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A.B. Med. Servs. v. Lumbermens Mut. Cas. Co.

Appellate Term of the Supreme Court of New York, Second Department
Jun 30, 2004
2004 N.Y. Slip Op. 50692 (N.Y. App. Term 2004)

Opinion

2003-1071 KC.

Decided June 30, 2004.

Appeal by plaintiffs from an order of the Civil Court, Kings County (L. Baily-Schiffman, J.), entered May 12, 2003, which denied their motion for summary judgment.

Order unanimously affirmed with $10 costs.

PRESENT: ARONIN, J.P., GOLIA and RIOS, JJ.


Plaintiffs commenced this action to recover first-party no-fault benefits for medical services they allegedly provided to their injured assignor. In support of their motion, plaintiffs submitted an affidavit in which David Safir stated that he is the "practice and billing manager of plaintiff," even though there are four distinct plaintiffs in this matter. Although A.B. Medical Services, PLLC and D.A.V. Chiropractic P.C. have the same business address, Daniel Kim's Acupuncture, P.C. and Royalton Chiropractic P.C. have different addresses. The affidavit does not indicate for which plaintiff he is the practice and billing manager, and this court cannot assume that he is acting on behalf of one particular plaintiff, or on behalf of all of the plaintiffs. Consequently, this affidavit is insufficient to establish that plaintiffs provided defendant with properly completed claim forms ( A.B. Med. Servs. v. Allstate Ins. Co., 3 Misc 3d 129 [A], 2004 NY Slip Op 50373 [U] [App Term, 2d 11th Jud Dists]). As a result, plaintiffs' motion for summary judgment was properly denied inasmuch as plaintiffs did not satisfy their burden of establishing a prima facie entitlement to judgment as a matter of law ( see Alvarez v. pect Hosp., 68 NY2d 320, 324; Winegrad v. New York Univ. Med. Center, 64 NY2d 851, 853; Zuckerman v. City of New York, 49 NY2d 557, 562; A.B. Med. Servs., 3 Misc 3d 129 [A], 2004 NY Slip Op 50373 [U]).

We further note that where an insurer adequately establishes that it possesses a "founded belief that the alleged injury does not arise out of an insured incident" ( Central Gen. Hosp. v. Chubb Group of Ins. Cos., 90 NY2d 195, 199), it may assert a fraudulent scheme, such as a staged accident, as a viable defense inasmuch as it is not an insured incident ( id.).


Summaries of

A.B. Med. Servs. v. Lumbermens Mut. Cas. Co.

Appellate Term of the Supreme Court of New York, Second Department
Jun 30, 2004
2004 N.Y. Slip Op. 50692 (N.Y. App. Term 2004)
Case details for

A.B. Med. Servs. v. Lumbermens Mut. Cas. Co.

Case Details

Full title:A.B. MEDICAL SERVICES PLLC D.A.V. CHIROPRACTIC P.C. DANIEL KIM'S…

Court:Appellate Term of the Supreme Court of New York, Second Department

Date published: Jun 30, 2004

Citations

2004 N.Y. Slip Op. 50692 (N.Y. App. Term 2004)