Sama Physical Therapy v. MVAIC
| Decision Date | 15 July 2019 |
| Docket Number | 720081/2013 |
| Citation | 106 N.Y.S.3d 565,64 Misc.3d 988 |
| Parties | SAMA PHYSICAL THERAPY, a/a/o Heather Thomas, Plaintiff, v. MVAIC, Defendant. |
| Court | New York Civil Court |
64 Misc.3d 988
106 N.Y.S.3d 565
SAMA PHYSICAL THERAPY, a/a/o Heather Thomas, Plaintiff,
v.
MVAIC, Defendant.
720081/2013
Civil Court, City of New York.
Decided July 15, 2019
The Rybak Firm, PLLC, Brooklyn (Oleg Rybak of counsel), for plaintiff.
Lawrence N. Rogak, LLC, Oceanside (Lawrence N. Rogak of counsel), and Jaime Gangemi, New York City, for defendant.
Tracy A. Catapano-Fox, J.
Plaintiff commenced this action against defendant to recover first party No-Fault benefits on November 20, 2013 and issue was joined on December 6, 2013. The parties appeared for trial on June 13, 2019, and as this Court is constrained to follow the order of the Honorable Jodi Orlow1
dated December 16, 2014, the parties were directed to submit memoranda of law on the sole issue of whether the timing of defendant's examination under oath requests were reasonable. The parties submitted memoranda of law on July 1, 2019, and upon review of the parties' submissions, I render the following decision.
Findings of Fact
The parties stipulated to the following facts. This action stems from plaintiff providing No-Fault medical benefits to assignor Heather Thomas, for personal injuries sustained in a motor vehicle accident. Plaintiff submitted two bills to defendant, one submitted in the amount of $677.60 and received by defendant on October 12, 2011, and a second bill in the amount of $246.40, received by defendant on November 11, 2011. Defendant sent to plaintiff assignor a request for an examination under oath mailed on December 9, 2013 and January 2014.
Plaintiff argues that defendant's examination under oath requests were untimely as a matter of law, and therefore it is entitled to judgment for both bills. It argues that the case law supports the conclusion that defendant's failure to timely request plaintiff assignor appear for an examination under oath precludes defendant from asserting this defense. Plaintiff claims that the No-Fault regulations require defendant to make a request for an examination under oath within fifteen business days of receipt of the bills, and since defendant's requests were over two years later, they are untimely. Further, plaintiff argues that since the requests were untimely, defendant is precluded from an asserting a defense of failure to appear at the examination under oath. Finally, as defendant failed to pay or timely deny plaintiff's bills, plaintiff argues it is entitled to judgment in the amount of $924, with statutory interest and fees.
Defendant argues that plaintiff is not entitled to judgment because plaintiff assignor failed to appear at an examination under oath, requested by defendant because there was evidence that plaintiff assignor was not a qualified person under Insurance Law Article 52. It argues that while under the No-Fault regulations, a request for an examination under oath must be sent within fifteen days from the date of receipt of the bill, there is an exception for defenses premised on lack of coverage. Defendant argues that a similar exception exists where defendant believes that the applicant for MVAIC coverage is not a qualified person and therefore would not be covered under MVAIC guidelines, and that this defense can be raised at any time. Defendant admits that the requests for examinations under oath were made in excess of two years from receiving the bills but argues that it is irrelevant because its requests were based upon the MVAIC qualification process, and not the No-Fault verification procedures. Therefore, defendant argues that since plaintiff assignor failed to appear for the examinations under oath, which were properly mailed to them, judgment must be awarded for defendant and dismissal of plaintiff's Complaint is warranted.
Conclusions of Law
Article 51 of the Insurance Law, commonly referred to as the No-Fault Law, was enacted by the Legislature to correct certain maladies recognized under the common-law tort system of compensating automobile accident victims. (
Licari v. Elliott , 57 N.Y.2d 230, 455 N.Y.S.2d 570, 441 N.E.2d 1088 [1982].) The purpose of the No-Fault Law is to assure claimants of expeditious compensation for injuries sustained in a motor vehicle accident by ensuring prompt payment of first party benefits regardless of fault. ( Dermatossian v. New York City Trans. Auth. , 67 N.Y.2d 219, 501 N.Y.S.2d 784, 492 N.E.2d 1200 [1986] ; see also Matter of American Ind. Ins. Co. v. Nova Acupuncture, P.C. , 137 A.D.3d 1270, 28 N.Y.S.3d 704 [2nd Dept. 2016].) Under the strict time frames of the No-Fault regulations which emphasize the great convenience of ‘prompt, uncontested first party insurance benefits’, an insurer may be precluded from untimely raising a defense, resulting in payment by the insurer of a No-Fault claim it might not have had to honor if the claim had been timely denied. ( Viviane Etienne Med. Care v. Country-Wide Ins. Co. , 25 N.Y.3d 498, 14 N.Y.S.3d 283, 35 N.E.3d 451 [2015].)
Insurance Law § 5106 states that payment of No-Fault benefits shall be made as the loss is incurred, and such benefits are overdue if not paid within thirty (30) days from the date the claimant supplies proof of the fact and the loss sustained. Pursuant to 11 NYCRR § 65-3.5, an insurer shall forward verification forms to the claimant within ten (10) days from the date of receipt of the application for No-Fault benefits, and any additional verification forms must be sent to the claimant within fifteen (15) days of receiving the initial verification forms.
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