Court Opinion

ID: 9958735
Source: CourtListenerOpinion
Date Created: 2024-04-09 20:10:17.778517+00
Date Added: 2024-06-11T08:18:39.815314
License: Public Domain

State Farm Mut. Auto. Ins. Co. v All City Family
                  Healthcare Ctr., Inc.
               2024 NY Slip Op 31113(U)
                      April 1, 2024
           Supreme Court, New York County
        Docket Number: Index No. 154735/2020
                  Judge: Leslie A. Stroth
Cases posted with a "30000" identifier, i.e., 2013 NY Slip
 Op 30001(U), are republished from various New York
 State and local government sources, including the New
  York State Unified Court System's eCourts Service.
 This opinion is uncorrected and not selected for official
                       publication.
                                                                                                                       INDEX NO. 154735/2020
  NYSCEF DOC. NO. 132                                                                                            RECEIVED NYSCEF: 04/03/2024

                                  SUPREME COURT OF THE STATE OF NEW YORK
                                            NEW YORK COUNTY
           PRESENT:             HON. LESLIE A. STROTH                                              PART                             12M
                                                                                    Justice
           ---------------------------------------------------------------------------------X      INDEX NO.          154735/2020
            STATE FARM MUTUAL AUTOMOBILE INSURANCE
                                                                                                   MOTION DATE        11/21/2023
            COMPANY,

                                                        Plaintiff,                                 MOTION SEQ. NO.        003

                                                - V -

            ALL CITY FAMILY HEALTHCARE CENTER , INC.,ATALS
            PHYSICAL THERAPY, INC ., BACK TO BALANCE
            ACUPNCTURE , P.C.,CENTER FOR
            NEURORESTORATIVE MEDICINE, PA, CLASSIC
            MEDICAL DIAGNOSTIC REHAB, P.C .,EXCELL CLINICAL
            LAB, INC.,MICHELE B. GLISPY, LAC ., GORDON C.
            DAVIS, MEDICAL, P.C .,HEAL-RITE P.T., P.C. ,HMP
            ORTHOPAEDICS, P.C .,MAX JEAN-GILLES, PHYSICIAN ,                                         DECISION + ORDER ON
            P.C .,JOSEPH A. RAIA, M.D., P.C.,LONGEVITY MEDICAL                                              MOTION
            SUPPLY, INC.,MYOCARE P.T., P.C.,NEW MILLENNIUM
            MEDICAL IMAGING, P.C.,NEW YORK PHYSICAL
            THERAPY CARE, P.C., PDA NY CHIROPRACTIC, P.C ., ST.
            MARY FAMILY PHYSICAL THERAPY, P.C., PRC
            SUPPLIES, INC.,NEXTSTEP HEALING, INC. ,JOHN
            FRANCOIS, JEFF LOUIS , JOSUE MARCEUS, MARIE
            SYLVERT

                                                        Defendant.
           ---------------------------------------------------------------------------------X

           The following e-filed documents, listed by NYSCEF document number (Motion 003) 86, 87 , 88, 89, 90,
           91, 92 , 93, 94, 95, 96, 97, 98, 99, 100, 101 , 102, 103, 104, 105, 106, 107, 108, 109, 110, 111 , 112, 113,
           114,115, 116, 117, 118, 119
           were read on this motion to/for                                                      JUDGMENT-SUMMARY
                     Plaintiff State Farm Automobile Insurance Company commenced this action seeking a

           declaratory judgment that it owes no duty to pay the claims of the defendant medical providers.

           Claimants/Defendants John Francois, Jeff Louis, and Josue Marceus ("Claimants") sought to

           collect no fault benefits for alleged serious bodily injuries sustained in a collision that occurred

           on February 5, 2019. Claimants were occupants of a 2002 Nissan Sentra, the insured vehicle,

           which was driven by Mr. Francois and insured by plaintiff State Farm in the name of Marie

           Sylvert.
            154735/2020 STATE FARM MUTUAL AUTOMOBILE vs. ALL CITY FAMILY HEALTHCARE                                   Page 1 of 6
            Motion No. 003

                                                                           1 of 6
[* 1]
                                                                                                    INDEX NO. 154735/2020
  NYSCEF DOC. NO. 132                                                                       RECEIVED NYSCEF: 04/03/2024

                      Plaintiff moves here for summary judgment against defendants All City Family

           Healthcare Center, Inc., Back to Balance Acupuncture, P.C., Excell Clinical Lab, Inc., Michele

           B. Glispy, L.A.C., Longevity Medical Supply, Inc., Myocare P.T., P.C., PDA NY Chiropractic,

           P.C., and Nextstep Healing, Inc., arguing that no-fault regulations have been violated due to the

           failure of John Francois, Jeff Louis, and Josue Marceus to appear for scheduled examinations

           under oath (EUO) and that claimants injuries did not rise from an insured incident. 1

                      Opposition was provided by defendants All City Family Healthcare Center, Inc., Back to

            Balance Acupuncture, P.C., Michele B. Glispy, L.A.C., Longevity Medical Supply, Inc.,

           Myocare P.T., P.C., and PDA NY Chiropractic, P.C., contending that plaintiff failed to establish

           that its EUO requests were timely made or that it timely denied claimant's claims. Opposing

           defendants also argue that plaintiff offered speculation in support of its allegations and that the

           instant motion is premature as discovery is incomplete.

