A trial court in New York has denied a no-fault insurer's motion for summary judgment in its action against health care providers seeking payment of benefits as assignees of an insured injured in a motor vehicle accident, concluding that the insurer had not timely noticed examinations under oath of the insured.
The Case
Jose Luis Escalona alleged that he was injured in a motor vehicle accident on July 31, 2017 and that he thereafter obtained medical treatment or medical supplies from various health care providers.
The health care providers sought payment for their services as assignees of Mr. Escalona from his no-fault insurance company, Country-Wide Insurance, which received claims for Mr. Escalona's care from about October 23, 2017 through November 7, 2017.
Country-Wide mailed notice for an examination under oath ("EUO") to Mr. Escalona on November 14, 2017. According to the insurer, he did not attend either the first or second rescheduled EUO.
The insurer moved for summary judgment against two defendants, contending that it was not required to pay no-fault benefits to them because Mr. Escalona had not appeared for duly scheduled EUOs.
The Court's Decision
The court denied Country-Wide's motion.
In its decision, the court explained that New York law required that Country-Wide demonstrate that its initial EUO notice was mailed to Mr. Escalona within 15 days of its receipt of the health care providers' claims.
The court then ruled that Country-Wide failed to demonstrate that it adhered to the 15-day requirement and that it did not "establish conclusively" that any failure to adhere to the requirement did not ultimately affect the timeliness of its denial of coverage within the 30-day limit prescribed by New York law.
The court pointed out that Country-Wide received one health care provider's claim on October 23, 2017, requested the first EUO on November 14, 2017, and did not deny coverage until January 10, 2018.
Accordingly, the court denied Country-Wide's motion for summary judgment.
The case is Country-Wide Ins. Co. v. Escalona, No. 652359/2018 (N.Y. Sup. Ct. N.Y. Co. Sept. 16, 2019).
Steven A. Meyerowitz
Steven A. Meyerowitz, a Harvard Law School graduate, is the founder and president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. He may be contacted at [email protected].