State Farm Mut. Auto. Ins. Co. v. Smith

• Decision Date: 08 May 2023
• Docket Number: Index No. 155607/2020,MOTION SEQ. No. 003
• Citation: 2023 NY Slip Op 31544 (U)
• Parties: STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Plaintiff, v. ALFORD A. SMITH, M.D., P.C., AFFINITY RX, INC., ANDALELLA CHIROPRACTIC, P.C., SONIA ARMENGOL, M.D., ATLAS PHARMACY, L.L.C., BEST EMPIRE MEDICAL, P.C., BEST HANDS-ON PHYSICAL THERAPY, P.C., BRAND MEDICAL SUPPLY, INC.,CHANG HEALTH PHYSICAL THERAPY, P.C., COMPLETE NEUROPSYCHOLOGY, P.C., EZ TRIBORO SERVICES, INC., HEALING SERVICES, INC., JAMES MIHALCHIK, M.D., KIM CHIROPRACTIC, P.C., MEDAID RADIOLOGY, L.L.C., OLGA GIBBONS, M.D. D/B/A ASTRO MEDICAL SERVICES, OS ACUPUNCTURE, P.C.,RIDGEWOOD DIAGNOSTIC LABORATORY, L.L.C., RIVERSIDE MEDICAL SERVICES, P.O.,PRISCILLA SANTANA, SPINAL PRO CHIROPRACTIC, P.C., SUPPORTIVE PRODUCTS CORP., SYOSSET ACUPUNCTURE, P.O. JONG LI, M.D., P.O.,VERNON REHAB & PHYSICAL THERAPY, P.C., WAKEFIELD CHIROPRACTIC, P.C., ULYSSES CHEDA, NELSON SANTIAGO, GEORGELINA VARGAS, GRISELDA TORRES Defendant.
• Court: New York Supreme Court

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2023 NY Slip Op 31544(U)

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Plaintiff, v. ALFORD A. SMITH, M.D., P.C., AFFINITY RX, INC., ANDALELLA CHIROPRACTIC, P.C., SONIA ARMENGOL, M.D., ATLAS PHARMACY, L.L.C., BEST EMPIRE MEDICAL, P.C., BEST HANDS-ON PHYSICAL THERAPY, P.C., BRAND MEDICAL SUPPLY, INC.,CHANG HEALTH PHYSICAL THERAPY, P.C., COMPLETE NEUROPSYCHOLOGY, P.C., EZ TRIBORO SERVICES, INC., HEALING SERVICES, INC., JAMES MIHALCHIK, M.D., KIM CHIROPRACTIC, P.C., MEDAID RADIOLOGY, L.L.C., OLGA GIBBONS, M.D. D/B/A ASTRO MEDICAL SERVICES, OS ACUPUNCTURE, P.C.,RIDGEWOOD DIAGNOSTIC LABORATORY, L.L.C., RIVERSIDE MEDICAL SERVICES, P.O.,PRISCILLA SANTANA, SPINAL PRO CHIROPRACTIC, P.C., SUPPORTIVE PRODUCTS CORP., SYOSSET ACUPUNCTURE, P.O. JONG LI, M.D., P.O.,VERNON REHAB & PHYSICAL THERAPY, P.C., WAKEFIELD CHIROPRACTIC, P.C., ULYSSES CHEDA, NELSON SANTIAGO, GEORGELINA VARGAS, GRISELDA TORRES Defendant.

Index No. 155607/2020, MOTION SEQ. No. 003

Supreme Court, New York County

May 8, 2023

Unpublished Opinion

MOTION DATE 03/16/2023

PRESENT: HON. LISA S. HEADLEY Justice

DECISION + ORDER ON MOTION

LISA S. HEADLEY, J.S.C.

The following e-filed documents, listed by NYSCEF document number (Motion 003) 145, 146, 147, 148, 149, 150, 151, 152, 153 154, 155, 156, 157, 158, 159, 160, 161, 162, 163, 164, 165 166, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177 178, 179, 180, 181, 182 were read on this motion to/for JUDGMENT - SUMMARY.

Upon the forgoing documents, it hereby ORDERED that the plaintiff, State Farm Mutual Automobile Insurance Company's ("State Farm/Plaintiff"), motion for summary judgment pursuant to CPLR §3212, is hereby GRANTED against defendants, ALFORD A. SMITH, M.D., P.C., AFFINITY RX, INC., ATLAS PHARMACY, L.L.C., BRAND MEDICAL SUPPLY, INC., CHANG HEALTH PHYSICAL THERAPY, P.C., COMPLETE NEUROPSYCHOLOGY, P.C., HEALING SERVICES, INC., JAMES MIHALCHIK, M.D., MED AID RADIOLOGY, L.L.C., OLGA GIBBONS, M.D. d/b/a ASTRO MEDICAL SERVICES, OS ACUPUNCTURE, P.C., RIDGEWOOD DIAGNOSTIC LABORATORY, L.L.C., SPINAL PRO CHIROPRACTIC, P.C., SYOSSET ACUPUNCTURE, P.C., TONG LI, M.D., P.C., VERNON REHAB & PHYSICAL THERAPY, P C. and WAKEFIELD CHIROPRACTIC, P C (hereinafter collectively "The Defendants").

