American Tr. Ins. Co. v Shaka Andre-Willie Deveaux Parkview Med. & Surgical, P.C.

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American Tr. Ins. Co. v Shaka Andre-Willie Deveaux Parkview Med. & Surgical, P.C. 2012 NY Slip Op 30436(U) February 10, 2012 Supreme Court, Nassau County Docket Number: 023559/10 Judge: Joel K. Asarch Republished from New York State Unified Court System's E-Courts Service. Search E-Courts (http://www.nycourts.gov/ecourts) for any additional information on this case. This opinion is uncorrected and not selected for official publication. -- --- --- ------- --------- -------- -- ------ --- ------- --------------- -- )( ------------------ -------- ------------- ------- ----- ----- -------- )( [* 1] SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NASSAU: PART AMERICAN TRANSIT INSURANCE COMPANY, Plaintiff DECISION AND ORDER - against - Inde)( No: 023559/10 SHAKA ANDRE- WILLIE DEVEAUX ARKVIEW MEDICAL & SURGICAL, P. BROOKDALE HOSPITAL EMERGENCY DEPT. COMPREHENSION PT, P. SUNRISE ACUPUNCTURE, P. SK PRIME MEDICAL SUPPLY, INC. NAQIJ MEDICAL SERVICES, P. Motion Sequence No: 002 Original Retur Date: 10- 24- PUGLSEY CHIROPRACTIC, PLLC KK MEDICAL DIAGNOSTIC, P. FIVE BORO PSYCHOLOGICAL AND LICENSED MASTER SOCIAL WORK SERVICES, PLLC TOTAL BODY DIAGNOSTICS, P. BAY NEEDLE CARE ACUPUNCTURE, P. MOBILITY EXPERTS MEDICAL, P. SM CHIROPRACTIC, P. M. SADDESS, MD, P. TONG LI, M. Defendants. PRESENT: HON. JOEL K. ASARCH, Justice of the Supreme Court. The following named papers numbered 1 to 12 were submitted on this Notice of Motion on November 25 , 2011: Papers numbered Notice of Motion , Affirmations(2) and Affdavits(5) Affirmations in Opposition (2) Reply Affrmations (2) 11- [* 2] This motion by plaintiff American Transit Insurance Company for an Order (1) pursuant to CPLR 3215 for a default judgment against the non-appearing defendants and (2) pursuant to CPLR 3212 for sumary judgment against the appearing defendants declaring that there is " no coverage " for defendant Shaka Andre- Wilie accident which allegedly occured Deveau)( and on August 5 , no- fault his assigns as a result of an automobile 2010 and that none of the defendants or their assigns are entitled to first-par no fault benefits on the grounds that the claimant Shaka Andre- Wilie denied as a question of fact is presented Deveau)( failed to appear for an E)(amination Under Oath is with respect to plaintiff s case. prima facie Plaintiff American Transit Insurance Company s claim for declaratory judgment against the defendant medical providers is premised solely upon the alleged failure of the claimant Shaka AndreWilie Deveau)( (Deveau)() to appear for scheduled e)(aminations under oath (EUO). The complaint states at paragraphs 39 and 40: 39. On October 8, 2010 , AMERICAN TRANSIT INSURACE COMPANY) sent to Defendant SHAKA ANDRE- WILLIE DEVEAUX if one was retained) at the address stated on the application for benefits a letter requesting that he/she attend an E)(amination Under Oath (" EUO" ) on October 2010 , at American Transit Insurance Company. (andhis/her attorney 40. Defendant SHAKA ANDRE- WILLIE DEVEAUX failed to attend the EUO. (emphasis supplied). The Denial of Claim dated 12/1110 also stated that the claim was denied " as the eligible person failed to appear for an e)(amination under oath on October 26 , 201 0 and November 24 , 2010. In support of the application for judgment , plaintiff submits the affrmation of Michael I. Josephs , Esq. , (Josephs), who states that he was prepared to conduct the first EUO scheduled for Friday, October 26 , 2010 at 11 :00 a. m. (E)(hibit " 4" to moving papers). However , Josephs [* 3] not affirmation does state that the claimant failed to appear for the EUO , contrar to the allegations of the pleading and other supporting papers. Rather , Josephs ' supporting affrmation states that counsel for the claimant and a man identified as his client appeared at the offices of American Transit Insurance Company, 330 West 34th Street , at E)(amination Room #2 on the seventh floor , that his identification was not satisfactory and that Josephs refused to go forward with the EUO. He states in relevant par: At about 11 :40 AM, Eric Tuy, Esq. ;. . . came to the EUO Room door with a black male. . . who appeared to be in his twenties. The Attorney said this was his client. . . . :50 AM , I began the E)(amination Under Oath. introduced myself and the black male was sworn in. Prior to the proceeding I received proof of identity. The man offered me a New York State Benefit Identification Card listing the name Shaka At about 11 DeveaU) with a birth date of 06/08/1989. . . A copy of both sides of the card has been added to the file. Josephs affirms that the claimant' s identification was defective but fails to submit a copy for the Court' s inspection , although he admittedly added a copy to the file. He describes the card as signed on the front instead of the back , with the lower right portion of the card missing. The photograph of Deveau)( was on the lower right portion and the missing par " included the entire lower par of the face and on half of the middle of the face " as well as par of an " access number Josephs opines that " (i)t appeared as if the card had been cut with a scissor or other tye of cutter... Josephs states that " the man" did not have a social security card or other picture identification , and stated that he was " waiting to get the NYS Non- driver further states (a)t this time I advised the claimant s ID card. " Josephs and his attomey that this Examination Under Oath could not proceed , but a new date would be scheduled for