Today’s Law Journal

While I think the decision is correct on the law, the opinion is more notable, to me, for its analysis of the law and the obvious time and effort spent by the judge in writing this.  Refreshing.  

 

Urban Radiology v. GEICO 

Civil Court, Kings County

Judge Reginald A. Boddie

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved by Order to Show Cause to consolidate this matter with forty-five other pending cases commenced by the same provider against the defendant, to amend its answer to include a fraudulent incorporation defense, for additional discovery, and for a stay pending resolution of this issue in all the cases. Plaintiff opposed the motion and seeks costs and sanctions.

Defendant alleged that plaintiff provider, Urban Radiology, is ineligible for reimbursement of no-fault benefits, under Insurance Law §5102 (a) (1), because at the time services were rendered plaintiff was fraudulently incorporated, in violation of Business Corporation Law §§1503, 1507,1508, and Education Law §§6530 and 6531. Courts have previously held that fraudulent incorporation is not a precluded defense and constitutes a complete bar to recovery under the no-fault insurance regulations (State Farm Mut. Auto. Ins. Co. v. Mallela, 4 NY3d 313 [2005]; AB Medical Services PLLC v. Utica Mut. Ins. Co., 11 Misc 3d 71 [2006]).

In brief, defendant asserted that “Although Dr. Rigney is listed as the owner of Urban Radiology, P.C. according to the Office of Professions of New York State, it is possible that he may not in fact be the ‘true’ owner of Urban Radiology, P.C. The instant UCC filing demonstrates that Ocean MRI, Inc. exerts total control of the proceeds and profits of Urban Radiology, P.C.” (affirmation of Eileen Hopkins ¶16). Defendant further alleged that Dr. Rigney was owner of JRWB Diagnostic Imaging, P.C., which also conducts MRIs, and that in January 1999 an arbitrator determined that Ocean MRI and David Batisyan were the true owners (affidavit of Eileen Hopkins ¶18). Accordingly, defendant requested depositions of Dr. John T. Rigney and Mr. Aleksander Kamsan, the former billing manager, with respect to all of plaintiff’s cases pending in this Court (Id. at ¶27).

During oral argument of this motion, defendant conceded that the cases are at various stages of litigation, including some which are already scheduled for trial, and that the facts differ in each case, except that the services were rendered by the same provider.

Consolidation

Civil Practice Law and Rules §602 (a) provides for consolidation of actions in appropriate circumstances as follows: 

When actions involving a common question of law or fact are pending before a court, the court, upon motion, may order a joint trial of any or all matters in issue, may order the actions consolidated, and may make such other orders concerning proceedings therein as may tend to avoid unnecessary costs or delay.

However, consolidation is highly disfavored by courts in no-fault insurance cases. Generally, no-fault benefit claims may not be consolidated unless the facts and circumstances arise from a common accident. (Metro Medical Diagnostics, P.C. v. Motor Vehicle Accident Indemnity Corp., 6 Misc 3d 136[A], 2005 NY Slip Op 50238[U] [2005]; Poole v. Allstate Ins. Co., 20 AD3d 158, 519 [2d Dept 2006] (holding it would be an improvident exercise of discretion not to sever forty-seven claims where a single trial of claims would prove unwieldy and confuse the trier of fact.) Here, defendant cannot establish that the no-fault cases arose from a common set of facts or accident as grounds for consolidation. Instead, defendant seeks to proceed on the basis that the claims share a common question of law.

The identical issue was presented in a case decided by the Appellate Term in 2008 (S&B Neurocare, P.C. v. Geico, 20 Misc 3d 132[A], 2008 NY Slip Op 51450[U] [2008]). There, the defendant also sought to consolidate all pending cases between the parties and assert a fraudulent incorporation defense. The court denied the motion, holding that merely alleging a medical provider is fraudulent fails to create sufficient questions of law and fact to justify consolidation. (id.) The court also upheld the denial of defendant’s motion to compel discovery because “[d]efendant failed to submit an affidavit specifying any facts entitling it to pretrial proceedings almost a year after the notice of trial was filed” (id.; see also New York City Civ Ct Act §208.17 [d]).

