Vazquez v. Aetna Casualty & Surety Co.

112 Misc. 2d 125, 446 N.Y.S.2d 176, 1982 N.Y. Misc. LEXIS 3106
Civil Court of the City of New York·Decided January 8, 1982·Published·Cited by 3 cases

Opinion

OPINION OF THE COURT

Benjamin F. Nolan, J.

On February 16, 1979, plaintiff brought this action pursuant to article 18 of the Insurance Law to recover no-fault benefits plus statutory interest and reasonable attorney fees because after a timely application had been made and appropriate proofs furnished defendant insurance carrier (Aetna) failed to pay him $3,422.50 in hospital and doctor expenses incurred when he sustained personal injuries in an accident on October 23,1977, resulting from the use and operation of a motor vehicle covered for liability by a policy of insurance issued by Aetna.

Aetna’s answer alleged as a first affirmative defense that at the time this action was commenced there was another suit pending for a portion of the claim underlying this action. That suit was for $1,271.50 in hospital expenses incurred by plaintiff when he was a patient at the [126] Whitestone General Hospital after the accident. The suit was brought against Aetna by the Whitestone General Hospital in a no-fault arbitration proceeding under an assignment executed by plaintiff while he was a patient at the Whitestone General Hospital.

In a second affirmative defense, Aetna denied coverage, alleging that the motor vehicle involved in the accident was a replacement for the insured vehicle and had not as yet been lawfully registered with the Department of Motor Vehicles at the time of the accident.

On May 25, 1979, an award was rendered in the no-fault arbitration proceeding in favor of the Whitestone General Hospital against Aetna. Thereafter, Aetna brought a proceeding in the New York County Supreme Court (Aetna Cas. & Sur. Co. v Whitestone Gen. Hosp., Index No. 16424/79) to vacate the arbitration award. In an order entered on October 2, 1979, the Supreme Court dismissed the petition and confirmed the award.

Thereafter, plaintiff moved in this court to dismiss both of the affirmative defenses. By order, dated January 10, 1980, another Civil Court Judge struck the first affirmative defense, holding that the “hospital form which was signed by plaintiff * * * does not constitute an assignment to the hospital” and that since “plaintiff is not a party to the arbitration proceeding * * * the outcome thereof is not binding on the plaintiff and does not compromise his claim against the Aetna policy.” The Civil Court Judge refused to strike the second affirmative defense, saying that “a factual issue is posed as to whether the language of (Aetna’s) disclaimer of coverage * * * is consistent with the language of its second affirmative defense.” On appeal, Appellate Term, First Department, in Vazquez v Aetna Cas. & Sur. Co. (NYLJ, Jan. 27, 1981, p 5, cols 1-2) upheld the assignment, saying:

“We construe the hospital insurance form executed by plaintiff, authorizing payment directly to the hospital of group insurance benefits ‘otherwise payable’ to him, as an assignment of first party benefits due plaintiff as a covered person under the subject policy and the Comprehensive Auto Insurance Reparations Act (Insurance Law, Sec. 671, [127] subd. 2, 10). It is a routine practice for hospitals and other health care providers to take assignments to protect their bills for services rendered, and this is mainfestly what was intended here; in fact, the regulations of the Department of Insurance authorize insurers to pay no-fault benefits directly to the providers of services ‘upon assignment’ (11 NYCRR 65.6 [i] [1], 65.15 [i] [1]).

“Generally, the assignee of a claim is the real party in interest and he alone can bring suit; the assignor loses control over the chose when he makes the assignment (6 N. Y. Jur. 2d, Assignments, Sec. 71). And it has been expressly held that assignees of claims for first party benefits under the no-fault law may avail themselves of the right their assignors had to arbitrate disputed claims (Matter of Rosenblum, 41 N. Y. 2d 966). Under certain circumstances, an insured who has given assignments to various health care providers has been permitted to arbitrate liability questions himself because his own interest outweighed that of any single assignee (Central General Hospital v American Arbitration Association, 91 Misc. 2d 516). But where the assignee has proceeded to arbitration first, and that proceeding is not stayed, and an award is thereafter made and confirmed, it is too late for the insured to relitigate the same claim in his own action. Moreover, only one claim exists for the hospital bill, and we are informed that the claim has been satisfied in full. If plaintiff’s assignee has already recovered the full amount of its bill, justice dictates that no recovery be allowed.”

Plaintiff now moves for summary judgment, seeking judgment for $2,151, which is the balance of the original claim for $3,422.50 after reduction by the $1,271.50 in hospital expenses which Appellate Term held to have been validly assigned by plaintiff to the Whitestone General Hospital and which was the subject of the award in arbitration. Plaintiff contends that he is entitled to summary judgment because all of the facts are either admitted or documented in the moving papers and not contradicted in the opposing affirmation. He further claims that he is also entitled to summary judgment on the theory of collateral estoppel because the no-fault arbitration award and the [128] confirmation thereof in the Supreme Court conclusively determined the issues in this case in his favor.

The issues of liability and coverage are identical in both lawsuits. Aetna is the defendant in each. The claims in both are part of plaintiff’s claim for all of the hospital and medical expenses he incurred in the same motor vehicle accident. In the arbitration proceeding, plaintiff’s assignee sued for payment of a portion of plaintiff’s claim. In the case at bar, plaintiff now seeks summary judgment for the balance of his claim. If plaintiff had not assigned a portion of his claim to the Whitestone General Hospital, there would have been no arbitration proceeding, since the entirety of plaintiff’s claim would have been disposed of in the case at bar.

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Vazquez v. Aetna Casualty & Surety Co., 112 Misc. 2d 125, 446 N.Y.S.2d 176, 1982 N.Y. Misc. LEXIS 3106 (N.Y. Super. Ct. 1982).

112 Misc. 2d 125 (Vazquez v. Aetna Casualty & Surety Co.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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