Opinion
2013-532 Q C
12-02-2015
Compas Medical, P.C. as Assignee of Valdine Sance, Appellant, v. Praetorian Ins. Co., Respondent.
PRESENT: :
Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered February 20, 2013. The order denied plaintiff's motion for summary judgment and granted defendant's cross motion for summary judgment dismissing the complaint.
ORDERED that the order is modified by providing that the branch of defendant's cross motion seeking summary judgment dismissing plaintiff's third cause of action is denied; as so modified, the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. The Civil Court denied plaintiff's motion, granted the branch of defendant's cross motion seeking summary judgment dismissing plaintiff's third cause of action as premature because plaintiff had failed to provide requested verification, and granted the branches of defendant's cross motion seeking summary judgment dismissing the remaining causes of action due to the failure of plaintiff's assignor to appear for independent medical examinations (IMEs) and examinations under oath (EUOs).
In support of the branch of defendant's cross motion seeking summary judgment dismissing plaintiff's third cause of action, defendant submitted an affidavit by its claims examiner which established that defendant had timely mailed its verification request and follow-up verification request (see St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Defendant also demonstrated prima facie that it had not received the requested verification and thus that plaintiff's third cause of action is premature (see 11 NYCRR 65-3.8 [a]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]). However, in opposition to the cross motion, plaintiff submitted an affidavit from plaintiff's owner, which affidavit was sufficient to give rise to a presumption that the requested verification had been mailed to and received by defendant (Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]). In light of the foregoing, there is a triable issue of fact as to whether this cause of action is premature (see Healing Health Prods., Inc. v New York Cent. Mut. Fire Ins. Co., 44 Misc 3d 59 [App Term, 2d, 11th & 13th Jud Dists 2014]).
Contrary to plaintiff's contention, defendant established that the IME scheduling letters had been timely mailed (see St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]), and that plaintiff's assignor had failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Since defendant demonstrated that plaintiff's assignor had failed to comply with a condition precedent to coverage (id. at 722) and that defendant had timely denied (see St. Vincent's Hosp. of Richmond, 50 AD3d 1123; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16) the claims underlying the remaining causes of action on that ground, defendant was entitled to summary judgment dismissing the remaining causes of action. In light of the foregoing, we need not pass upon plaintiff's contention that defendant failed to establish that plaintiff's assignor had failed to appear for duly scheduled EUOs, which alleged nonappearance was another basis for the denial of these claims.
Accordingly, the order is modified by providing that the branch of defendant's cross motion seeking summary judgment dismissing plaintiff's third cause of action is denied.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: December 02, 2015