Summary
In Natural Therapy Acupuncture, P.C. and Bay Med., P.C., this court held that dispute resolution is not mandatory pursuant to NJSA § 39:6A–5.1(a), as implemented by NJAC § 11:3–5.
Summary of this case from St. Chiropractic, P.C. v. Geico Gen. Ins. Co.Opinion
2014-1315 Q C
12-14-2015
NATURAL THERAPY ACUPUNCTURE, P.C. as Assignee of Leila Milfort, Appellant, v. GEICO INS. CO., Respondent.
The Rybak Firm, PLLC, Brooklyn (Damin J. Toell of counsel), for appellant. Law Office of Printz & Goldstein, Woodbury (Bryan P. Fauci of counsel), for respondent.
The Rybak Firm, PLLC, Brooklyn (Damin J. Toell of counsel), for appellant.
Law Office of Printz & Goldstein, Woodbury (Bryan P. Fauci of counsel), for respondent.
Opinion
Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses B. Leverett, J.), dated May 20, 2014. 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 defendant's cross motion for summary judgment dismissing the complaint is denied; as so modified, the order is affirmed, without costs.
Plaintiff's assignor was injured in a motor vehicle accident while riding in a vehicle which was insured by a New Jersey automobile insurance policy issued by defendant. Thereafter, plaintiff commenced this action to recover, among other things, assigned first-party no-fault benefits for the services it had rendered to its assignor, alleging that its claims were unpaid. Plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint on the ground that the dispute had to be resolved by arbitration. In opposition to plaintiff's motion and in support of the cross motion, defendant addressed only the merits of plaintiff's motion, made no arguments in support of its cross motion, and did not move to compel arbitration. The Civil Court denied plaintiff's motion and granted defendant's cross motion.
Since the insurance policy at issue contains a provision that “[t]he policy and any amendments and endorsements are to be interpreted pursuant to the laws of the state of New Jersey,” New Jersey law applies (see Bay Med., P.C. v. GEICO Ins. Co., 41 Misc.3d 145[A], 2013 N.Y. Slip Op. 52084[U], 2013 WL 6510716 [App.Term, 2d, 11th & 13th Jud.Dists.2013] ). In Bay Med, P.C., this court held that dispute resolution is not mandatory pursuant to N.J.S.A. § 39: 6A–5.1 (a), as implemented by N.J.A.C. § 11:3–5.1(a), which provides that a dispute regarding the recovery of no-fault benefits may be submitted to dispute resolution upon the initiative of either party to the dispute (see also New Jersey Mfrs. Ins. Co. v. Bergen Ambulatory Surgery Ctr., 410 N.J.Super. 270, 272–273, 982 A.2d 1 2009 ). The insurance policy in question also states that a matter may be submitted to dispute resolution “on the initiative of any party to the dispute.” However, the existence of an option to arbitrate is not a ground for dismissal of a court action; such an option—if exercised by way of a motion to compel arbitration—is a ground to stay the court action (see CPLR 7503[a] ). As defendant has not moved to compel arbitration, defendant's cross motion for summary judgment dismissing the complaint should have been denied (see Bay Med., P.C. v. GEICO Ins. Co., 41 Misc.3d 145[A], 2013 N.Y. Slip Op. 52084[U], 2013 WL 6510716; Advanced Med. Diagnostics of Queens, P.C. v. GEICO Ins. Co., 38 Misc.3d 140[A], 2013 N.Y. Slip Op. 50219[U], 2013 WL 554113 [App.Term, 2d, 11th & 13th Jud.Dists.2013] ).
Contrary to plaintiff's contention, the underwriter's affidavit that defendant submitted in support of its cross motion laid a sufficient foundation to allow consideration of the exhibits annexed to the cross motion.
Inasmuch as plaintiff failed to establish, in the first instance, the medical necessity of the services rendered (see Elkins v. New Jersey Mfrs. Inc. Co., 244 N.J.Super. 695, 583 A.2d 409 1990 ) and failed to show that defendant did not properly pay any claim within 60 days after it had been furnished with written notice of the fact of a covered loss and the amount of same (see N.J.S.A. § 39:6A–5 [g] ), under New Jersey law, plaintiff's motion for summary judgment was properly denied.
Accordingly, the order is modified by providing that defendant's cross motion for summary judgment dismissing the complaint is denied.
ALIOTTA, J.P., PESCE and SOLOMON, JJ., concur.