                      It is a well-established principle that the "function of summary judgment is issue finding,

           not issue determination" (Assafv Ropog Cab Corp., 153 AD2d 520 (1st Dept 1989), quoting

           Sillman v Twentieth Century-Fox Film Corp., 3 NY2d 395 (1957)). As such, the proponent of a

            motion for summary judgment must tender sufficient evidence to show the absence of any

           material issue of fact and the right to entitlement to judgment as a matter of law (See Alvarez v

           Prospect Hospital, 68 NY2d 320 (1986); see also Wine grad v New York University Medical

            Center, 64 NY2d 851 (1985)). "Once this showing has been made, however, the burden shifts to

           the party opposing the motion for summary judgment to produce evidentiary proof in admissible

           form sufficient to establish the existence of material issues of fact which require a trial of the

            1
                Oral argument was held for this application on November 21, 2023.
                154735/2020 STATE FARM MUTUAL AUTOMOBILE vs. ALL CITY FAMILY HEALTHCARE             Page 2 of 6
                Motion No. 003

                                                             2 of 6
[* 2]
                                                                                                   INDEX NO. 154735/2020
  NYSCEF DOC. NO. 132                                                                      RECEIVED NYSCEF: 04/03/2024

            action" (Alvarez v Prospect Hosp., 68 NY2d 320 (1986); citing Zuckerman v City of New York,

            49 NY2d 557 (1980)).

                   New York No-Fault Regulation, 11 NYCRR 65-1.1 states, in pertinent part, "[n]o action

            shall lie against [a No-Fault insurer] unless, as a condition precedent thereto, there shall have

            been compliance with the terms of [the] coverage" and that "[u]pon request by the Company, the

            eligible injured person or that person's assignee or representative shall ... (b) as may reasonably

            be required submit to examinations under oath by any person named by the Company and

            subscribe the same." The failure to appear for a scheduled EUO is a breach of a condition

            precedent under a no-fault policy, and a denial of coverage premised on such a breach voids the

            policy ab initio (See Unitrin Advantage Ins. Co. v Bayshore Physical Therapy, PLLC, 82 AD3d

            559 (1st Dept 2011)).

                   A no-fault insurer seeking a declaration of no coverage due to claimants' failures to

            appear for EUO requested under the no-fault policy must demonstrate that the insurer complied

            with the procedural and timeliness requirements of 11 NYCRR 65-3.5, governing the handling of

            no-fault claims (See American Transit Ins. Co. v. Longevity Med. Supply, Inc., 131 AD3d 841

            (1st Dept 2015)). To do so, the no-fault insurer must submit an affidavit of a person with

            personal knowledge that the mailing of the EUO letters occurred and describe the standard office

            practice or procedure used to ensure that items were properly addressed and mailed (See New

            York & Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 54 7 (2nd Dept 2006); Residential Holding

            Corp. v Scottsdale Ins. Co., 286 AD2d 679 (2nd Dept 2001); Hospital for Joint Diseases v

            Nationwide Mut. Ins. Co., 284 AD2d 374 (2nd Dept. 2001)).

                   Opposing defendants contend that, pursuant to 11 NYCRR 65-3.5 and 11 NYCRR 65-

            3 .6, plaintiff failed to request an EUO within 15-days ofreceipt of the claim forms or the NF-2,

             154735/2020 STA TE FARM MUTUAL AUTOMOBILE vs. ALL CITY FAMILY HEALTHCARE              Page 3 of 6
             Motion No. 003

                                                          3 of 6
[* 3]
                                                                                                   INDEX NO. 154735/2020
  NYSCEF DOC. NO. 132                                                                       RECEIVED NYSCEF: 04/03/2024

            follow-up within 10-days, and issue a proper denial under 11 NYCRR 65-3.8. "An insurer must

            request any additional verification ... to establish proof of claim within 15 business days after

            receiving the prescribed verification forms it forwarded to the parties required to complete them"

            (Hertz Vehicles, LLC v. Best Touch PT, P.C., 162 A.D.3d 617 (1 st Dept 2018)).

                   In support of its application, State Farm provided an Affidavit by Andrea Hutchinson, a

            Claim Specialist affirming that plaintiff conducted an investigation, noting the following

            discrepancies:

                   The insured's policy had an address of 133 Jay Street, Albany, New York 12210, while
                   State Farm suspects Ms. Sylvert resides at 2416 New Kirk Avenue, Apt. lF, Brooklyn,
                   New York; the insured was not an occupant of the insured vehicle during the time of the
                   loss; a person named Ron Castorina resides at the policy address and informed plaintiff
                   that the insured does not reside there and that his address was previously used by her
                   without his permission; according to the police report, the insured vehicle is still
                   registered with the prior owner Berny Cean; Ms. Sylvert initially told State Farm that she
                   did not know of the February 5th collision and that it was a fraudulent claim; and the 2002
                   Nissan was deemed junked, without knowledge of State Farm.