Similarly, the facts here clearly militate against consolidation. The cases are all at unspecified stages of litigation. Although defendant failed to set forth the procedural posture of each case, defendant acknowledged that many of the cases had proceeded past discovery and were noticed for trial. Notably, plaintiff stated, “Most cases the defendant seeks to consolidate have had a Notice of Trial filed, and the defendant is precluded from demanding additional discovery therein” (affirmation of Michael Reich ¶16). Consequently, it would be unwieldy to join the cases and clearly prejudicial to the plaintiff. Furthermore, defendant’s underlying premise for alleging fraudulent incorporation, on these facts, is speculative. For the reasons set forth herein, consolidation is inappropriate and therefore denied.

Stay

Defendant also sought a stay pursuant to CPLR 2201, pending the outcome of discovery and a hearing on the alleged fraudulent incorporation defense. Defendant averred that a stay is necessary to maintain the status quo, to promote judicial economy and in the interests of justice (affirmation of Eileen Hopkins ¶34).

CPLR 2201 provides, “[e]xcept where otherwise prescribed by law, the court in which an action is pending may grant a stay of proceedings in a proper case, upon such terms as may be just.” A search revealed no cases where the Civil Court issued a stay of multiple actions, in similar circumstances, pending further discovery and the hearing of a Mallela claim. However, where relief was requested in the Supreme Court seeking a stay of Civil Court proceedings, the court treated these motions as motions for preliminary injunction. (see St. Paul Travelers Ins. Co. v. Nandi, 15 Misc 3d 1145[A], 2007 NY Slip Op 51154[U] [2007]; New York Central Mutual Ins. Co. v. McGee et al, 25 Misc 3d 1232[A], 2009 NY Slip Op 52385[U] [2009].) 

To prevail on an application for preliminary injunction, the moving party must demonstrate a probability of success on the merits, danger of irreparable harm in the absence of being granted relief and a balance of equities in its favor (St. Paul Travelers at *7). Here, defendant clearly did not meet this test. Defendant has not established that it can properly assert a claim of fraudulent incorporation. Defendant also cannot establish irreparable harm since proof of fraud is an absolute defense to a claim for payment; nor can defendant demonstrate a balance of equities in its favor at this juncture in the litigation.

Nevertheless, the parties need not be held to the elevated standard of a preliminary injunction since, unlike the requests in St. Paul Travelers and New York Central Mutual, the defendant here does not seek to have this court stay proceedings pending in another court (15 Misc 3d 1145[A]; 25 Misc 3d 1232[A]). As such, defendant is not required to show that it would be entitled to preliminary injunction (Siegal, Practice Commentaries, McKinney’s Cons Laws of NY, Book 7B, CPLR C2201:2).

As the Court of Appeals artfully noted in Mallela,

The [no fault] regulatory scheme, however, does not permit abuse of the truth seeking opportunity that 11 NYCRR 65-3.16 (a) (12) authorizes. Indeed, the Superintendent’s regulations themselves provide for agency oversight of carriers, and demand that carriers delay the payment of claims to pursue investigations solely for good cause (see 11 NYCRR65-3.2 [c]). In the licensing context, carriers will be unable to show “good cause” unless they can demonstrate behavior tantamount to fraud. Technical violations will not do. (Mallela, 4 NY3d 313 [2005].)

Here, defendant’s statement that, “Although Dr. Rigney is listed as the owner of Urban Radiology, P.C. according to the Office of Professions of New York State, it is possible that he may not in fact be the ‘true’ owner of Urban Radiology, P.C.” is insufficient to show that defendant has a good faith basis to allege that Dr. Rigney is not the owner of Urban Radiology. Defendant has presented no affidavits or documents which address the issue of the alleged fraud with any certainty. Rather, defendant moved this court to stay the actions in order to explore the possibility of fraud. Consequently, this court declines to grant a discretionary stay in circumstances where, as here, the defendant’s request for relief is based almost entirely on speculation rather than specific testimonial or documentary proof. (see St. Paul Travelers at *7.) Accordingly, defendant’s request for a stay is denied. Defendant may renew its request in the individual cases, as appropriate, upon presentation of additional proof consistent with this decision.

