McCarthy v. Commercial Union Insurance

194 Misc. 2d 295, 752 N.Y.S.2d 209, 2002 N.Y. Misc. LEXIS 1563
CourtNew York Supreme Court
DecidedDecember 3, 2002
StatusPublished
Cited by1 cases

This text of 194 Misc. 2d 295 (McCarthy v. Commercial Union Insurance) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McCarthy v. Commercial Union Insurance, 194 Misc. 2d 295, 752 N.Y.S.2d 209, 2002 N.Y. Misc. LEXIS 1563 (N.Y. Super. Ct. 2002).

Opinion

OPINION OF THE COURT

Alan L. Lebowitz, J.

Defendant’s motion for summary judgment dismissing the complaint is denied.

This action arises out of an automobile accident which occurred shortly before 11:00 p.m. on the night of February 8, 1995, when plaintiff’s vehicle came into contact with a wooden utility pole located on the north side of Richmond Terrace in the Borough of Staten Island. After initially paying 100% of plaintiff’s claims for no-fault benefits and the like, defendant, plaintiff’s insurer, issued a denial of coverage in or about December of 1995 predicated on the receipt of hospital records indicating that plaintiff’s blood alcohol level on the night in [296]*296question was .21 of one percentum by weight of alcohol, more than twice the legal limit (Vehicle and Traffic Law § 1192). This action, inter alia, to compel the payment of no-fault and supplementary uninsured motorist benefits ensued.

In moving for summary judgment dismissing the complaint, defendant maintains (1) that plaintiffs intoxication at the time of the accident constitutes a per se exclusion from coverage (see Insurance Law § 5103 [b] [2]); (2) that plaintiffs claim for supplementary uninsured motorist (SUM) benefits should be pursued through arbitration; (3) that plaintiff has failed to establish “contact” with another vehicle, a condition precedent to SUM coverage; and (4) that plaintiff failed to sustain a “serious injury” within the meaning of Insurance Law § 5102 (d).

In opposition, plaintiff asserts (1) that defendant’s purported disclaimer of coverage is untimely; (2) that the role of intoxication in the happening of the accident presents a triable issue of fact; (3) that the arbitration of a SUM claim is optional with the insured; (4) that defendant has waived its right (if any) to compel arbitration; and (5) that “serious injury” has been demonstrated, inter alia, through plaintiffs hospital and medical records.

As was previously indicated, defendant’s motion for summary judgment is denied.

Beginning with a consideration of the first issue presented, it is the determination of this court that defendant’s uncontro-verted payment of 100% of plaintiffs initial claims for no-fault benefits satisfied the requirement of both the Insurance Law and the regulations promulgated by the Superintendent of Insurance requiring an insurer either to pay or deny such claims within 30 calendar days after proof of claim is received (see Insurance Law § 5106 [a]; 11 NYCRR 65.15 [g] [3]; cf. Presbyterian Hosp. v Maryland Cas. Co., 90 NY2d 274). Under such circumstances, the initial payment of no-fault benefits must be regarded as timely (cf. 11 NYCRR 65.15 [g] [1] [i]), as must defendant’s denial of coverage on the ground of intoxication within 10 days of receipt of plaintiffs hospital records indicating the presence of blood alcohol levels well in excess of the statutory maximum on the night of the occurrence (see 11 NYCRR 65.15 [g] [5], [7]; see also 11 NYCRR 65.15 [d]). Accordingly, there is no basis in. either the Insurance Law or the Superintendent’s regulations to preclude this defendant from asserting an intoxication defense in this action (cf. Presbyterian Hosp. v Maryland Cas. Co., 90 NY2d 274, supra).

The foregoing, however, is not the end of inquiry, for even assuming arguendo that defendant’s proof of plaintiffs intoxica[297]*297tion at the time of the accident had been tendered in admissible form (but see North v Travelers Ins. Co., 218 AD2d 901, 902), it is not the fact of plaintiffs intoxication but rather the existence of a causal connection between it and the happening of the accident which triggers the exclusion1 (see Insurance Law § 5103 [b] [2]; 11 NYCRR 65.15 [m] [2] [i]; Scahall v Uni-gard Ins. Co., 222 AD2d 1070; North v Travelers Ins. Co., 218 AD2d at 902; Cernik v Sentry Ins., 131 AD2d 952). Accordingly, plaintiffs allegation that the accident occurred when an unidentified vehicle struck him in the rear, causing him to lose control of his car and strike a utility pole, presents a triable issue of fact which precludes summary judgment (see Scahall v Unigard Ins. Co., 222 AD2d at 1071; North v Travelers Ins. Co., 218 AD2d at 902; Cernik v Sentry Ins., 131 AD2d at 953).

Turning to defendant’s claim that plaintiffs attempt to recover SUM benefits can only be obtained through arbitration, it is clear from the language of defendant’s policy that in the event of a dispute regarding SUM coverage “then, at the option and upon written demand of such insured, the matter or matters upon which [the parties] * * * do not agree shall be settled by arbitration” (plaintiffs exhibit 1, at 26, para 12). There is no evidence of any such written demand by either party in the papers presently before the court. Moreover, in view of defendant’s active participation in this litigation for nearly two years, including, inter alia, its role in procuring the examinations before trial of plaintiff, his wife and his insurance agent, the former must be deemed to have waived its right (if any) to demand that the matter be resolved through arbitration (see Nishio v E.F. Hutton & Co., 168 AD2d 224; see also Sherrill v Grayco Bldrs., 64 NY2d 261, 272).

As for defendant’s alternate ground to dismiss the complaint insofar as it seeks SUM benefits, defendant maintains that plaintiff has failed to establish “contact” between himself and another vehicle, a necessary condition precedent to recovery. In this regard, defendant relies, in part, upon the absence of any reference to a second vehicle in the police report prepared at the scene (see defendant’s exhibit C), as well as plaintiffs alleged failure to comply with so much of defendant’s SUM policy endorsement as requires the

“insured or someone on the insured’s behalf to have reported the accident within 24 hours or as soon as [298]*298reasonably possible to a police, peace or judicial officer or to the Commissioner of Motor Vehicles and to have filed with the Company a statement under oath that the insured or the insured’s legal representative has a cause or causes of action arising out of such accident for damages against a person or persons whose identity is unascertainable, and setting forth the facts in support thereof’ (plaintiffs exhibit 1, at 23, para 1 [c] [2]).

Although it is uncontroverted that the police report prepared on the night of February 8,1995 makes no reference to a second or hit-and-run vehicle (see defendant’s exhibit C), plaintiff testified at his examination before trial that he lost consciousness after the accident (plaintiffs exhibit G at 25), and that he did “not really” recall speaking to the police (id. at 30). However, he testified to being hit in the rear by an unidentified vehicle at his examination before trial on March 22, 2002 (id. at 21), testimony which is not only consistent with his wife’s deposition testimony as to their conversations at the hospital during the early morning hours of February 9, 1995 (defendant’s exhibit O at 13), but the photograph of the rear of plaintiffs vehicle (plaintiffs exhibit H) and the MV-104 filed on his behalf by his insurance agent later that same day (defendant’s exhibit F).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Westchester Medical Center v. Government Employees Insurance
77 A.D.3d 737 (Appellate Division of the Supreme Court of New York, 2010)

Cite This Page — Counsel Stack

Bluebook (online)
194 Misc. 2d 295, 752 N.Y.S.2d 209, 2002 N.Y. Misc. LEXIS 1563, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mccarthy-v-commercial-union-insurance-nysupct-2002.