King's Med. Sup. Inc. v. Kemper Auto Home Ins.

10 Citing cases

  1. Barshay v. State Farm Ins.

    14 Misc. 3d 74 (N.Y. App. Term 2006)   Cited 39 times

    Defendant alleged that it requested that assignor submit to an examination under oath (EUO) in December 2001. However, "the insurance regulations in effect prior to April 5, 2002 did not provide for EUOs as a form of verification" ( A.M. Med. Servs., P.C. v Nationwide Mut. Ins. Co., 12 Misc 3d 143 [A], 2006 NY Slip Op 51425[U] [App Term, 2d 11th Jud Dists 2006]; see also King's Med. Supply v Kemper Auto Home Ins. Co., 3 Misc 3d 131 [A], 2004 NY Slip Op 50401[U] [App Term, 2d 11th Jud Dists 2004]), and the absence of an EUO provision in the former verification scheme "may [not] be remedied by reference to policy provisions requiring that an insured cooperate with the insurer's investigation of a claim, even if a clause therein explicitly provides for cooperation in that form" ( Melbourne Med., P.C. v Utica Mut. Ins. Co., 4 Misc 3d 92, 93 [App Term, 2d 11th Jud Dists 2004]).

  2. JUL POL CORP. v. TRUMBULL INS. CO.

    2006 N.Y. Slip Op. 50580 (N.Y. App. Term 2006)

    In any event, proper verification requests would have been untimely at that point. Moreover, defendant's notices for examinations under oath did not toll the statutory period inasmuch as the applicable insurance regulations did not contain a provision entitling an insurer to an examination under oath ( see King's Med. Supply v. Kemper Auto Home Ins. Co., 3 Misc 3d 131 [A], 2004 NY Slip Op 50401[U] [App Term, 2d 11th Jud Dists]; cf.11 NYCRR 65-3.5 [e], eff. Apr. 5, 2002). Inasmuch as defendant failed to timely pay or deny the claim, it is precluded from raising most defenses ( see Presbyterian Hosp. in City of N.Y. v. Maryland Cas. Co., 90 NY2d 274).

  3. Ocean Diagnostic Imaging P.C.

    2005 N.Y. Slip Op. 51080 (N.Y. App. Term 2005)

    The burden then shifted to defendant to show a triable issue of fact ( see Alvarez v. Prospect Hosp., 68 NY2d 320, 324). It is uncontroverted that defendant denied plaintiff's claim more than two months after its receipt. The court below properly determined that defendant's requests for examinations under oath did not toll the 30-day claim determination period inasmuch as the insurance regulations in effect at the time lacked a provision entitling an insurer to an examination under oath ( see King's Med. Supply v. Kemper Auto Home Ins. Co., 3 Misc 3d 131[A], 2004 NY Slip Op 50401[U] [App Term, 2d 11th Jud Dists]; A.B. Med. Servs. PLLC v. State Farm Mut. Auto. Ins. Co., 4 Misc 3d 141[A], 2004 NY Slip Op 51031[U] [App Term, 9th 10th Jud Dists]).

  4. GPM Chiropractic, P.C. v. ST FM Mut. Ins. Co.

    2005 N.Y. Slip Op. 50861 (N.Y. App. Term 2005)

    Consequently, defendant is precluded from raising most defenses ( see Central Gen. Hosp. v. Chubb Group of Ins. Cos., 90 NY2d 195; Presbyterian Hosp. in City of N.Y. v. Maryland Cas. Co., 90 NY2d 274, 282), including any deficiency in the assignments ( see New York Hosp. Med. Ctr. of Queens v. New York Cent. Mut. Fire Ins. Co., 8 AD3d 640; Presbyterian Hosp. in City of N.Y. v. Aetna Cas. Sur. Co., 233 AD2d 433; A.B. Med. Servs. PLLC. v. Nationwide Mut. Ins. Co., 6 Misc 3d 70 [App Term, 2d 11th Jud Dists 2004]). Moreover, defendant's requests for examinations under oath did not toll the 30-day claim determination period inasmuch as the applicable insurance regulations did not contain a provision entitling an insurer to an examination under oath ( see King's Med. Supply v. Kemper Auto Home Ins. Co., 3 Misc 3d 131[A], 2004 NY Slip Op 50401[U] [App Term, 2d 11th Jud Dists]).

  5. Ocean Diag. Imaging P.C. v. Utica Mut. Ins.

    2005 N.Y. Slip Op. 50611 (N.Y. App. Term 2005)

    It is uncontroverted that defendant denied plaintiff's claim more than two months after it received said claim. Contrary to defendant's contention, however, its requests for examinations under oath did not toll the 30-day claim determination period inasmuch as the insurance regulations in effect at the time lacked a provision entitling an insurer to an examination under oath ( see King's Med. Supply v. Kemper Auto Home Ins. Co., 3 Misc 3d 131 [A], 2004 NY Slip Op 50401[U] [App Term, 2d 11th Jud Dists]; A.B. Med. Servs. PLLC v. State Farm Mut. Auto Ins. Co., 4 Misc 3d 141 [A], 2004 NY Slip Op 51031[U] [App Term, 9th 10th Jud Dists]).