Leave to amend the answers and permit additional discovery

Finally, defendant requested leave to amend its answers and for additional discovery. CPLR 3025 (b) commits the grant or denial of such leave to the trial court’s discretion (Edenwald Contracting, 60 NY2d at 959, citing Murray v. City of New York, 43 NY2d 400, 404-05 [1977]; Thomson v. Suffolk County Police Dept., 50 AD3d 1015 [2d Dept 2008]). It provides that leave “shall be freely given upon such terms as may be just” (CPLR 3025 [b]). 

In other words, the court should freely grant leave to amend a pleading based on the facts and circumstances of each case and where there is no significant prejudice or surprise to the non-moving party (Sewkarran v. DeBillis, 11 AD3d 445 [2d Dept 2004]). However, the evidence submitted in support of the motion must indicate that the amendment may have merit (Edenwald Contracting, 60 NY2d at 959; Ingrami v. Rover, 45 AD3d 806, 808 [2007]). Where the proposed amendment is “palpably insufficient or patently devoid of merit,” the court should deny leave to amend (Yemini v. Goldberg, 46 AD3d 806 [2d Dept 2007] (citations omitted); Beja v. Meadowbrook Ford, 48 AD3d 495 [2d Dept 2008]).

CPLR 3101 governs disclosure and requires “full disclosure of all matter material and necessary in the prosecution or defense of an action, regardless of the burden of proof” (CPLR 3101 [a]). The court has previously held that, under appropriate circumstances, a party may move to seek additional discovery for the purpose of supporting a Mallela claim, pursuant to CPLR 3101 (a) (One Beacon Ins. Group, LLC v. Midland Medical Care, P.C., 54 AD3d 738, 740 [2d Dept 2008]). In instances where such discovery is sought, movant is not required to show “good cause,” but rather that the documents sought are “material and necessary in the prosecution” of the action (CPLR 3101 [a]; One Beacon at 741 (citations omitted)).

Here, the court is unable to determine whether leave to amend and for additional discovery is appropriate, or in which cases it may be appropriate, as defendant has failed to articulate details regarding the procedural posture of each case. In any event, in as much as the court has declined to consolidate the cases, these issues need not be determined. Accordingly, the requests for leave to amend and for additional discovery are denied without prejudice to renew upon a proper showing in each case.

Other relief

Defendant’s remaining requests for relief are premature, and therefore not addressed. Plaintiff’s requests for costs and sanctions are denied.

This constitutes the Decision and Order of the Court.

“Regulatory Capture”?

The Insurance Department is required by law to conduct examinations into the affairs of domestic insurers, and also has the authority to conduct examinations into the affairs of any insurer doing, or authorized to do, any insurance business in New York.  The main tool at the Department’s disposal is the “Market Conduct Examination,” which is focused on ensuring the fair treatment of policyholders, and includes an examination of insurer operations, complaint handling, marketing, claims, rate and form filing and policyholder service.

The importance of such examinations, and the Department’s expected “vigorous” oversight of insurers, was part of the “difficult policy balance” struck by the Court of Appeals in Mallela to address the argument that Mallela-type inquiries “conflict[ed] with the prompt payment goals of the no-fault statutes.”  

The regulatory scheme, however, does not permit abuse of the truth-seeking opportunity that 11 NYCRR 65-3.16 (a) (12) authorizes. Indeed, the Superintendent’s regulations themselves provide for agency oversight of carriers, and demand that carriers delay the payment of claims to pursue investigations solely for good cause (see11 NYCRR 65-3.2 [c]) . . . We expect, and the Legislature surely intended, vigorous enforcement action by the Superintendent against any carrier that uses the licensing-requirement regulation to withhold or obstruct reimbursements to nonfraudulent health care providers.

