Metropolitan Radiological Imaging, P.C. v. State Farm Mutual Automobile Insurance

7 Misc. 3d 675
CourtCivil Court of the City of New York
DecidedFebruary 17, 2005
StatusPublished
Cited by4 cases

This text of 7 Misc. 3d 675 (Metropolitan Radiological Imaging, P.C. v. State Farm Mutual Automobile Insurance) 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
Metropolitan Radiological Imaging, P.C. v. State Farm Mutual Automobile Insurance, 7 Misc. 3d 675 (N.Y. Super. Ct. 2005).

Opinion

OPINION OF THE COURT

Charles J. Markey, J.

The instant controversy raises issues of immense importance governing the permissible scope of discovery in litigation for no-fault first-party benefits. To illustrate the significance of the legal issues posed, this court has consolidated six motions only for purposes of this decision.

The six cases have several common denominators. An insurer has served multiple discovery notices on a plaintiff assignee medical provider of no-fault first-party benefit services. In each of the six motions, an insurer seeks to strike plaintiff’s complaint or to preclude plaintiff from testifying at trial for failing to respond to the discovery notices or to compel answers to the various demands. In the six motions, although the movant insurers attached copies of the pleadings, they failed to attach copies of the NF-10, the all-important denial of claim form (11 NYCRR 65-3.8), or a timely demand for verification, the NF-3 or NF-5, or demand for additional verification (11 NYCRR 65-3.5). In none of the motions was there a discussion by the movant insurers of the relevancy of the information sought, especially in terms of a timely denial or a timely demand for verification. In each of the motions, however, the plaintiffs counsel not only failed to cross-move for a protective order, but also did not oppose the motion or even appear in court on the return date.

The legal issues of first impression raised by the six consolidated motions require resolution of the permissible scope of discovery in no-fault litigation, definition of a barometer or yardstick by which to measure whether a discovery request in a no-fault action is legitimate or simply vexatious and oppressive, and, finally, a determination of the degree of judicial tolerance to be afforded to a palpably improper discovery demand despite a plaintiff’s inaction. These issues are of weighty magnitude because of the thousands of no-fault cases that arise each year throughout this state and the discovery disputes that arise therefrom.

In these six actions for no-fault benefits, a health care provider who rendered medical or chiropractic treatment to the [677]*677plaintiffs patient, in exchange for an assignment of the patient’s right to collect no-fault benefits, seeks recovery from a defendant insurer. The No-Fault Law replaced the common-law right to seek tort recovery with a statutory system designed to provide “a quick, sure and efficient system for obtaining compensation for economic loss suffered as a result of [automobile] accidents” (Walton v Lumbermens Mut. Cas. Co., 88 NY2d 211, 214 [1996]).

Prior to discussing the specifics of each of the motions, a review of the rubrics in No-Fault Law is essential in arriving at judicial holdings in this controversy. First, an insurer must make a timely denial of benefits within 30 days of receipt of a claim in a denial of claim form, the NF-10, or must have timely demanded a verification. Failure to do so will result in a defendant insurer waiving all defenses — except for those of lack of coverage and fraud — to a claim and thus exposing itself to a successful plaintiffs summary judgment motion (Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195 [1997]; A.B. Med. Servs. PLLC v Nationwide Mut. Ins. Co., 6 Misc 3d 70 [App Term, 2d Dept 2004]; Diagnostic Rehab. Medicine Serv. P.C. v Travelers Indem. Co., 6 Misc 3d 685 [App Term, 2d Dept 2004]; King’s Med. Supply Inc. v Country-Wide Ins. Co., 5 Misc 3d 767 [Civ Ct, Kings County 2004]).

