Failure to answer questions voids coverage November 28, 2015

Country-Wide Ins. Co. v Gotham Med., P.C., 2015 NY Slip Op 25387 (Sup. Ct. NY CO. 2015)
“Dr. Scheer’s failure to answer all relevant questions at the EUO, as required by the provisions of the applicable insurance policies, constitutes a material breach of contract, and precludes recover

Delay letters v. verification requests November 28, 2015

New Way Acupuncture, P.C. v New York Cent. Mut. Fire Ins. Co., 2015 NY Slip Op 51706(U)(App. Term 2d Dept. 2015)
“A review of defendant’s letters reveals that they merely notified plaintiff that defendant was delaying payment, but they did not request any specific verification. As a res

Why was misrepresentation material? November 28, 2015

Gutierrez v Tri State Consumers Ins. Co., 2015 NY Slip Op 51703(U)(App. Term 2d Dept. 2015)
“Defendant demonstrated that the assignor, who was also the insured under the insurance policy in question, had misrepresented, among other things, his use of the subject vehicle when he had submitted

EBT upheld November 28, 2015

Duke Acupuncture, P.C. v Mercury Cas. Co., 2015 NY Slip Op 51701(U)(App. Term 2d Dept. 2015)
“Defendant sufficiently established the timely mailing (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) of the denial of claim form at issue, which denied

Another less than valid verification compliance affidavit suffices November 28, 2015

Compas Med., P.C. v Praetorian Ins. Co.,2015 NY Slip Op 51699(U)(App. Term 2d Dept. 2015)
However, in opposition to the cross motion, plaintiff submitted an affidavit from plaintiff’s owner, which affidavit was sufficient to give rise to a presumption that the requested verification had been m

Need to wait for the non-EUO based verification before disclaiming November 28, 2015

Alleviation Med. Servs., P.C. v Citiwide Auto Leasing, 2015 NY Slip Op 51709(U)(App. Term 2d Dept. 2015)
“Contrary to plaintiff’s contention, defendant established that verification requests and EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v G

Maya failed to prove mailing of the IME scheduling letters November 28, 2015

Sharp View Diagnostic Imaging, P.C. v Maya Assur. Co., 2015 NY Slip Op 51721(U))(App. Term 2d Dept. 2015)
“Plaintiff correctly argues on appeal that the affidavit submitted by defendant did not sufficiently set forth a standard office practice or procedure that would ensure that the letters s

Clennon applied November 28, 2015

Palafox PT, P.C. v State Farm Mut. Auto. Ins. Co., 2015 NY Slip Op 51653(U)(App. Term 2d Dept. 2015)
“With respect to plaintiff’s contention that defendant failed to demonstrate justification for its EUO requests, the Appellate Division, Second Department, has held that where an insurer

Failed to avail itself of the opportunity afforded to it on the NF-10 November 28, 2015

Healthway Med. Care, P.C. v Country Wide Ins. Co., 2015 NY Slip Op 51654(U)(App. Term 2d Dept. 2015)
“As defendant established its prima facie entitlement to judgment as a matter of law, the burden shifted to plaintiff. Despite being informed by the denial of claim forms that it had the oppor

Lost to Dr. Bhatt November 28, 2015

Ap Orthopedic & Rehabilitation, P.C. v Allstate Ins. Co., 2015 NY Slip Op 51656(U)(App. Term 2d Dept. 2015)
“In reviewing a determination made after a nonjury trial, the power of this court is as broad as that of the trial court, and this court may render the judgment it finds warranted b

  1. Alan M. Elis says:

    This is not a summary judgment motion. A trier of fact is free to assess and reject an uncontradicted expert opinion. It’s in the very West Tremont case that arbitrators continually mis-cite.