Mallela was rendered 5 years ago.  The Department’s website provides, for public viewing, copies of the examinations conducted.  When searching for the relevant reports, look for those labeled “Market” or “Combined.”  If you have trouble finding any done within the last few years, don’t worry, because so did I.  Also, if you have difficulty finding any examinations for the State’s largest insurers, the same thing goes for those.

Violations found during Market Conduct Examinations often result in fines and other disciplinary actions taken against the subject insurer.  The Department’s website provides details of such discipline, updated every couple of months.  Following are the fines assessed against insurers for violations of the No-Fault Regulations since January 2007.

  • 7/21/10-    $0
  • 5/21/10-    $0
  • 3/8/10-      $0
  • 1/6/10-      $0
  • 11/23/09- $0
  • 9/25/09-   $0
  • 7/31/09-   $0
  • 6/17/09 -  $0
  • 5/6/09-     $0
  • 3/3/09-     $0
  • 2/5/09-     $0
  • 12/23/08- $0
  • 12/5/08-   $0
  • 11/4/08-    1 insurer fined $15,000
  • 10/01/08- $0
  • 9/10/08-   $0
  • 8/1/08-      $0
  • 7/2/08-     $0
  • 6/9/08-     $0
  • 4/25/08-   2 insurers fined $19,300 and $19,550, respectively.
  • 3/25/08-   $0
  • 3/5/08-      $0
  • 2/7/08-      $0
  • 1/4/08-       1 insurer fined $13,700. 
  • 11/26/07- $0
  • 10/24/07- $0
  • 8/23/07-   $0
  • 7/24/07-   $0
  • 6/26/07-   $0
  • 6/1/07-      $0
  • 4/23/07-   $0
  • 3/26/07-   $0
  • 2/20/07-   $0
  • 1/17/07-    1 insurer fined $56,000.

To the contrary, health insurers and HMOs have been fined $9,100,000.00 in prompt pay violations since 1998 when the Prompt Pay Law became effective, including $716,800.00 announced today.

Just the Facts

I read every (maybe missed a few over the last 10 years) no-fault case that is published at the Slip Op site.  By far, the Appellate Term for the Second, Eleventh and Thirteenth Judicial Districts renders the lion’s share of these cases.  It is no secret that over the last four years, that Appellate Term has become an “insurer-friendly” venue.   How much so, was the question I wanted to explore.  As a caveat, this was in no way a scientific examination.  A case here or there may have been missed or mislabeled, but I have confidence in the results.  

The Conclusion: 

Insurers prevail on about 3 of every 4 appeals filed.   

Here are the stats from 2007 through today:

682   Total No-Fault appeals (326 brought by plaintiff, 356 brought by defendant)

503   Decisions in favor of Defendant (represents affirmations when plaintiff appeals and reversals when defendant appeals)

179   Decisions in favor of Plaintiff (represents affirmations when defendant appeals and reversals when plaintiff appeals)

The reasons for this disparity?  DKI, but I’m sure we all have our own beliefs.

Law Journal Wrap-Up

I (normally with DG) write a quarterly article in the New York Law Journal concerning developments in New York no-fault insurance litigation. The latest installment addresses the new acupuncture fee schedule, the pitfalls of trial stipulations, and notices to admit in the First Department. 

Telling it like it is?

In my daily scouring of the web for all things related to no-fault insurance — aided of course by Google Alerts – I came across this post by Steven Gursten over at the Michigan Auto Lawyer Blog.  I’m reposting it here because I think it is compelling; and whether you agree with the post or not, the author’s passion and conviction is admirable. 

