage for no-fault benefits sought by defendants-respondents Jules Francois Parisien, M.D. and SP Orthotic Surgical & Medical Supply, Inc., unanimously reversed, on the law, with costs, the motion granted, and it is declared that plaintiff has no coverage obligation for no-fault benefits sought by the defendants-respondents. The Clerk is directed to enter judgment accordingly.
Where, as here, the insurer submits evidence of a medical provider claim (NF-3), the timely request for an independent medical examination (IME) of the injured claimant within 15 days of the receipt of that claim, and the injured claimant is a no-show at two duly noticed IMEs, the basis for disclaimer of coverage is established, as a matter of law, and summary judgment is properly awarded to the insurer with respect to further coverage obligations and reimbursement of outstanding medical bills with respect to all treating providers (see Kemper Independence Ins. Co. v Adelaida Physical Therapy, P.C., 147 AD3d 437 [1st Dept 2017]; National Liab. & Fire Ins. Co. v Tam Med. Supply Corp., 131 AD3d 851 [1st Dept 2015]). Concur—Renwick, J.P., Kapnick, Gesmer, Kern, JJ.
Reported in New York Official Reports at Matter of Global Liberty Ins. Co. of N.Y. v Avangard Supply, Inc. (2020 NY Slip Op 06855)
| Matter of Global Liberty Ins. Co. of N.Y. v Avangard Supply, Inc. |
| 2020 NY Slip Op 06855 [188 AD3d 568] |
| November 19, 2020 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| In the Matter of Global Liberty Insurance Company of New
York, Appellant, v Avangard Supply, Inc., et al., Respondents. |
The Law Office of Jason Tenenbaum, P.C., Garden City (Jason Tenenbaum of counsel), for appellant.
Samandarov & Associates, P.C., Floral Park (David M. Gottlieb of counsel), for respondents.
Order, Supreme Court, Bronx County (Alison Y. Tuitt, J.), entered January 15, 2020, which denied the petition to vacate a master arbitration award, dated June 17, 2019, affirming the no-fault arbitrator’s award of no-fault benefits to respondents, and dismissed the proceeding brought pursuant to CPLR article 75, unanimously affirmed, without costs, and the matter remanded to Supreme Court for a determination of respondents’ reasonable attorneys’ fees for this appeal.
The no-fault arbitrator found that petitioner’s vague and conclusory explanation that the denial was based on an independent medical examination which did not support reimbursement, without providing any of the examination’s findings, or checking boxes on the NF-10 form to indicate that the denial was based on a lack of medical necessity, was insufficient. The master arbitrator reviewed the no-fault arbitrator’s determination and the parties’ submissions, and confirmed the no-fault arbitrator’s award of benefits to respondent assignees. Supreme Court, reviewing the findings of the master and no-fault arbitrators, correctly found that the award was rational, and was not arbitrary and capricious (see Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d 207, 211 [1981]; Matter of Rose Castle Redevelopment II, LLC v Franklin Realty Corp., 184 AD3d 230, 234 [1st Dept 2020]; Azrielant v Azrielant, 301 AD2d 269, 275 [1st Dept 2002], lv denied 99 NY2d 509 [2003]). Petitioner’s vague declination of benefits lacked the degree of specificity required by statute and case law, which provide that insurers must clearly inform applicants of their position regarding disputed matters by “appris[ing] the claimant with a high degree of specificity of the ground or grounds on which the disclaimer is predicated” (General Acc. Ins. Group v Cirucci, 46 NY2d 862, 864 [1979]; see 11 NYCRR 65-3.2 [e]). Respondents are entitled to reasonable attorneys’ fees for this appeal, to be determined by Supreme Court (see Matter of Country-Wide Ins. Co. v Bay Needle Acupuncture, P.C., 167 AD3d 404 [1st Dept 2018]; 11 NYCRR 65-4.10 [j] [4]). Concur—Webber, J.P., González, Scarpulla, Shulman, JJ.
Reported in New York Official Reports at Unitrin Advantage Ins. Co. v Cohen & Kramer M.D., P.C. (2020 NY Slip Op 06474)
| Unitrin Advantage Ins. Co. v Cohen & Kramer M.D., P.C. |
| 2020 NY Slip Op 06474 [188 AD3d 511] |
| November 12, 2020 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| Unitrin Advantage Insurance Company,
Appellant, v Cohen & Kramer M.D., P.C., Respondent. |
Goldberg, Miller & Rubin, P.C., New York (Harlan R. Schreiber of counsel), for appellant.
