NYU Hosps. Ctr. v MEI Rong Huang
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NYU Hosps. Ctr. v MEI Rong Huang 2012 NY Slip Op 32497(U) September 27, 2012 Supreme Court, New York County Docket Number: 102832/2011 Judge: Doris Ling-Cohan 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. SCANNED ON 101112012 [* 1] c " ORDER MOT1 ON DATE MOTlON SEQ. NO. QN MOTIBN CAL.NO. I ! The following papers( 1 to 2ware read on thls motfon tolfor Papers Notice 9f MdtloyhOrder to S h o w Cause - Affldavlta gxhlblta N urn bero d i ! I AnswerlnQ Affldavlts 1 Exhibits Replylng Abldavlts Cross-Motlon: f 1 Yes [ ] NO Upon the foregolng papers, It is ordered that* -->- r..m& ;.. Y ..................................................................... C&$E DISRIOSED 0 2. CHEOrU AS APPROPRIATE; .............. M O l l Q ~S 0GmrUreD! I: DENIED 1 ChtEC%WW \ 3. CHECKIF APPROPRIATE: ................................................ SETTLE-ORDER DO NOT POST NON-FINAL DISPOSfllON 0GRANTED IN PART 0O T V m '0 SUBMIT ORDER FIDUCIARY APPOINTMENT 0REPEREKE [* 2] 1 NYU HOSPITALS CENTER, Plaintiff, : ME1 RONG HUANG, AETNA LIFE INSURANCE COMPANY, and PHILIPS-VAN HEUSEN CORPORATION, D e c i s i o n and Order : -against- Index No. 102832-2011 : Motion S e q . No. 003 On January 18, 2012, this court issued a Decision and Order granting in part, and denying in part, a motion by defendants Aetna Life Insurance Company (Aetna) and PVH Corporation' (PVH) to dismiss plaintiff NYU Hospitals Center's (NYU) complaint against them, pursuant to C P L R 3211 (a) (3) (clairrlant lacks the capacity to sue) a n d 3211 (a) (7) (failure to state a cause of action). Such decision dismissed the fifth cause of action in the complaint against PVH, which alleged that PVH "negligently omitted to inform Aetna that the patient's coverage was to terminate as of January 1, 2009'' and "misrepresented to plaintiff through Aetna that the patient was insured" (affirmation of Hecht, exhibit A, Complaint, at 5, ¶ 43 & 47). The fifth cause of action is the only cause of action asserted against PVH. ' NYU Effective June 23, 2011, the Phillips-Van Heusen Corporation changed its name to the PVH Corporation. 1 [* 3] now moves, pursuant to CPLR 2221 (d), ( e ) and ( f ) for l e a v e to reargue and renew P V H ' s p r i o r motion to dismiss the complaint for failure to state a cause of a c t i o n . NYU challenges the court's decision on two grounds that N Y U argues that the court overlooked or misapprehended. First, N Y U claims that PVH failed to refute that the complaint set forth a claim f o r equitable estoppel, and that the court a l s o failed to address the equitable estoppel allegations in the complaint. Specifically, NYU argues that the court mischaracterized the allegations in the fifth cause of action against PVH as a negligent misrepresentation cause of action, and so, did n o t address t h e allegations as a claim for equitable estoppel. NYU insists that the causes of action are maintainable under both theories. Second, NYU contends that certain facts "were not raised because it was believed that the complaint would withstand PVH's . . . challenge to dismiss the complaint ... under the liberal standard of review applicable to such motion" (affirmation of Hecht, at 4, ¶ 14). NYU argues that it is now proffering new f a c t s n o t offered on the previous motion that would have changed the outcome. These "new facts" a r e allegedly found in an affidavit previously provided to the court by Aetna. In response, PVH claims that these arguments are meritless. NYU also argues that, in the event that the motion is 2 [* 4] granted and the court reinstates the claim for equitable estoppel against PVH, NYU will serve a supplemental summons adding PVH s medical plan, PVH Corp. & Subsidiaries Health and Welfare Benefits Plan (PVH Plan) as a defendant, and serve an amended complaint asserting a claim for equitable estoppel against the PVH Plan. Copies of the proposed amended complaint and supplemental summons were annexed to N Y U s motion papers. Deleted from the proposed amended complaint are allegations that the patient was covered under a group health insurance policy. BACKGROUND The facts and circumstances of the case are set forth in detail in the prior written decision of the court discussed i n f r a , and only the portions pertinent f o r present purposes will be set forth here. N Y U seeks payment for inpatient 2009 through March 3 0 , 2009, which plaintiff alleges that defendants promised to pay. NYU sued Mei Rong Huang, the patient s alleged spouse and former PVH employee, Aetna, and PVH, which had a group health insurance policy for its employees with Aetna. NYU is a participating provider in Aetna s health care 3 [* 5] ANALYSIS A. Motion to R e a r g u e CPLR 2 2 2 1 ( d ) (2) provides that " [ a ] reargue: . . . (2) shall be motion for leave to based upon matters of fact or law allegedly overlooked or misapprehended by the court