How Insurance Company IME Doctors Are Ruining Michigan’s No-Fault Insurance System

August 17th, 2010

No-Fault insurance lawyer explains how “independent” medical examiners devastate lives after serious car accidents and undermine our No-Fault system

When people suffer personal injury in  car accidents in Michigan, their auto insurance companies must pay No-Fault insurance benefits for all auto accident-related medical treatment that’s reasonably necessary for the injured person’s recovery and rehabilitation. By simply filing an application for No-Fault insurance benefits within one year of the car accident date with their own No-Fault insurers, auto accident victims are provided with legally mandated No-Fault insurance so they can try to heal and put their lives back together.

That is, until typically between three to six months passes and that auto insurance company claims adjuster decides to send that injured person out for a “second opinion” exam by an “independent” doctor selected by an insurance claims adjuster or insurance company defense attorney to perform an “independent” medical examination,” also known as an IME.

This is where Michigan’s No-Fault insurance system runs right into the brick wall called reality.

In a state without bad faith laws, punitive damages, or a consumer protection law that allows lawyers to protect Michigan residents from insurance company abuse, the doctors who perform these one-time insurance exams at the behest of insurance companies and workers compensation carriers do some outrageous and dishonest things.

And they routinely get away with it, while making vast amounts of money every year. Sadly, our No-Fault insurance lawyers have to fight these abuses everyday, because every insurance company in Michigan is now using the same “cut-off” doctors to deny and suspend legitimate no fault insurance benefits.

What an “independent” medical exam is really about

While our system of No-Fault benefits (also called personal injury protection (PIP) benefits) sounds great in theory — aside from the newest propaganda war being unleashed against unlimited medical payment by the Insurance Institute of Michigan, whose members are at the same time flush with record-breaking profits — the harsh reality is many accident victims find themselves in a situation where aggressive insurance companies cut off their insurance benefits for no good reason. These insurance companies focus far more on profits than the welfare of their own customers, and these IME examiners that they select play right into this.

Typically, these cut-offs stem from a 10 or 15 minute exam by the IME doctor. These “second opinion” exams are particularly exasperating for car accident victims, many of whom have devastating personal injuries, but soon find their No-Fault benefits halted after the brief examination by a doctor they are told they must see by their insurance claims adjuster. And for No-Fault insurance lawyers in Michigan who see the same notorious doctors performing these insurance examinations time and time again, we know that these independent medical examiners are sadly, anything but independent.

Too many of these doctors are making hundreds of thousands of dollars every year finding nothing wrong with people. Over time, IME doctors have created practices where almost all of their annual income is derived from performing these second-opinion exams (read: cutting off innocent auto accident victims from medical benefits and lost wages). Instead of using their knowledge and expertise to heal and treat, these doctors have devoted their professional lives to helping insurance companies get even richer, especially in Michigan.

Requiem and Rebirth

About three years ago, I hired Dave Gottlieb and inherited ownership of this blog.  I think most of you will agree that Dave did an excellent job maintaining the blog and keeping it interesting (and pretty humorous) during that time.  However, as most of you know, Dave has moved on.  So now I am left with this thing, with no real clue of how it works.  What I think I do know, however, is New York no-fault insurance law.  My intention is keep this thing going, hopefully with the same honesty, evenhandedness, and humor (attempted) as Dave.

So feel free to comment, critique and kibitz as we go on.  Thanks.

I backtraced it!

Astoria Wellness Med., P.C. v Progressive Northeastern Ins. Co., 2010 NY Slip Op 51333(U) (App. Term, 2nd, 11th & 13th Jud. Dists. 2010)

In this action by a provider to recover assigned first-party no-fault benefits, defendant, insofar as is relevant to this appeal, moved for summary judgment dismissing the complaint on the ground that the acupuncture services at issue were rendered by plaintiff, a professional service corporation, which is owned solely by a doctor who is neither licensed nor certified to perform acupuncture. Plaintiff cross-moved for summary judgment, arguing that it is eligible for reimbursement of such no-fault benefits because the acupuncture services were rendered by a licensed acupuncturist employed by plaintiff. The court granted defendant’s motion for summary judgment and denied plaintiff’s cross motion as moot. This appeal ensued.

