Shady Grove Orthopedic Associates, P.A. v. Allstate Insurance

293 F.R.D. 287, 2013 WL 4067116, 2013 U.S. Dist. LEXIS 113303
CourtDistrict Court, E.D. New York
DecidedAugust 7, 2013
DocketNo. 06-CV-1842 (NG)(JO)
StatusPublished
Cited by10 cases

This text of 293 F.R.D. 287 (Shady Grove Orthopedic Associates, P.A. v. Allstate Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Shady Grove Orthopedic Associates, P.A. v. Allstate Insurance, 293 F.R.D. 287, 2013 WL 4067116, 2013 U.S. Dist. LEXIS 113303 (E.D.N.Y. 2013).

Opinion

OPINION & ORDER

GERSHON, District Judge:

Plaintiff Shady Grove Orthopedic Associates, P.A (“Shady Grove”) brings this class action against defendant Allstate Insurance Company (“Allstate”), seeking payment of statutory interest penalties mandated by the New York State Insurance Law and accompanying regulations. By this motion, Shady Grove seeks certification of the following class, pursuant to Rule 23(b)(3) of the Federal Rules of Civil Procedure:

All health care providers who, since April 20, 2003, submitted claims for first-party no-fault benefits under New York auto policies issued by Allstate Insurance Company, where (i) those claims were never disputed by Allstate within 30 days of its receipt of the claims (accompanied by verification or proof of claim, as those terms are used in 11 NYCRR 65-3.5); (ii) though ultimately paid by Allstate, those claims were not paid within 30 days of its receipt of the claims; and (iii) Allstate made no payment of statutory interest against the claim; provided, however, that eligibility for class membership shall not derive from any claim for which Allstate requested verification or proof of claim additional to that which was submitted with the original claim.1

BACKGROUND

Although the parties’ familiarity with the allegations set forth in the Complaint2 and with the prior proceedings in this case is presumed, a brief discussion of the background and procedural history is nonetheless helpful.

1. Factual Allegations

This class action lawsuit was commenced in 2006 by plaintiffs Shady Grove and Soma E. Galvez, who sought to collect certain statutory interest penalties, which they alleged had been withheld by defendant Allstate in contravention of the New York Insurance Law (N.Y.Ins.Law) § 5106 (the Fair Claims Settlement portion of the New York Comprehensive Motor Vehicle Insurance Reparations Act) and Part 65 of Title 11 of the New York Compilation of Codes, Rules and Regulation (Regulations Implementing the Comprehensive Motor Vehicle Insurance Reparations Act).

Pursuant to the statute, first-party no-fault benefits must be paid within thirty days after the claimant provides “proof of the fact and the amount of the loss sustained____ All

overdue payments shall bear interest at the rate of two percent per month.” N.Y. Ins. Law § 5106(a). Similarly, Subpart 65-3 of the implementing regulation provides, “All overdue mandatory and additional personal [294]*294injury protection benefits due an applicant or assignee shall bear interest at a rate of two percent per month, calculated on a pro-rata basis using a 30-day month.” 11 N.Y.C.R.R. § 65-3.9(a), And, when payment is made on an overdue claim, “any interest calculated to be due in an amount exceeding $5 shall be paid to the applicant or the applicant’s assignee without demand therefor.” Id.

Plaintiff Shady Grove is “a Maryland corporation established for the practice of orthopedic medicine.” (Complaint ¶ 5.) Defendant Allstate is an Illinois-based corporation in the insurance business, which regularly sells automobile insurance policies in the state of New York. (Id. ¶ 7.) Plaintiff Ms. Galvez is a Maryland resident who was insured under an Allstate policy, and who assigned to Shady Grove her rights to the no-fault benefits thereunder. (Id. ¶ 6.)

Shady Grove alleges that Allstate routinely fails to pay covered first-party no-fault benefits within 30 days, and that, when it does make payment on these overdue claims, it fails to pay the accrued interest, in accordance with §§ 5106 and 65-3.9(a). (See id. ¶¶ 17-19.) Plaintiff further alleges that Allstate “routinely and falsely claims to have never received” the claimant’s proof of loss, “as a means of avoiding the consequences of its violation of the thirty-day standard.” (Id. ¶ 20.)

With regard to its status as a proposed class representative, Shady Grove alleges that Ms. Galvez was entitled to payment of certain benefits under her no-fault insurance policy, that she assigned the right to those benefits to Shady Grove, and that Allstate neither made timely payment of those benefits, nor paid the interest that accrued pursuant to N.Y. Ins. Law § 5106(a) and 11 N.Y.C.R.R. § 65-3.9(a). (See id. ¶¶ 21-26.) Moreover, Shady Grove alleges that Allstate falsely claimed not to have received one or more of the claims that Shady Grove submitted in connection with these benefits, “for the purposes of avoiding the consequences of its violation of the thirty-day payment standard.” (Id. ¶ 27.) Shady Grove therefore asserts that it is an appropriate class representative, and that the proposed class satisfies all of the requirements of Rule 23 of the Federal Rules of Civil Procedure. (See id. ¶¶ 28-37.)

II. Procedural History

By Order dated December 15, 2006, I granted defendant’s motion to dismiss in its entirety, concluding that Ms. Galvez, as assignor of her rights and interest in her no-fault benefits to Shady Grove, lacked standing to bring the action and that the class action was barred by § 901(b) of New York’s Civil Practice Law and Rules (C.P.L.R.). See Shady Grove Orthopedic Assoc’s, P.A v. Allstate Ins. Co., 466 F.Supp.2d 467, 473-75 (2006). Since, without the class action claims, Shady Grove’s individual claims did not reach the required amount in controversy under 28 U.S.C. § 1332(a), I dismissed those claims for lack of subject matter jurisdiction. Id. at 476.

While this decision was affirmed by the Second Circuit, it was subsequently reversed by the United States Supreme Court.3 See Shady Grove Orthopedic Assoc’s, P.A. v. Allstate Ins. Co., 549 F.3d 137 (2d Cir.2008), rev’d 559 U.S. 393, 130 S.Ct. 1431, 176 L.Ed.2d 311 (2010). The action was remanded back to this court in June 2010. See Shady Grove Orthopedic Assoc’s, P.A. v. Allstate Ins. Co., 380 Fed.Appx. 96, 97 (2d Cir. 2010). The parties commenced and completed discovery relating to class certification.

Of the five counts originally alleged in the Complaint, two remain: Count IV, violations of N.Y. Ins. Law § 5106; and Count V, violations of N.Y. Gen. Bus. Law § 349 (Consumer Protection from Deceptive Acts and Practices). Counts I—III, which were claims for declaratory judgment, breach of contract, and bad faith breach of contract, respectively, were all dismissed, on the record, during the proceedings of January 24, 2012. (See Oral Arg. Tr., Jan. 24.2012.) Plaintiff now [295]

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293 F.R.D. 287, 2013 WL 4067116, 2013 U.S. Dist. LEXIS 113303, Counsel Stack Legal Research, https://law.counselstack.com/opinion/shady-grove-orthopedic-associates-pa-v-allstate-insurance-nyed-2013.