Slotnick & Ashkenazy, LLP, Rockville Centre (Howard J. Stern of counsel), for respondent.
Order, Supreme Court, New York County (Lynn R. Kotler, J.), entered on or about August 1, 2019, which, in this action pursuant to Insurance Law § 5106 (c) for de novo review of a master arbitrator’s award, denied plaintiff insurer’s motion for summary judgment declaring it has no obligation to pay no-fault benefits to defendant medical provider, and granted defendant’s cross motion for summary judgment confirming the arbitration award, unanimously reversed, on the law, without costs, to grant plaintiff’s motion and to deny defendant’s cross motion. The Clerk is directed to enter judgment declaring in plaintiff’s favor.
Plaintiff insurer’s evidence, including affidavits attesting in detail to the regular business procedures and practices in the handling of its no-fault claims, including providing notice of scheduled IME exams to claimants, together with the mailing ledgers, which were signed and date-stamped by U.S. Postal Service employees, and listed therein IME notices received for mailing to the claimant here at his resident address, provided sufficient proof of proper mailing to support a presumption that the IME notices were received by the claimant (see Badio v Liberty Mut. Fire Ins. Co., 12 AD3d 229 [1st Dept 2004]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2d Dept 2001]). Although the notices incorrectly added the designation “1st Floor” to the address, there is no dispute that the address was otherwise correct and that claimant resided at that building (see Cadle Co. v Tri-Angle Assoc., 18 AD3d 100 [1st Dept 2005]).
The burden on the motion having shifted, defendant failed to offer any evidence in opposition, such as an affidavit from the claimant disavowing receipt of the IME notices or even describing the building composition in a manner that would support an inference that the inclusion of a floor in the address would result in nonreceipt. Plaintiff thus established that the injured claimant failed to appear for three properly scheduled IMEs, constituting breach of a condition precedent to no-fault coverage, warranting the denial of defendant’s claims to no-fault benefits for its medical services rendered to the claimant (see 11 NYCRR 65-1.1; Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559 [1st Dept 2011], lv denied 17 NY3d 705 [2011]). Concur—Kapnick, J.P., Mazzarelli, Moulton, Mendez, JJ.
Reported in New York Official Reports at Kemper Independence Ins. Co. v AB Med. Supply, Inc. (2020 NY Slip Op 06209)
| Kemper Independence Ins. Co. v AB Med. Supply, Inc. |
| 2020 NY Slip Op 06209 [187 AD3d 671] |
| October 29, 2020 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| Kemper Independence Insurance Company,
Appellant, v AB Medical Supply, Inc., et al., Respondents, et al., Defendants. |
Goldberg, Miller & Rubin, P.C., New York (Eli Shmulik of counsel), for appellant.
The Rybak Firm, PLLC, Brooklyn (Maksim Leyvi of counsel), for respondents.
Order, Supreme Court, New York County (Lynn R. Kotler, J.), entered on or about December 10, 2019, which denied as premature plaintiff’s motion for summary judgment declaring that it is not obligated to reimburse defendants-respondents for no-fault claims submitted in connection with a motor vehicle accident, unanimously affirmed, without costs.
Plaintiff no-fault insurer failed to provide the injured claimant’s assignees with the “specific objective justification” for its request that the injured claimant submit to an examination under oath (EUO) to establish proof of claim (11 NYCRR 65-3.5 [e]; see American Tr. Ins. Co. v Jaga Med. Servs., P.C., 128 AD3d 441 [1st Dept 2015]). As the criteria by which plaintiff determined that an EUO was required constitute facts unavailable to defendants for use in opposing plaintiff’s motion, the motion was premature (CPLR 3212 [f]). Moreover, as the court noted, plaintiff moved for summary judgment before any depositions had been conducted (see e.g. Blech v West Park Presbyt. Church, 97 AD3d 443 [1st Dept 2012]).
We have considered plaintiff’s remaining contentions and find them unavailing. Concur—Renwick, J.P., Gesmer, Kern, Singh, JJ.