  6. Ocean Diag. Imaging P.C. v. Allstate Ins.

    2005 N.Y. Slip Op. 50181 (N.Y. App. Term 2005)

    Moreover, defendant did not establish a reasonable excuse for its default inasmuch as defendant failed to offer any excuse for its failure to oppose plaintiff's motion which sought a default judgment ( see O'Shea v. Bittrolff, 302 AD2d 439). Furthermore, defendant also failed to demonstrate the existence of a meritorious defense ( see King's Med. Supply v. Kemper Auto Home Ins. Co., 3 Misc 3d 131[A], 2004 NY Slip Op 50401[U] [App Term, 2d 11th Jud Dists 2004]; S M Supply, Inc. v. GEICO Ins., 2003 NY Slip Op 51192[U] [App Term, 2d 11th Jud Dists]). In light of the foregoing, we find that the court improvidently exercised its discretion when it granted defendant's motion to vacate the default judgment entered against it ( see Epps v. LaSalle Bus, 271 AD2d 400).

  7. Melbourne Med. v. UTICA INS.

    4 Misc. 3d 92 (N.Y. App. Term 2004)

    A new regulation, effective April 5, 2002, which explicitly provides for such verification, is inapplicable to the instant claim (see 11 NYCRR 65-3.5 [e]; Kings Med. Supply Inc. v GEICO Ins., 4 Misc 3d 138[A], 2004 NY Slip Op 50904[U] [App Term, 2d & 11th Jud Dists]). We have also rejected the argument that the absence of an EUO provision in the former verification scheme may be remedied by reference to policy provisions requiring that an insured cooperate with the insurer's investigation of a claim, even if a clause therein explicitly provides for cooperation in that form (e.g. King's Med. Supply v Kemper Auto & Home Ins. Co., 3 Misc 3d 131[A], 2004 NY Slip Op 50401[U] [App Term, 2d & 11th Jud Dists]). Such provisions may not be invoked to alter the terms of the mandatory no-fault endorsement because the "internally complete and distinct part of the insurance policy . . . cannot be qualified by. . . conditions . . . of the liability portions of the policy" (Utica Mut. Ins. Co. v Timms, 293 AD2d 669, 670 [2002]; A.B. Med. Servs. v State Farm Mut. Auto. Ins. Co., 3 Misc 3d 130[A], 2004 NY Slip Op 50387[U] [App Term, 2d & 11th Jud Dists]).

  8. Brentwood Pain Reab. Servs. v. Prog. Ins.

    2009 N.Y. Slip Op. 31881 (N.Y. Sup. Ct. 2009)   Cited 1 times

    that the insurance regulations in effect prior to April 5, 2002 did not authorize EUOs ( see Webster Diagnostic Medicine, P.C. v State Farm Ins. Co., 15 Misc 3d 97 [App Term, 2nd Dept 2007] ["(T)he insured had no obligation to appear for an examination under oath because 'at the applicable time, the insurance regulations contained no authorization for examinations under oath'" (citation omitted)]; Oleg Barshay, D.C., P.C. v State Farm Ins. Co., 14 Misc 3d 74 [App Term, 2d Dept 2006] ["an absence of an EUO provision in the former verification scheme 'may (not) be remedied by reference to policy provisions requiring that an insured cooperate with the insurer's investigation of a claim . . .'" (citation omitted)]; Ocean Diagnostic Imaging P.C. v State Farm Mut. Auto. Ins. Co., 9 Misc 3d 73 [App Term, 2d Dept 2005] ["(U)nder the applicable prior regulations (11 NYCRR 65.12 [e]), defendant had no right to request an EUO"]; King's Med. Supply v Kemper Auto Home Ins. Co., 3 Misc 3d 131 [A], 2004 NY Slip Op 50401[U] [App Term, 2d 11th Jud Dists 2004] [EUOs were not available as a form of verification by the Insurance Regulations in effect prior to April 5, 2002; nor may an insurer base its right to an EUO on the policy provisions providing for "cooperation"]; King's Medical Supply Inc. v Progressive Ins., 3 Misc 3d 126 [A], 2004 NY Slip Op 50311[U] (App Term, 2d 11th Jud Dists 2004]).

  9. E. Acupuncture v. Allstate

    8 Misc. 3d 849 (N.Y. Civ. Ct. 2005)   Cited 5 times

    The former insurance regulations, 11 NYCRR 65.15, apply to claims submitted before April 5, 2002. ( See King's Med. Supply, Inc. v. Kemper Auto Home Ins. Co., 3 Misc 3d 131[A], 2004 NY Slip Op 50401[U] [App Term, 2d 11th Jud Dists 2004].) With regard to the date that interest accrues on an overdue no-fault claim, the applicable provisions of the former insurance regulations require the same analysis as the new regulations.

  10. Melbourne Med. v. Utica Ins. Co.

    4 Misc. 3d 92 (N.Y. Sup. Ct. 2004)

    A new regulation, effective April 5, 2002, which explicitly provides for such verification, is inapplicable to the instant claim ( see 11 NYCRR 65-3.5 [e]; Kings Med. Supply Inc. v. GEICO Ins., 4 Misc 3d 138[A], 2004 NY Slip Op 50904[U] [App Term, 2d 11th Jud Dists]). We have also rejected the argument that the absence of an EUO provision in the former verification scheme may be remedied by reference to policy provisions requiring that an insured cooperate with the insurer's investigation of a claim, even if a clause therein explicitly provides for cooperation in that form ( e.g. King's Med. Supply v. Kemper Auto Home Ins. Co., 3 Misc 3d 131[A], 2004 NY Slip Op 50401[U]