As the pertinent facts of this case are the same as those in Quality Med. Care, P.C. v New York Cent. Mut. Fire Ins. Co. (26 Misc 3d 139[A], 2010 NY Slip Op 50262[U] [App Term, 2d, 11th & 13th Jud Dists 2010]), for the reasons stated in that case, the order, insofar as appealed from, is affirmed.

Infinity Health Prods., Ltd. v Progressive Ins. Co., 2010 NY Slip Op 51334(U) (App. Term, 2nd 11rh & 13th Jud. Dists. 2010)

To raise a triable issue of fact based on the assignor’s failure to appear at scheduled EUOs, defendant was required to demonstrate that its initial and follow-up requests for verification were timely (see Insurance Department Regulations [11 NYCRR] §§ 65-3.5 [b]; 65-3.6 [b]) and establish, by an affidavit of one with personal knowledge, that the assignor had failed to appear for the EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Since defendant failed to establish that the EUO scheduling letters were timely mailed (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]), defendant failed to demonstrate that the 30-day claim determination period (Insurance Department Regulations [11 NYCRR] § 65-3.8) was tolled. As a result, defendant failed to establish that its denial of claim forms were timely and, thus, that it is not precluded from raising as a defense the failure of plaintiff’s assignor to appear for an EUO (see Presbyterian Hosp. in City of NY v Maryland Cas. Co., 90 NY2d 274, 282 [1997]).

There is a Golia dissent.  I don’t believe Phillips v Kantor & Co., 31 NY2d 307 (1972) supports the proposition he gives, based on the cases I’ve seen that cited it.  I’ll check, eventually.

Points of Health Acupuncture, P.C. v Lancer Ins. Co., 2010 NY Slip Op 51338(U) (App. Term, 2nd 11rh & 13th Jud. Dists. 2010)

The first set of letters sent by defendant to plaintiff after defendant received plaintiff’s $334.14 claim (dates of service: July 24, 2006-July 31, 2006) and plaintiff’s $222.76 claim (dates of service: August 14, 2006 and August 15, 2006) merely stated that defendant was waiting for the results of an investigation by its special investigation unit as well as the scheduling of an EUO. Since it is well settled that an insurer’s delay letters, which request no verification, do not toll the statutory time period within which a claim must be paid or denied (see Nyack Hosp. v Encompass Ins. Co., 23 AD3d 535 [2005]; Careplus Med. Supply, Inc. v Selective Ins. Co. of Am., 25 Misc 3d 48 [App Term, 9th & 10th Jud Dists 2009]; Ocean Diagnostic Imaging P.C. v Citiwide Auto Leasing Inc., 8 Misc 3d 138[A], 2005 NY Slip Op 51314[U] [App Term, 2d & 11th Jud Dists 2005]), defendant did not toll the statutory period within which defendant had to pay or deny said claims. While the rest of the letters sent by defendant in response to the remaining claims sent by plaintiff were in fact verification requests, the affidavit submitted by defendant’s no-fault specialist failed to establish that they were timely mailed (see New York & Presbyt. Hosp., 29 AD3d 547; Residential Holding Corp., 286 AD2d 679; Top Choice Med., P.C. v New York Cent. Mut. Fire Ins. Co., 22 Misc 3d 133[A], 2009 NY Slip Op 50230[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). There was thus no tolling of the 30-day period as to these remaining claims. Consequently, with respect to the claims for which defendant did not [*3]establish that the 30-day period was tolled, defendant is precluded from raising most defenses.