Reported in New York Official Reports at Global Liberty Ins. Co. v Laruenceau (2020 NY Slip Op 05851)
| Global Liberty Ins. Co. v Laruenceau |
| 2020 NY Slip Op 05851 [187 AD3d 570] |
| October 20, 2020 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| Global Liberty Insurance Company,
Appellant, v Gabriel Laruenceau et al., Defendants, and Longevity Medical Supply, Inc., et al., Respondents. |
The Law Office Jason Tenenbaum, P.C., Garden City (Jason Tenenbaum of counsel), for appellant.
The Law Office of Melissa Betancourt, P.C., Brooklyn (Jamin Koo of counsel), for Longevity Medical Supply Inc., respondent.
Kopelevich & Feldsherova, P.C., Brooklyn (David Landfair of counsel), for Jamaica Wellness Medical, P.C., and LVOV Acupuncture, P.C., respondents.
Order, Supreme Court, Bronx County (Wilma Guzman, J.), entered on or about September 30, 2019, which, to the extent appealed from as limited by the briefs, denied plaintiff’s motion to renew its motion for summary judgment declaring in its favor against defendants Longevity Medical Supply, Inc., Jamaica Wellness Medical, P.C., United Wellness Chiropractic, P.C., and Lvov Acupuncture, P.C., unanimously reversed, on the law, without costs, the motion for renewal granted and, upon renewal, the motion for summary judgment granted. The Clerk is directed to enter judgment declaring that plaintiff owes no coverage to said defendants.
Plaintiff provided a policy of insurance to VIP Limousine & Tuxedo, Inc. (VIP) that included a no-fault endorsement to an insured or eligible person for necessary expenses resulting from a motor vehicle accident. In April 2014, one of VIP’s limousines was hit in the rear by another car. Thereafter, the driver and passengers of the limousine (the individual defendants) filed claims as eligible persons under the policy issued by plaintiff, and later assigned their rights to the no-fault benefits to various medical providers (medical provider defendants).
Plaintiff moved for summary judgment, asserting that the accident was staged and therefore, none of the individual defendants or the medical provider defendants were entitled to benefits under the policy. Supreme Court denied the motion, finding that plaintiff failed to demonstrate as a matter of law that the accident was fraudulently or intentionally procured.
Plaintiff moved to renew its prior motion for summary judgment. In support of its motion to renew, plaintiff submitted additional evidence that the accident was staged in the form of a videotape confession by one of the passengers, which it had procured, after extensive motion practice, from the Police Department, Department of Financial Services, Insurance Fraud Bureau (DFS), and Kings County District Attorney’s Office. Supreme Court denied renewal on the grounds that plaintiff failed to offer any reasonable explanation as to why the videotape could not have been attached to its prior motion, and that the videotape was not properly authenticated for purposes of summary judgment.
Plaintiff appealed. We now reverse finding that renewal should have been granted in the interests of justice and substantive fairness (see Ross v Lewis, 181 AD3d 423, 424 [1st Dept 2020]; Cruz v Bronx Lebanon Hosp. Ctr., 73 AD3d 597, 598 [1st Dept 2010]; Rancho Santa Fe Assn. v Dolan-King, 36 AD3d 460, 461 [1st Dept 2007]). “Although it is true that a motion to renew should generally be based upon newly-discovered facts, this rule is not inflexible, and the court has discretion to grant renewal in the interest of justice even upon facts that were known to the movant at the time the original motion was made” (Kaszar v Cho, 160 AD3d 501, 502 [1st Dept 2018]).
Here, plaintiff demonstrated that the additional evidence it submitted in support of its motion to renew would change the prior determination and that it was required to engage in extensive motion practice to obtain the material. Plaintiff also established that it was unaware of the nature and extent of the information held by those agencies before then (CPLR 2221 [e] [2], [3]). The material, which included statements by the passengers who assigned their claims to defendants, proves that the motor vehicle accident was staged (see Matter of Global Liberty Ins. Co. of N.Y. v Eveillard, 171 AD3d 749, 750-751 [2d Dept 2019]; CPLR 2221 [e]).
