Source: https://casetext.com/case/am-transit-ins-co-v-brune
Timestamp: 2019-04-21 14:56:51+00:00

Document:
AMERICAN TRANSIT INSURANCE COMPANY, v. LUCAS BRUNE, et al.
HON. LYNN R. KOTLER, J.S.C.
Action Against Company. No action shall lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with the terms of this coverage. Additionally, the policy and New York State Insurance Regulation 68 further provide that: The eligible injured person shall submit to an Independent Medical Examination by physicians selected by, or acceptable to, the Company when, and as often as, the Company may reasonably require. Brune alleged that he received medical treatment from the Providers, and assigned the rights to collect no-fault benefits to the medical provider defendants under claim number 783626-02 under the policy relating to the July 18, 2015 motor vehicle accident. Brune also has sought to collect no-fault benefits in his own right. ATIC received Brune's claims for no-fault benefits on an NF-2 form dated August 19, 2015, and a letter of representation from his attorney on August 19, 2015. By letters dated August 28, 2015 and September 23, 2015, ATIC wrote to Brune's attorneys requesting that Brune appear for IMEs by Drs. Michael Russ and Corey Stein on September 22, 2015 and October 6, 2015. ATIC submits affidavits from Sandra Joseph and Luis Campbell attesting to its mailing procedures and with personal knowledge of Brune"s failure to appear for IMEs. In addition, ATIC submits the affidavits of Dr. Russ and Dr. Stein, at whose offices Brune failed to appear for his IMEs. Lynn Hershman, an employee of Independent Physical Exam Referrals, Inc., also submits an affidavit attesting to the fact that she mailed notices to Brune and that she received notification that he failed to appear. ATIC's "Denial of Claims Form" (NF-10), signed and dated October 23, 2015, denied benefits to Brune based on his failure to appear for scheduled IMEs. ATIC commenced the captioned action by filing a summons and verified complaint April 14, 2016. Plaintiff alleges its served all corporate defendants pursuant to CPLR Article 3 by serving the New York Secretary of State on July 21, 2016 and affidavits of service were filed with the clerk of the court on August 12, 2016. ATIC alleges that Brune was personally served with the summons and complaint at his home on July 20, 2016. Plaintiff also submits proof that all defendants were served with an additional copy of the summons and verified complaint by mail March 16, 2017. Furthermore, ATIC asserts that the defendants served with summons and complaint have failed to appear, plead or proceed in this action and that the time set forth by law for the defendants to answer or appear has expired and has not been extended by the Court. Therefore, ATIC argues that it is entitled to a default judgment against Brune and the defaulting medical Providers pursuant to CPLR 3215. CPLR 3215 provides that the movant is required to submit proof of service of the summons and complaint, proof of the facts constituting the claim, and proof of the defaulting party's default in answering or appearing." See Atlantic Cas. Ins. Co. v RJNJ Servs. Inc., 89 AD3d 649, 651, 932 N.Y.S.2d 109 (2d Dept 2011). Here, ATIC has submitted proof that it properly served the defendants with copies of the summons and complaint pursuant to CPLR Article 3 on July 20, 2016 and July 21, 2016, respectively and that the affidavits of service were duly filed with the Clerk of the Court. Additionally, all defendants were served with an additional copy of the summons and complaint as per CPLR 3215. Defendants have failed to answer or otherwise appear as required within 20 days and their time to answer has not been extended by this Court. Accordingly, defendants Brune and Providers have defaulted in this action. Declaratory judgment actions "'will not be granted on the default and pleadings alone'" but require that the "'plaintiff establish a right to a declaration against . . . a defendant.'" Levy v Blue Cross & Blue Shield of Greater N.Y. 124 AD2d 900, 902, 508 N.Y.S.2d 660 (3d Dept 1986), quoting National Sur. Corp. v Peccichio, 48 Misc2d 77, 78, 264 N.Y.S.2d 177 (Sup Ct Albany County 1965)." de Beeck v Costa, 39 Misc3d 347, 959 N.Y.S.2d 628 (Sup Ct New York County 2013). While a default in answering the complaint constitutes an admission of the factual allegations therein, and the reasonable inferences which may be made therefrom (Rokina Optical Co., Inc. v. Camera King, Inc., 63 NY2d 728 ), plaintiff is entitled to default judgment in its favor, provided it otherwise demonstrates that it has a prima facie cause of action (Gagen v. Kipany Productions Ltd., 289 AD2d 844 [3d Dept 2001]). An application for a default judgment must be supported by either an affidavit of facts made by one with personal knowledge of the facts surrounding the claim (Zelnick v. Biderman Industries U.S.A., Inc., 242 AD2d 227 [1st Dept 1997]; and CPLR § 3215[f]) or a complaint verified by a person with actual knowledge of the facts surrounding the claim (Hazim v. Winter, 234 AD2d 422 [2d Dept 1996]; and CPLR § 105 [u]). ATIC has demonstrated that it has a prima case as set forth herein. Here, ATIC has shown, through proof of timely mailing in compliance with all no-fault requirements, the scheduling of IMEs and its timely filing of its denials of coverage under the policy, proof of Brune's failure to appear on two occasions for duly noticed and scheduled IMEs, and through the filing of its verified amended complaint, that it has met its prima facie entitlement to a judgment declaring that defendant Brune and the Provider Defendants are not entitled to no-fault coverage for the subject claims due to Brune's having breached a condition precedent to coverage under No-Fault Regulation 11 NYCRR 65-1.1 . Base on the foregoing, Brune is not an "eligible injured person" entitled to no-fault benefits under the American Transit policy.
Any requested relief not expressly addressed herein has nonetheless been considered and is hereby expressly denied and this constitutes the decision and order of the Court.

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