Opinion
2005-612 K C.
Decided February 1, 2006.
Appeal from a judgment of the Civil Court of the City of New York, Kings County (Ann E. O'Shea, J.), entered January 3, 2005. The judgment, after a nonjury trial, awarded plaintiff the principal sum of $1,522.50, and dismissed defendants' counterclaim.
Judgment affirmed without costs.
PRESENT: PESCE, P.J., WESTON PATTERSON and BELEN, JJ.
Plaintiff sought payment of $1,522.50 for orthodontic services rendered to defendants' daughter, Tiffany. Defendants counterclaimed for $575, the amount they had paid to plaintiff, alleging "professional misconduct, misrepresentation [and] unnecessary prolonged treatment." The orthodontic services were provided pursuant to a signed form financial agreement which listed an "estimated insurance payment" of $1,500. Defendants paid $575 to plaintiff prior to the start of Tiffany's treatment. Defendants' family was covered by a MetLife health insurance plan, which included dental benefits. Ultimately, MetLife denied coverage because plaintiff did not participate in its plan.
At trial, plaintiff's office manager testified that when defendants had their initial visit to the office, she explained to them that plaintiff was not a participating provider, and that they would be responsible for any amounts not paid by MetLife. Over the course of several months, the office manager submitted numerous claims to the carrier, some more than once, and each of the claims was denied on the ground that the treatment was not covered under the policy. The office manager was finally told by a MetLife representative that the claims were denied because plaintiff was out-of-network. When informed of MetLife's denial of coverage, defendants refused to pay plaintiff. Mrs. Chan testified that their refusal to pay was based upon plaintiff's initial representation that he accepted MetLife insurance and that his fees would be covered by the carrier.
A person who executes a contract is presumed to know its contents and to assent to them ( see Moon Choung v. Allstate Ins. Co., 283 AD2d 468). The financial agreement which Mrs. Chan signed sufficiently advised her that defendants would be responsible for any charges which were not paid by her insurer. Moreover, it was up to defendants to know what their insurance policy covered by reading its provisions and by making inquiries of the insurer if they had any questions ( see Metzger v. Aetna Ins. Co., 227 NY 411, 416). Furthermore, the trial court found credible the testimony of plaintiff's office manager that she verbally informed Mrs. Chan of her responsibility for any amounts not covered by MetLife. Thus, even if plaintiff told defendants that he accepted MetLife insurance, this did not relieve defendants of their responsibility to pay plaintiff should his fees not be covered.
To the extent that defendants contend that plaintiff violated sections 349, 350 and 350-b of the General Business Law, those statutes are inapplicable to the instant case. With respect to their counterclaim, which we construe as one sounding in dental malpractice, as the trial court noted, defendants failed to demonstrate at trial that plaintiff's treatment of Tiffany was a departure from good and accepted dental practice. Accordingly, we find that the trial court did not err in awarding judgment to plaintiff and dismissing the counterclaim.
Pesce, P.J., and Weston Patterson, J., concur.
Belen, J., taking no part.