him to appear with ID. " (emphasis [* 4] supplied). Josephs also stated , apparently to the claimant and his attorney, that the American Transit Insurance Company letter notifying him of the EUO advised that "proof of identity was required in order to proceed. " However the e)(hibits ofthe notice ofEUO submitted to the court do not contain such advice. Plaintiff sent an additional EUO notice for November 24 , 201 0 , and avers that the claimant failed to appear. Plaintiffthus contends that Deveau)( failed to appear twice for scheduled e)(aminations under oath , that his failure vitiates coverage ab inito and that , therefore , there is no coverage under which the defendant medical providers may seek reimbursement as assignees of Deveaux. The mandatory personal injury protection endorsement for motor vehicle liability insurance policies contains two conditions precedent to coverage , written notice of the accident and written proof of a claim (11 NYCRR . 65- 1 (d)). The notice of accident condition requires an eligible injured person to set forth " details sufficient to identify the eligible injured person , along with reasonably obtainable information regarding the time , place and circumstances of the accident. . . as soon as reasonably practicable , but in no event more than 30 days after the date of the accident" The proof of claim condition , in the case of a claim for health service e)(penses , requires a claimant or his assignee health care service provider to give "full pariculars ofthe nature and extent of the injuries and treatment received and contemplated , as soon as reasonably practicable but , in no event later than 45 days after the date services are rendered" (supra). Failure to comply with the time requirements of the first condition , written notice of accident , results in a failure of coverage even if a health care service provider timely submits proof of claim after the time has expired. " (T)he [* 5] proof of claim submission of. . . within 45 days of the date health care services are rendered may written notice of accident not serve as timely after the 30-day period for providing such written v. (New York and Presbyterian Hasp. notice has e)(pired" Country- Wide Ins. Co. 17 NY3d 586 593 (2011)(emphasis supplied)). As noted , plaintiff American Transit Insurance Company relies upon the purorted failures ofDeveau)( to appear for two EUOs to dismiss the claims ofthe named medical provider defendants for lack of coverage. claim that the claimant twice failed to prima facie Simply, plaintiff has failed to sustain a appear. Rather , the affirmation of Michael I. J?sephs , Esq. , at best , raises a question of fact regarding the identity of the person who appeared for the first scheduled EUO. then plaintiff canot claim that he did not appear and there is no would be entitled to a judgment (1989); Lanza v. (Maurizzio v. If it was Deveau)( coverage defense. Defendants Lumbermens Mut. Cas. Co. 73 NY2d 951 , 953 Wagner 11 NY2d 317 , 334 (1962)) declaring that plaintiff may not rely upon a coverage defense based upon Deveau)( ' failure to appear for an EUO. A hearing is necessary where plaintiff may present evidence to support its pleading allegation and grounds for denial that the claimant did not appear for the EUO on October 26 , 2011, i. , that the person who appeared was not DeveaU). With respect to a legal issue which is also presented , plaintiff avers that a failure to timely appear for properly noticed EUO and follow up EUO results in a coverage defense , claimant failed to appear there is no coverage under which the defendant medical assert a claim , citing New York and Presbyterian Hasp. v. and if the providers may Country- Wide Ins. Co. 17 NY3d 586, 593 (2011)). The Court need not reach such issue ifplaintifffails to prove that the claimant did not [* 6] appear at the first scheduled EUO. Accordingly the Cour wil resolve the legal issue at this time as it may be rendered not moot by the trial. It is enough at this juncture to note the question is whether the issue is governed by Lincoln Gen. Ins. Co. which held that failure to appear for EUOs does Westchester Med. Ctr. not present a coverage defense , Presbyterian Hosp. v. or whether Westchester New York and has been overrled by Country- Wide Ins. Co. which held that there is no coverage if a timely written notice of accident within the 30-day period for providing such written notice has e)(pired notwithstanding a health care provider s timely submission ofa proof of claim within 45 days ofthe date health care services are rendered (compare, AD3d 1045 1046- 1047 (2d Dept2009), Hasp. v. Iv app den Med. Ctr. Lincoln Gen. Ins. Co. , 60 13 NY3d 714 , with New York and Presbyterian Westchester Country- Wide Ins. Co. 17 NY3d 586 593 (2011)). Thus , after due deliberation , it is ORDERED , that the plaintiffs motion is denied; and it is fuer ORDERED , that the compliance conference previously scheduled for at 9:30 a. m. shall be held at the Courhouse , 100 Supreme Cour Drive York 11501 on such date and time. The foregoing constitutes the Decision and Order of the Cour. Dated: Mineola , New York Februar 10 2012 ENTER: JOEL K. ASARCH, lS. ENTERED FEB 14 2012 NASSAU COUNTY COUNTY CLERK" OFFtCE February 23, 2012 , Room 151 , Mineola, New [* 7] Copies mailed to: The Law Offce of Jason Tenenbaum, P. Attorneys for Plaintiff Gar Tsirelman , PC Attorneys for Defendants Sunise AcupunctUre , P. , PLLC. Five Boro Psychological and Licensed Master 'Social Work Services The Rybak Firm, PLLC Attorneys for Defendant SK Prime Medical Supply, Inc.

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