Notwithstanding the foregoing, defendant correctly asserts that plaintiff’s cross motion for summary judgment was premature under CPLR 3212 (f). Defendant established that while facts may exist that are essential to justify the denial of plaintiff’s summary judgment motion, defendant was unable to set forth such facts with respect to its non-precluded defense that plaintiff was fraudulently incorporated (see Insurance Department Regulations [11 NYCRR] § 65-3.16 [a] [12]; State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]; Midwood Acupuncture, P.C. v State Farm Fire & Cas. Co., 21 Misc 3d 144[A], 2008 NY Slip Op 52468[U] [App Term, 2d & 11th Jud Dists 2008]), since this information was within plaintiff’s possession and plaintiff had not complied with defendant’s discovery demands therefor (see CPLR 3212 [f]). As plaintiff had failed to challenge the propriety of defendant’s discovery demands, the Civil Court should have granted the branch of defendant’s motion seeking to compel plaintiff to provide the information demanded in defendant’s interrogatories and notice for discovery and inspection with the exception of requests which were palpably improper or which sought information or documents which were privileged (see Fausto v City of New York, 17 AD3d 520 [2005]; Midwood Acupuncture, P.C. v State Farm Fire and Cas. Co., 21 Misc 3d 144[A], 2008 NY Slip Op 52468[U] [App Term, 2d & 11th Jud Dists 2008]; Great Wall Acupuncture v State Farm Mut. Auto. Ins. Co., 20 Misc 3d 136[A], 2008 NY Slip Op 51529[U] [App Term, 2d & 11th Jud Dists 2008]).

I need to check the record, but I doubt defendant made the sort of showing required to invoke CPLR R. 3212(f).

Uptodate Med. Servs., P.C. v State Farm Mut. Auto. Ins. Co., 2010 NY Slip Op 51345(U)(App. Term, 2nd 11rh & 13th Jud. Dists. 2010) (Collateral Estoppel)

AVA Acupuncture, P.C. v AutoOne Ins. Co., 2010 NY Slip Op 51350(U) (App. Term, 2nd 11rh & 13th Jud. Dists. 2010)

However, to the extent that defendant seeks, in item 5, to compel the production of Ms. Anikeyeva’s personal income tax returns, defendant has failed to establish its entitlement to such documents. “It is well settled that tax returns are generally not discoverable in the absence of a strong showing that the information is indispensable to the claim and cannot be obtained from other sources” (Altidor, 22 AD3d at 435-436 [citations and internal quotation marks omitted]; see also Benfeld, 44 AD3d at 600). At this juncture, defendant has failed to meet its burden of establishing that Ms. Anikeyeva’s personal income tax returns are properly discoverable, particularly since defendant is entitled to disclosure of plaintiff’s income tax returns and the requested financial information with respect to said corporation (see Great Wall Acupuncture, 20 Misc 3d 136[A], 2008 NY Slip Op 51529[U]).

Likewise, at this juncture, defendant has failed to meet its burden of establishing that Ms. Anikeyeva’s bank account statements, “bank account registers, cancelled checks and ledger” are “material and necessary” (CPLR 3101 [a]) to the defense of this action (see Altidor, 22 AD3d 435; Crossbay Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., 24 Misc 3d 140[A], 2009 NY Slip Op 51636[U] [App Term, 1st Dept 2009]; cf. Dore, 264 AD2d 804). Accordingly, [*3]defendant is entitled to the information sought in items 12 and 13, solely with respect to plaintiff.

Item 7 seeks a copy of the assignment. However, defendant did not seek verification with respect to the assignment, and its denial of claim form did not deny the claim on the ground that the assignment was defective. As a result, because defendant is now precluded from litigating the validity of the assignment (see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312 [2007]), defendant’s demand for a copy of the assignment is palpably improper.

Finally, item 11 seeks expert witness disclosure. In view of the fact that CPLR 3101 (d) (1) (i) does not require a party to respond to a demand for expert witness information within any specifically restricted time limit, plaintiff should not be compelled to respond to item 11 at this juncture.

Accordingly, defendant is entitled to the production of the information sought in items 1 through 4, 6, 8 through 10, 12 (only as to plaintiff), 13 (only as to plaintiff) and 14 of defendant’s supplemental demand for discovery and inspection.

