X

Thank you for sharing!

Your article was successfully shared with the contacts you provided.

Recitation, as required by CPLR §2219(a), of the papers considered in the review of this motion: Papers/Numbered Notices of Motion and Affidavits Annexed  1 Answering Affidavits and Notice of Cross-Motion          2 Replying Affirmation and Opposition to Cross-Motion 3 Exhibits Email Correspondence                4 Other BACKGROUND Plaintiff medical provider, Restorative Chiropractic Solutions, PC, brings this action against insurer defendant State Farm Mutual Automobile Ins. Co., to recover first-party no-fault benefits for medical services provided to its assignor, Lourdes Clyne (“plaintiff assignor”). Defendant makes the instant motion for summary judgment based on its denials of the claims. The bulk of the denials — three out of five of them — allege material misrepresentation in the procurement of the policy. Defendant asks that if this court does not grant summary judgment on a proper denial of material misrepresentation, that it determine its denials were at a minimum timely. Plaintiff opposes the motion and cross-moves for summary judgment. Plaintiff assignor was involved in a motor vehicle accident on June 14, 2017, and sought medical treatment. This action seeks reimbursement for five claims corresponding to dates of service between August 1, 2017 to September 7, 2017, totaling $505.98. Defendant supplied the following chart that provides information relevant to its request for verification and denials: Bill Dates of Service Amount of Bill Amount Paid Date Received Delay letter Date of Denial Reason for Denial 18/01/17$54.74$43.799/05/17N/A9/12/17Bill was partially paid and remainder was denied 28/02/17 - 8/10/17$69.36$55.499/05/17N/A9/12/17Bill was partially paid and remainder was denied 38/11/17- 8/22/17$173.40$09/18/179/26/17- 10/27/1711/27/17Material Misrepresentation in Procurement of the Policy 48/23/17-8/24/17$69.36$09/18/179/26/17- 10/27/1711/27/17Material Misrepresentation in Procurement of the Policy 58/31/17-9/07/17$138.72$09/29/1710/05/1711/27/17Material Misrepresentation in Procurement of the Policy Plaintiff assignor acquired the policy with a residential address in Florida. The subject motor vehicle accident occurred in New York. Defendant’s investigation of the claims prompted questions about plaintiff assignor’s residency and principal garaging location of the insured vehicle (Galluzo Aff.,

18-19). Defendant mailed verification request letters to plaintiff seeking an examination under oath (“EUO”) of plaintiff assignor to ascertain if there was a material misrepresentation in procurement of the policy (Galluzo Aff., Exh. E). The EUO was held on November 3, 2017 (Galluzo Aff., Exh. G). Plaintiff assignor testified that at the time of the subject accident she resided in Brooklyn, New York, and principally garaged the insured vehicle there as well (id.; Galluzo Aff.,

 
Reprints & Licensing
Mentioned in a Law.com story?

License our industry-leading legal content to extend your thought leadership and build your brand.

More From ALM

With this subscription you will receive unlimited access to high quality, online, on-demand premium content from well-respected faculty in the legal industry. This is perfect for attorneys licensed in multiple jurisdictions or for attorneys that have fulfilled their CLE requirement but need to access resourceful information for their practice areas.
View Now
Our Team Account subscription service is for legal teams of four or more attorneys. Each attorney is granted unlimited access to high quality, on-demand premium content from well-respected faculty in the legal industry along with administrative access to easily manage CLE for the entire team.
View Now
Gain access to some of the most knowledgeable and experienced attorneys with our 2 bundle options! Our Compliance bundles are curated by CLE Counselors and include current legal topics and challenges within the industry. Our second option allows you to build your bundle and strategically select the content that pertains to your needs. Both options are priced the same.
View Now
October 15, 2024
Los Angeles, CA

Join the industry's top owners, investors, developers, brokers & financiers at THE MULTIFAMILY EVENT OF THE YEAR!


Learn More
October 15, 2024
Los Angeles, CA

Law.com celebrates the California law firms and legal departments driving the state's dynamic legal landscape.


Learn More
October 15, 2024
Dallas, TX

The Texas Lawyer honors attorneys and judges who have made a remarkable difference in the legal profession in Texas.


Learn More

parkingticket.com is the world-leader in local, municipal compliance. Whether it be a food delivery, or a fine bottle of wine being delive...


Apply Now ›

The Partners Group is currently recruiting a VP of Legal for our burgeoning client, a real estate investment firm in Atlanta, GA. The firm h...


Apply Now ›

McCarter & English, LLP is actively seeking a patent associate for its Intellectual Property Practice Group. Candidates should have supe...


Apply Now ›