            As a result, plaintiff argues that the insured made a material misrepresentation in procuring her

            policy. State Farm also claims that the subject collision was intentional, the injuries did not arise

            from the collision, and that treatment by defendant medical providers are not causally related to

            the collision, which are all non-coverable events under no-fault regulations.

                   Plaintiff proved that it timely and properly sent the EUO letters to claimants, through the

            affidavit of Ms. Hutchinson after State Farm received claims on April 15, 2019. Plaintiff also

            submitted an affirmation by Michael E. Tomsky, Esq. in support of this motion. In addition,

            State Farm demonstrated that John Francois, Jeff Louis, and Josue Marceus failed to appear for

            any of the scheduled Examinations Under Oath. Plaintiff mailed letters dated April 16, 2019,

            May 8, 2019, and May 28, 2019 to Mr. Francois requesting that he appear for an EUO (Exhs E &

            F). Mr. Louis was mailed letters on April 16, 2019, April 18, 2019, and May 8, 2019, requesting

             154735/2020 STATE FARM MUTUAL AUTOMOBILE vs. ALL CITY FAMILY HEALTHCARE                Page 4 of 6
             Motion No. 003

                                                          4 of 6
[* 4]
                                                                                                 INDEX NO. 154735/2020
  NYSCEF DOC. NO. 132                                                                    RECEIVED NYSCEF: 04/03/2024

            that he appear for an EUO (Exhs E & G). Finally, plaintiff mailed letters dated April 16, 2019,

            May 8, 2019, and May 30, 2019 to Mr. Marceus requesting that he appear for an EUO (Exhs E &

            H).

                   Opposing defendants failed to provide any affidavit to create a material issue of fact (See

            GTF Marketing Inc. v Colonial Aluminum Sales. Inc., 66 NY2d 965 ( 1985) ("As we have

            previously noted, an affidavit or affirmation of an attorney without personal knowledge of the

            facts cannot 'supply the evidentiary showing necessary to successfully resist the motion."). As

            plaintiff provided an affidavit and affirmation from individuals with personal knowledge of the

            mailing of the EUO letters and of claimants' non-appearance, it satisfies its burden of proving

            that the letters were mailed and that the claimants failed to appear (See Hertz Corp v Active Care

            Med. Supply Corp., 124 AD3d 411 (1st Dept 2015) ). Plaintiff also provided proof of denial (Exh

            J).

                   Furthermore, since claimants did not appear at their timely-scheduled Examinations

            Under Oath, violating a condition precedent to coverage, the policy is vitiated (See PV Holding

            Corp. v Hank Ross Med., P.C., 188 AD3d 429 (1st Dept 2020)). Therefore, plaintiff is entitled to

            summary judgment on its declaratory judgment claims against defendants All City Family

            Healthcare Center, Inc., Back to Balance Acupuncture, P.C., Excell Clinical Lab, Inc., Michele

            B. Glispy, L.A.C., Longevity Medical Supply, Inc., Myocare P.T., P.C., PDA NY Chiropractic,

            P.C., and Nextstep Healing, Inc.

                                                  *      *        *
                   Accordingly, it is hereby

                   ORDERED, that plaintiffs motion for summary judgment against defendants All City

            Family Healthcare Center, Inc., Back to Balance Acupuncture, P.C., Excell Clinical Lab, Inc.,

             154735/2020 STATE FARM MUTUAL AUTOMOBILE vs. ALL CITY FAMILY HEALTHCARE             Page 5 of 6
             Motion No. 003

                                                         5 of 6
[* 5]
                                                                                                    INDEX NO. 154735/2020
  NYSCEF DOC. NO. 132                                                                       RECEIVED NYSCEF: 04/03/2024

            Michele B. Glispy, L.A.C., Longevity Medical Supply, Inc., Myocare P.T., P.C., PDA NY

            Chiropractic, P.C., and Nextstep Healing, Inc. is granted in its entirety; and it is further

                   ORDERED, that plaintiff shall be entitled to a judgment declaring that it owes no duty to

            pay the no-fault claims of defendants All City Family Healthcare Center, Inc., Back to Balance

            Acupuncture, P.C., Excell Clinical Lab, Inc., Michele B. Glispy, L.A.C., Longevity Medical

            Supply, Inc., Myocare P.T., P.C., PDA NY Chiropractic, P.C., and Nextstep Healing, Inc. with

            respect to the February 5, 2019 collision; and it is further

                   ORDERED that, within 30 days of the date of this order, plaintiff is directed to submit a

            proposed order and judgment in accordance with this decision via NYSCEF.

                   The foregoing constitutes the decision and order of the Court.

            Dated: April 1, 2024

            Check One:               D     Case Disposed                   0     Non-Final Disposition

            Check if Appropriate:    D     Other (Specify
                                                            -------------------
                                                                                                                   )

             154735/2020 STATE FARM MUTUAL AUTOMOBILE vs. ALL CITY FAMILY HEALTHCARE                 Page 6 of 6
             Motion No. 003

                                                            6 of 6
[* 6]