in determining the prior motion, but shall not include any matters Of fact not offered on the prior motion." Reargument is not "designed to afford the unsuccessful party successive opportunities to reargue issues previously decided or to present arguments different from t h o s e originally asserted [internal citations omitted]" (William P. P a h l Equip. C a r p . v K a s s i s , 1 8 2 A D 2 d 2 2 , 27 [lst D e p t 1 9 9 2 1 ; Foley v Roche, 68 A D 2 d 558 [Ist Dept 19791). Moreover, reargument is not available where the moving party seeks only to argue a new theory of liability not previously advanced, and failed to show how the court misconstrued facts or law ( s e e DeSoignies v Cornasesk House Tenants' C o r p . , 21 AD3d 715 [lst Dept 2 0 0 5 1 ) . Additionally, leave to reargue is based upon the discretion of the court ( s e e McGill v G o l d m a n , 2 6 1 AD2d 593, 5 9 4 [2d Dept 19991). In its original decision, the court determined that t h e fifth cause o f action, identified by the court as a claim for negligent misrepresentation, was insufficient to state a cause of action. On this motion to reargue, NYU now asserts t h a t the fifth cause of action was actually an equitable estoppel cause of 4 .- [* 6] - . . ..- . . action. To the extent that there is confusion as to the nature of the fifth cause of action, and in light of the fact that the court did not address a claim for equitable estoppel, the court will, in the interest of justice, address dismissal of such a claim and therefore, grants reargument to this limited extent. Upon reargument, however, N Y U has not successfully asserted a claim for equitable estoppel against PVH. The doctrine of equitable estoppel may be invoked in the interest of fairness to prevent a fraud or injustice upon the person against whom enforcement of a right is sought, and who justifiably relied upon the opposing party's words or conduct ( N a s s a u T r u s t Co. v Montsose Concrete P r o d s . C o r p . , 5 6 N Y 2 d 175, 184 [1982]). In order for PVH to be equitably estopped from denying that coverage existed under t h e employee plan, NYU must show: (1) conduct by PVH which amounts to a false representation which is calculated to convey the impression that the f a c t s are otherwise than what PVH asserts in this case; (2) PVH's intention or expectation t h a t its conduct would be acted upon b y NYU; and ( 3 ) PVH's knowledge of the true f a c t s (see BWA COKP. v A l l t r a n s Express U . S . A . , A D 2 d 850, 853 [lst Dept 1 9 8 5 1 ) . 112 Further, N Y U must show, with respect to itself, a lack of knowledge of the t r u e facts, reliance upon the conduct of PVH, and a prejudicial change in position (id.; see also River S e a f o o d s , Inc. v JPMorgan Chase 5 [* 7] Bank, 19 AD3d 120, 122 [Ist Dept 2 0 0 5 1 ) . In the present case, NYU did not allege, in its complaint, that PVH had actual or constructive knowledge of the true facts or that it concealed a material fact. In fact, the complaint specifically alleges that "PVH negligently omitted to inform Aetna that the patient's coverage was to terminate" (Complaint, at 5, ¶ 43). Based upon this language, the court expressly considered a negligent misrepresentation cause of action, and rejected it for failure to state a cause of action. Since NYU alleged that PVH acted negligently, it cannot satisfy the "knowing the true facts" or "concealing a material fact" prongs of the equitable estoppel claim. There is no claim that PVH intentionally set o u t to mislead NYU. However, N Y U contends that this missing element is unimportant, as courts do not always require a showing that the party estopped knew its representation was false. NYU's argument rests primarily on Matter of Shondel J. v M a r k D. ( 7 NY3d 320 [ 2 0 0 6 ] ) , a matter related to a child support proceeding, where the N e w Y o r k Court of Appeals held that a man who has mistakenly represented himself as a child's father could be estopped from denying paternity, based on the best interests of the child. The S h o n d e l J. C o u r t stated that the doctrine of equitable estoppel "preclude[s] a person from asserting a right after having l e d a n o t h e r to form the reasonable belief that the 6 [* 8] right would not be asserted (id. at 326). The New York Court of Appeals further stated a party who ... does not realize that his representation was factually inaccurate may yet be estopped from denying the representation when someone else--here the child--justifiably relied on it to her detriment (id. at 331, citing to R o m a n o v Metropolitan L i f e I n s . Co., 2 7 1 NY 2 0 8 , 2 9 3 2 9 4 [1936]; T r i p l e C i t i e s C o n s t r . C o . v M a r y l a n d C a s . C o . , 443, 4 NY2d 448 [1958]). Under the terms of the PVH Summary Plan Description (SPD), Aetna was responsible, as the claims administrator, for precertification, and PVH has the discretion to interpret plan provisions and the S P D . The complaint alleges that an unidentified NYU representative contacted an unidentified Aetna representative, who precertified the patient s admission, and stated that the patient was entitled to health care benefits for the services to be provided. Tqus, NYU rendered services to the patient, pursuant to authorizations issued by Aetna. Subsequently, NYU billed Aetna, and Aetna paid plaintiff $76,923.25. Aetna eventually recouped its payment, alleging that the patient was not entitled to health care benefits from Aetna on the d a t e s of service. The complaint further alleges that PvH retroactively cancelled the patient s coverage under its group health insurance policy after services had been rendered, a n d after Aetna had paid NYU. After examining the complaint, the 7 [* 9] equitable estoppel cause of action asserted by NYU a g a i n s t PVH i s insufficient. NYU s claim of reasonable reliance on PVH s representations is l a c k i n g ; accepting NYU s position that Aetna represented that the patient had insurance coverage, and that NYU relied on that representation, the fact remains that t h e complaint fails to a l l e g e that NYU detrimentally relied either on a specific oral or written representation made by PVH of its intent to be bound or on its conduct, as the equitable estoppel claim requires. Therefore, NYU cannot avail itself of the equitable estoppel cause of action against PVH. B. Motion to Renew Alternatively, NYU urges renewal on the ground t h a t i t is, allegedly offering new facts, in the form of an affidavit submitted by Mary Kazan, PVH s Group Vice-president, Benefits and Compensation, to which the SPD was annexed as an exhibit. Those facts include that: PVH s health care plan is self-insured [ i , e . claims f o r health care benefits are paid with p V H s f u n d s ] for the majority of the claims paid from the plan (affirmation of Hecht, exhibit C, PVH Company Medical Plan, Introduction, at 7, 4); PVH s network providers are Aetna s participating providers ( i d . at Bates No. 000006); PVH network providers are required to obtain precertification for hospital admissions from Aetna (id. at Bates NO. 000014, 000024, 000054); and PVH network providers are required to obtain authorization from Aetna for a patient s 8 ¶ [* 10] misrepresentation and equitable estoppel against PVH. A motion for leave to renew: 1. shall be identified specifically a s such; 2 . shall be based upon new facts not offered on the prior motion that would change the prior determination or shall demonstrate that there has been a change in the l a w t h a t would change the p r i o r determination; a n d 3 . shall contain reasonable justification for the failure to present such f a c t s on the prior motion. Turning to the merits, NYU s motion to renew is not based on facts previously, because it did not believe that these facts original decision on the motion to dismiss. The a l l e g e d new facts merely highlight the fact that Aetna administers all claims a grant of renewal, or modification of this court s prior decision. 9 [* 11] reason for not placing those facts b e f o r e the court a t the time the prior motion was made. Relying on B u s t o s v Lenox H i l l Hosp. (80 AD3d 5 3 9 , 539 [lst Dept 20111), Rancho S a n t a Fe Assn. v Dolan-King ( 3 6 A D 3 d 460, 461 [lst Dept 2 0 0 7 1 ) , and M e j i a v N a n n i (307 AD2d 870, 871 [lst Dept 20031), NYU argues that even if the requirements for renewal are not met in this case, renewal may still be granted as a matter of "substantive fairness" (Rancho S a n t a F e Assn. v Dolan-King, 36 AD3d at 4 6 2 ) . However, "[rlenewal is granted sparingly . . . ; it is not a second chance freely given to parties who have not exercised due diligence in making their first factual presentation [internal quotation marks and citation omitted] . (Henry v P e g u e r o , 7 2 AD3d I ' 600, 602 [lst Dept 20101). While a court may, in its discretion, and in the interest of justice and fairness, grant a motion to renew on the basis of facts known to the moving p a r t y at the time of the prior motion, a c o u r t may also decline to exercise its 10 [* 12] dismiss, is denied. CONCLUSION Accordingly, it is hereby ORDERED that, the portion of th moti n of plaintiff NYU Hospitals Center for leave to r e a r g u e the motion to dismiss the fifth cause of action against defendant PVH Corporation is granted; and it is further 11 [* 13] ORDERED that, upon reargument, the c o u r t adher es t o its Decision and Order, d a t e d January 18, 2012, granting a n d denying the motion to dismiss in part, and dismissing the fifth cause of action against defendant PVH Corporation; and it is further ORDERED that the portion of the motion of plaintiff f o r l e a v e to renew the motion to dismiss the fifth cause of action is denied. Doris Ling-Cohan, J.S.C. J:\Renew.Reargue\NYU v. PVH.070512alma gomez.wpd c 12
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