Contrary to defendants’ contentions, the videotape of the confession of one of the defendants who participated in the scheme and the statements others provided to the police and DFS are admissible as party admissions (see People v Soto, 26 NY3d 455, 461 [2015]; People v Caban, 5 NY3d 143, 150-151 n [2005]). Plaintiff demonstrated the authenticity of this material by proof of the complete chain of custody (see People v Price, 29 NY3d 472, 481-482 [2017]).
Defendants failed to submit any evidence controverting plaintiff’s proof that the accident was staged. Concur—Kapnick, J.P., Singh, Kennedy, Mendez, JJ.
Reported in New York Official Reports at Kemper Independence Ins. Co. v Cornerstone Chiropractic, P.C. (2020 NY Slip Op 03876)
| Kemper Independence Ins. Co. v Cornerstone Chiropractic, P.C. |
| 2020 NY Slip Op 03876 [185 AD3d 468] |
| July 9, 2020 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| Kemper Independence Insurance Company,
Appellant, v Cornerstone Chiropractic, P.C., et al., Defendants, and JS Medical, P.C., et al., Respondents. |
Goldberg, Miller & Rubin, P.C., New York (Timothy R. Bishop of counsel), for appellant.
Order, Supreme Court, New York County (Barbara Jaffe, J.), entered December 20, 2018, which denied plaintiff’s motion for summary judgment declaring that defendants JS Medical, P.C. and Wert Specialty Orthopedics, P.C. (together, defendants) have no right to collect no-fault benefits from plaintiff with respect to the subject accident, and granted defendants’ cross motion for summary judgment to the extent of dismissing the complaint as against JS, unanimously reversed, on the law, without costs, plaintiff’s motion granted and defendants’ motion denied, and it is declared that defendants have no right to collect said no-fault benefits.
The claimants’ failure to subscribe and return the transcripts of their examinations under oath (EUOs) violated a condition precedent to coverage and warranted denial of the claims (see Hereford Ins. Co. v Forest Hills Med., P.C., 172 AD3d 567 [1st Dept 2019]). This is so notwithstanding plaintiff’s failure to present proof of proper delivery of the denials (see Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 [1st Dept 2011], lv denied 17 NY3d 705 [2011]). Plaintiff is entitled to summary judgment on the additional ground that defendants failed to appear at two scheduled EUOs (see Hertz Vehs. LLC v Significant Care, PT, P.C., 157 AD3d 600 [1st Dept 2018]; Mapfre Ins. Co. of N.Y. v Manoo, 140 AD3d 468 [1st Dept 2016], appeal withdrawn 29 NY3d 995 [2017]). Considering the brevity of the delay and JS’s ultimate failure to appear, we find that plaintiff’s “one-day tardiness in issuing its follow-up request for the EUO scheduled for” JS was “a technical defect excusable under 11 NYCRR 65-3.5 (p)” (Z.M.S. & Y. Acupuncture, P.C. v Geico Gen. Ins. Co., 56 Misc 3d 926, 930 [Civ Ct, Kings County 2017]). Concur—Friedman, J.P., Renwick, Gische, Mazzarelli, Moulton, JJ.
Reported in New York Official Reports at Kamara Supplies v GEICO Gen. Ins. Co. (2020 NY Slip Op 50414(U))
against
GEICO General Insurance Co., Defendant-Respondent.
Plaintiff appeals from an order of the Civil Court of the City of New York, New York County (Judy H. Kim. J.), entered April 18, 2019, which granted defendant’s motion to vacate so much of the judgment as awarded plaintiff attorneys’ fees pursuant to 11 NYCRR § 65-4.6(c).
Per Curiam.
Order (Judy H. Kim, J.), entered April 18, 2019, affirmed, with $10 costs.
Upon the trial of this action, the court determined that plaintiff-provider established its entitlement to no-fault benefits in the amount of $4,590.72 and that defendant-insurer failed to establish its independent medical examination (IME) no-show defense. This determination is not challenged on appeal. The issue before us is whether plaintiff, who is entitled to attorneys’ fees pursuant to the governing Insurance Department Regulations (see 11 NYCRR § 65-4.6), is entitled to said fees pursuant to the standard fee provision contained 11 NYCRR § 65-4.6(d), which limits attorneys’ fees to 20% of the amount recovered, subject to a then-maximum fee of $850 (now $1,360), or pursuant to the hourly rate fee provision contained in 11 NYCRR § 65-4.6(c). Civil Court held that the standard fee provision contained in section 65-4.6(d) applies in this case. We agree, and therefore affirm.
