Carothers v. Insurance Companies

13 Misc. 3d 970
CourtCivil Court of the City of New York
DecidedSeptember 21, 2006
StatusPublished
Cited by3 cases

This text of 13 Misc. 3d 970 (Carothers v. Insurance Companies) is published on Counsel Stack Legal Research, covering Civil Court of the City of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Carothers v. Insurance Companies, 13 Misc. 3d 970 (N.Y. Super. Ct. 2006).

Opinion

OPINION OF THE COURT

Peter P. Sweeney, J.

The within motions and cross motions are decided as follows:

The various motions and cross motions herein were argued before the court on August 17, 2006. The motions and cross motions concern discovery in thousands of actions to recover first-party no-fault benefits which involve millions of dollars in disputed claims. The plaintiff in all of the actions is Andrew Carothers, M.D., PC. The defendant insurance companies brought the motions seeking, inter alia, orders compelling Dr. Andrew Carothers, plaintiffs sole shareholder, to appear for examinations before trial (EBTs) on the issue of whether the plaintiff corporation, Andrew Carothers, M.D., P.C., was fraudulently incorporated within the meaning of State Farm Mut. Auto. Ins. Co. v Mallela (4 NY3d 313, 320-321 [2005]).1 Plaintiff opposes the motions and cross-moves for protective orders against the various moving defendants maintaining, inter alia, that defendants are not entitled to discovery on the issue of fraudulent incorporation because they have not shown “good [972]*972cause” for an EBT by demonstrating “behavior [on plaintiffs part] tantamount to fraud.” Plaintiff contends that under Mallela, this is what must be shown for an insurer to obtain such discovery. The motions and cross motions herein are hereby joined for disposition.

Discussion

The court disagrees with plaintiffs contention that Mallela requires an insurer to show “good cause” by demonstrating “behavior [on a medical provider’s part] tantamount to fraud” before it can obtain discovery on the issue of fraudulent incorporation. The Mallela court, referring specifically to 11 NYCRR 65-3.2 (c), stated that the Superintendent’s regulations “demand that carriers delay the payment of claims to pursue investigations solely for good cause” (Mallela, 4 NY3d at 322 [emphasis added]). The Court went on to state that “[i]n the licensing context, carriers will be unable to show ‘good caused unless they can demonstrate behavior tantamount to fraud” (id.).

11 NYCRR 65-3.2 (c) prohibits insurers from demanding “verification of facts unless there are good reasons to do so” and requires that any request for “verification of facts” be made “as expeditiously as possible.” (Emphasis added.) There is no language in the regulation indicating that its purpose is to govern discovery once actions on disputed claims have been commenced. Indeed, 11 NYCRR 65-3.2 (c) is contained in a regulation entitled “[c]laim practice principles to be followed by all insurers.” It is apparent to this court that the investigations the Court was discussing in Mallela are those conducted by insurers during the claims process in accordance with their entitlement under the regulatory scheme to seek verification of claims (11 NYCRR part 65)2 and not those conducted by litigants during the discovery process. While the Superintendent is certainly empowered to regulate investigations of claims, it is the Legislature, through the statutory pronouncements contained in article 31 of the CPLR, that regulates discovery in actions before this court (CCA 1101 [a]). The disclosure provisions contained in article 31 of the CPLR simply do not condition [973]*973discovery on a showing of “good cause”3 and if plaintiffs construction of Mallela is adopted, it would necessarily mean that 11 NYCRR 65-3.2 (c) overrides these statutory provisions. It is unfathomable that the Mallela court would have intended this result.

Further, the entire discussion in Mallela concerning “good cause” can only be viewed as nonbinding dicta. The only question the Mallela court agreed to answer was whether “ ‘a medical corporation that was fraudulently incorporated under N.Y. Business Corporation Law §§ 1507, 1508, and N.Y. Education Law § 6507(4)(c) [is] entitled to be reimbursed by insurers, under New York Insurance Law §§ 5101 et seq., and its implementing regulations, for medical services rendered by licensed medical practitioners’ (372 F3d 500, 510 [2004])” (Mallela, 4 NY3d at 320).

The court also disagrees with plaintiff’s contention that there are special rules of discovery that apply to no-fault actions. The permissible scope of discovery in a no-fault action, as in any other action commenced in this court, is governed by “[t]he procedures set forth in the CPLR relative to disclosure” (CCA 1101 [a]). The disclosure provisions in the CPLR that pertain to actions are contained in article 31, whose guiding principle is that there shall be “full disclosure of all matter material and necessary in the prosecution or defense of an action” (CPLR 3101 [a]). The words material and necessary “are ... to be interpreted liberally to require disclosure, upon request, of any facts bearing on the controversy which will assist preparation for trial by sharpening the issues and reducing delay and prolixity. The test is one of usefulness and reason” (Allen v Crowell-Collier Publ. Co., 21 NY2d 403, 406 [1968]).

This is not to say that the realities attendant to no-fault litigation should not be considered by the court in determining the scope of proper discovery in a particular case. The court is quite aware that the amount in dispute in a typical no-fault action is relatively small. While the disclosure provisions of the CPLR are ordinarily to be construed liberally, “the scope of permissible discovery is not entirely unlimited and the trial court is invested with broad discretion to supervise discovery and to [974]*974determine what is ‘material and necessary’ as that phrase is used in CPLR 3101 (a)” (NBT Bancorp v Fleet/Norstar Fin. Group, 192 AD2d 1032, 1033 [1993]; Allen v Crowell-Collier Publ. Co., 21 NY2d 403 [1968]; see also Vasile v Chisena, 272 AD2d 610 [2d Dept 2000]). “[D]iscovery determinations are discretionary; each request must be evaluated on a case-by-case basis with due regard for the strong policy supporting open disclosure” (Andon v 302-304 Mott St. Assoc., 94 NY2d 740, 747 [2000]), and, in determining which discovery devices should be available to a litigant in a particular case, “[a] sensitive balance must be struck between the intrusiveness of the discovery device and the merits, or lack thereof, of the claim” (Greater N.Y. Mut. Ins. Co. v Lancer Ins. Co., 203 AD2d 515, 517 [2d Dept 1994]).

The primary tool used by the court to control and supervise the scope of discovery in particular actions is the protective order. It is this tool, not the formulation of special rules, that should be used to regulate discovery in no-fault actions. CPLR 3103 (a) provides that “[t]he court may at any time on its own initiative, or on motion of any party or of any person from whom discovery is sought, make a protective order denying, limiting, conditioning or regulating the use of any disclosure device. Such order shall be designed to prevent unreasonable annoyance, expense, embarrassment, disadvantage, or other prejudice to any person or the courts.”

The regulation of the terms and provisions of disclosure so as to prevent abuse through the issuance of a protective order under CPLR 3103 is generally left to the sound discretion of the trial court (see, Matter of U. S. Pioneer Elecs. Corp. [Nikko Elec. Corp. of Am.], 47 NY2d 914, 916 [1979]; see also Pedone v Schlotman, 249 AD2d 526, 526 [2d Dept 1998];

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Bluebook (online)
13 Misc. 3d 970, Counsel Stack Legal Research, https://law.counselstack.com/opinion/carothers-v-insurance-companies-nycivct-2006.