Defendants, ALFORD A. SMITH, M.D., P.C., JAMES MIH.ALCHIK, M.D., MEDAID RADIOLOGY, L.L.C., OS ACUPUNCTURE, P.C., SPINAL PRO CHIROPRACTIC, P.C., TONG LI, M.D., P.C., WAKEFIELD CHIROPRACTIC, P.C. (hereinafter collectively, "the Provider Defendants #1"), by and through their attorney Oleg Rybak, Esq. from The Rybak Firm, PLLC, filed opposition.

Defendants, ALFORD A. SMITH, M.D., (this is the same as above) ATLAS PHARMACY, L.L.C., CHANG HEALTH PHYSICAL THERAPY, P.C., RIDGEWOOD DIAGNOSTIC LABORATORY, L.L.C., SYOSSET ACUPUNCTURE, P.C., and VERNON REHAB &PHYSICAL THERAPY, P.C. (hereinafter collectively, "the Provider Defendants #2") by and through their attorney, Joseph Padrucco, Esq. from the Law Offices of Gabriel &Moroff, P.C., also filed opposition.

In support of the motion, the plaintiff submitted, inter alia, affidavits from David F. Boucher, Jr. Esq., ("Mr. Boucher") who is the managing partner/supervisor and Vitaly Vilenchik, Esq., ("Ms. Vilenchik") who is an associate at Rubin, Fiorella, Friedman, &Mercante LLP, ("RFFM counsel"). Mr. Boucher and Ms. Vilenchik both work in the department that is responsible for generating and mailing all EUO demand letters. Plaintiff also submits the affidavit of plaintiff s claims specialist, Timothy Dacey.

Plaintiff argues State Farm is entitled to summary judgment on the additional ground that the claimants Ulysses Cheda, Nelson Santiago, and Georgelina Vargas failed to appear at two scheduled EUOs. See, Hertz Vehs. LLC v. Significant Care, PT, P.C., 157 A.D.3d 600 (1st Dep't 2018). Plaintiff contends that timely notices were properly mailed to the Claimants. (See, Exhibit E, NYSCEF Doc. No. 151). Specifically, plaintiff submits that Ulysses Cheda and Nelson Santiago's EUO were scheduled to be held on August 19, 2019, and September 16, 2019. Georgelina Vargas' EUO was scheduled to be held on August 20, 2019, and September 17, 2019. However, RFFM counsel stated that the claimants, Ulysses Cheda ("Cheda"), Nelson Santiago ("Santiago"), and Georgelina Vargas ("Vargas") failed to appear for the EUOs scheduled

In addition, plaintiff argues that although claimant Griselda Torres appeared for her EUO scheduled on September 17, 2019. (See, NYSCEF Doc. 152). Plaintiff claims that Torres failed to return a subscribed copy of her EUO transcript. Plaintiff argues that returning the transcripts of the EUO is a condition precedent to coverage and warrants a denial of the claims. See, Hereford Ins. Co. v. Forest Hills Med., P.C., 172 A.D.3d 567 (1st Dep't 2019). Therefore, plaintiff contends the insurance coverage for the claims must be denied.

Furthermore, plaintiffs claims specialist, Timothy Dacey, contends that the insured Ulysses Cheda made material misrepresentations about his residence and the garage location of the insured vehicle when he procured the policy. Therefore, plaintiff argues that "a misrepresentation in an insurance application is material, voiding the policy ab initio, if, had the true facts been known, either the insurer would not have issued the policy or would have charged a higher premium." Starr Indem. & Liab. Co. v. Monte Carlo, LLC, 190 A.D.3d 441, 442, leave to appeal dismissed, (1st Dep't 2021).

In opposition, the Provider Defendants #1 argue, inter alia, that plaintiff failed to demonstrate compliance with the No-Fault regulations because plaintiff has not established that it complied with the regulations governing EUOs. The Provider Defendants #1 assert plaintiff has not established that notices had been served in conformity of those requirements pursuant to 11 NYCRR § 65-3.5, which imposes a time limit for insurers to request additional verification. Provider defendants #2 assert that failure to return a subscribed transcript is not grounds for summary judgment because "the unsigned transcript is not inadmissible and does not constitute a bar to coverage" pursuant to CPLR §3116. The Provider Defendants #2 also argue, inter alia, there are issues of fact concerning the plaintiff s request for EUOs. The Provider Defendants #2 contend that the plaintiff failed to submit admissible evidence as to when the bills and/or claims were received by defendant. The Provider Defendants #2 also argue there are issues of fact concerning whether there were ever any properly scheduled EUOs; and...