We note that, contrary to plaintiff’s contention, the Civil Court properly held that plaintiff’s motion for summary judgment was premature pending the completion of discovery (see CPLR 3212 [f]; Jimenez v New York Cent. Mut. Fire Ins. Co., 71 AD3d 637 [2010]). Plaintiff’s remaining contention lacks merit.

Kew Gardens Med & Rehab, P.C. v Travelers Ins. Co., 2010 NY Slip Op 51356(U) (App. Term, 2nd 11rh & 13th Jud. Dists. 2010)

Plaintiff commenced this action in July 2002 to recover assigned first-party no-fault benefits. Issue was joined in September 2002, and there was no further activity in relation to the litigation until March 2007, when defendant served on plaintiff’s counsel of record a 90-day demand pursuant to CPLR 3216 (b). Plaintiff did not respond to the demand, and, by order entered November 24, 2008, the Civil Court granted defendant’s motion pursuant to CPLR 3216 (a) to dismiss the complaint for failure to prosecute, upon plaintiff’s default in opposing the motion. Thereafter, plaintiff moved to vacate the November 24, 2008 order, alleging that it had no notice of the motion, the papers having been improperly served on plaintiff’s former counsel, who had been replaced as counsel by present counsel in May 2003. The Civil Court denied the motion, citing plaintiff’s failure to produce a consent to change attorney form executed by plaintiff or to file said form with the Civil Court. Plaintiff appeals and we affirm.

If a notice of change of attorney form was executed in 2003, there is no proof that it was filed with the Civil Court at any time prior to defendant’s service of the 90-day demand in March 2007 (see CPLR 321 [b]; Moustakas v Bouloukos, 112 AD2d 981, 983 [1985]). Plaintiff’s present counsel does not claim that he communicated with defendant or its counsel during that four-year period, nor do any grounds appear on this record to support an inference that defendant was aware of the change of counsel, thereby rendering the filing requirement a mere “formality,” [*2]which may be disregarded (Bevilacqua v Bloomberg, L.P., 70 AD3d 411, 412 [2010]). Consequently, the counsel on whom defendant served its 90-day demand remained the counsel of record, and service of the demand and of the subsequent motion to dismiss on said counsel was proper (Stancage v Stancage, 173 AD2d 1081 [1991]), as was the order dismissing the complaint on plaintiff’s default in opposing defendant’s motion to dismiss. Under the circumstances, the noncompliance with the filing and notice requirements of CPLR 321 (b) represented no mere neglect of formalities, but the failure to transfer representation to new counsel (Splinters, Inc. v Greenfield, 63 AD3d 717, 719 [2009]; Hawkins v Lenox Hill Hosp., 138 AD2d 572, 573 [1988]; Moustakas v Bouloukos, 112 AD2d at 983; see Weinstein-Korn-Miller, NY Civ Prac ¶ 321.11 [2d ed]).

consequences will never be the same

Marina v Praetorian Ins. Co., 2010 NY Slip Op 51292(U) (App. Term, 1st, 2010)

In this action to recover assigned first-party no-fault benefits, defendant established prima facie that it mailed the notices of the independent medical examinations (IMEs) to the assignors and that the assignors failed to appear for the IMEs (Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 [2006]). In opposition, plaintiff failed to raise a triable issue regarding the reasonableness of the requests or the assignors’ failure to attend the IMEs (see Inwood Hill Med. v General Assurance Co., 10 Misc 3d 18, 20 [2005]). Thus, defendant was entitled to summary judgment dismissing the complaint based upon plaintiff’s failure to comply with a condition precedent to coverage (see id.).

I’ve done no formal research on this, but I’m probably right

Insurance carriers spend far more money on their attorneys, peers, re-peers, IME doctors, and “experts” each year than it would cost to pay every single no-fault claim as it came in.

Unicorns, Rainbows, or Kittens

Only one can be the new theme for this blog.  You have until Saturday to vote.  Vote in the comments.

I can’t sleep.