The hourly rate fee provision contained in 11 NYCRR § 65-4.6(c) governs disputes where “one of the issues involves a policy issue as enumerated on the prescribed denial of claim form(NYS form NF-10)” (emphasis added). However, the “policy issues” enumerated on the denial of claim form at bar are clearly limited to include only: (1) the policy was not in force on the date of the accident (box 3); (2) the injured person is excluded under policy conditions or exclusion (box 4); (3) the policy conditions were violated, which is limited to two categories involving late submission of a notice of claim (box 5); (4) the injured person is not an eligible injured person (box 6); (5) and the injuries did not arise out of use or operation of a motor vehicle (box 7).
The language of 11 NYCRR § 65-4.6(c) and the specifically enumerated policy issues on the denial of claim form are clear and unambiguous; patently they do not include the assignor’s [*2]failure to attend an IME. Therefore, plaintiff was not entitled to hourly attorneys’ fees pursuant to 11 NYCRR 65-4.6(c). Since the standard fee provision applies to “all other disputes” (11 NYCRR § 65-4.6[d]), it was properly applied in this case.
Plaintiff’s arguments to the contrary do not warrant a different result. While the failure to attend an IME “is a breach of a condition precedent to coverage under the no-fault policy” (Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 [2011], lv denied 17 NY3d 705 [2011]), it is not a “policy issue as enumerated on the prescribed denial of claim form” (11 NYCRR § 65-4.6[c]). Nor is defendant’s characterization of its defense as a policy issue dispositive. Construing the regulation strictly, as we must since it is in derogation of the common law rule that parties to a controversy pay their own counsel fees (see McKinney’s Cons Laws of NY, Book 1, Statutes, § 301[a]; Matter of A.G. Ship Maintenance Corp. v Lezak, 69 NY2d 1, 5 [1986]), hourly attorneys’ fees are allowable where one of the specifically enumerated policy issues is involved, not whether one party designates a particular defense as a policy issue.
The opinion letters issued by Department of Financial Services (DFS) relied upon by plaintiff do not interpret the counsel fees regulation at issue. Nor did DFS explicitly state, in interpreting its own regulations, that the failure of the assignor to appear for an IME constitutes a “policy violation” so as to trigger additional attorneys’ fees under Insurance Department Regulations (11 NYCRR § 65-4.6[c]).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concur I concur I concur
Decision Date: April 13, 2020
Reported in New York Official Reports at Matter of Global Liberty Ins. Co. of N.Y. v Capital Chiropractic, P.C. (2020 NY Slip Op 01466)
| Matter of Global Liberty Ins. Co. of N.Y. v Capital Chiropractic, P.C. |
| 2020 NY Slip Op 01466 [181 AD3d 429] |
| March 3, 2020 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
[*1]
| In the Matter of Global Liberty Insurance Company of
New York, Appellant, v Capital Chiropractic, P.C., as Assignee of Oliver Rigor, Respondent. |
Law Office of Jason Tenenbaum, P.C., Garden City (Jason Tenenbaum of counsel), for appellant.
Fazio, Rynsky & Associates, LLP, Syosset (Svetlana Sobel of counsel), for respondent.
Order, Supreme Court, Bronx County (Donna Mills, J.), entered April 16, 2019, which denied the petition to vacate a master arbitrator’s award, unanimously reversed, on the law, without costs, and the petition granted.
The master arbitrator’s award was arbitrary in that it irrationally ignored well-established precedent that “the no-fault policy issued by petitioner was void ab initio due to respondent’s assignor’s failure to attend duly scheduled independent medical exams” (Matter of Global Liberty Ins. Co. of N.Y. v Top Q. Inc., 175 AD3d 1131, 1131 [1st Dept 2019]; see Matter of Global Liberty Ins. Co. v Professional Chiropractic Care, P.C., 139 AD3d 645, 646 [1st Dept 2016]; Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d 559, 560 [1st Dept 2011], lv denied 17 NY3d 705 [2011]). Concur—Renwick, J.P., Gische, Kern, Singh, JJ.