No better case illustrates the importance of mailing a timely denial or timely demand for a verification than the Court of Appeals decision in Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co. (90 NY2d 274 [1997] [4-3 decision]). In that case, although it was later established that the plaintiffs assignor was legally drunk at the time of the motor vehicle accident, the High Court sustained a medical provider’s entitlement to summary judgment. The insurer’s failure to issue a timely denial or a timely demand for verification was deemed a waiver of all defenses and did not even entitle the insurer to responses to a demand for written interrogatories. During the requisite period for issuing a denial or demand for a verification, “the carrier chose to sit on its rights and do nothing in this respect” {id. at 280).

The Court of Appeals in Presbyterian Hosp. stated that “a core and essential objective” of the insurance regulations is “to provide a tightly timed process of claim, disputation and payment” {id. at 281). The Court of Appeals, in pertinent part, stated:

“No-fault reform was enacted to provide prompt uncontested, first-party insurance benefits . . . The [678]*678tradeoff of the no-fault reform still allows carriers to contest ill-founded, illegitimate and fraudulent claims, but within a strict, short-leashed contestable period and process designed to avoid prejudice and red-tape dilatory practices.” (Id. at 285.)

Although the insurer actually later procured proof that the assignor was legally drunk while operating a motor vehicle— certainly conduct that offends our State’s public policy and criminal law — the Court of Appeals refused to permit the assertion of a late defense of intoxication and even to allow discovery on the issue. Since the insurer failed to adhere to the “tightly timed process” (id. at 281), the Court of Appeals expressly did not let the defendant insurer “string out belated and extra bites at the apple” (id. at 286).

The importance of a timely denial is underscored by the Appellate Division’s recent decision forbidding an insurer from relying on a prior blanket denial that simply stated that it would dishonor further claims. In A & S Med. P.C. v Allstate Ins. Co. (15 AD3d 170 [1st Dept 2005]), an insurer’s failure to deny a specific claim in timely fashion, despite a previously issued blanket denial that advised that all future claims would be rejected, warranted the grant of a medical provider’s motion for summary judgment.

An insurer’s denial must be made “with a high degree of specificity of the ground or grounds on which the disclaimer is predicated,” and an insurer will not be permitted to assert a defense not specifically made in the NF-10, even though a denial of claim may have been previously issued in a timely manner (General Acc. Ins. Group v Cirucci, 46 NY2d 862, 864 [1979] [per curiam]; accord Paul M. Maintenance, Inc. v Transcontinental Ins. Co., 300 AD2d 209, 212 [1st Dept 2002]; see also, Universal Acupuncture Pain Servs. v Lumbermens Mut. Cas. Co., 195 Misc 2d 352, 354-355 [Civ Ct, Queens County 2003] [citing cases]). Thus, if an insurer’s NF-10 denied a claim only on grounds of intoxication, it cannot later be permitted to assert another defense, such as the invalidity of an assignment, which was not preserved in the denial of claim form (see, e.g., Bonetti v Integon Natl. Ins. Co., 269 AD2d 413 [2d Dept 2000] [defense of allegedly unnecessary surgeries not preserved]; Presbyterian Hosp. in City of N.Y. v Aetna Cas. & Sur. Co., 233 AD2d 433 [2d Dept 1996] [defense of invalid assignment not preserved]; St. Clare’s Hosp. v Allcity Ins. Co., 201 AD2d 718 [2d Dept 1994] [insurer’s failure to deny claim in 30 days]).

[679]*679In accord with the Presbyterian Hosp.

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

Related

All-Boro Medical Supplies, Inc. v. Progressive Northeastern Insurance
17 Misc. 3d 950 (Civil Court of the City of New York, 2007)
All-County Medical & Diagnostic P.C. v. Progressive Casualty Insurance
8 Misc. 3d 616 (Nassau County District Court, 2005)
Socrates Psychological Services, P.C. v. Progressive Casualty Insurance
7 Misc. 3d 642 (Civil Court of the City of New York, 2005)

Cite This Page — Counsel Stack

Bluebook (online)
7 Misc. 3d 675, Counsel Stack Legal Research, https://law.counselstack.com/opinion/metropolitan-radiological-imaging-pc-v-state-farm-mutual-automobile-nycivct-2005.