JCC Medical, P.C. a/o Damis, Magalie v. Lancer Insurance Co

New Way Medical Supply Corp., a/o Mondestin, Lilaine v. Lancer Insurance Co

Adelaida Physical Therapy, P.C. a/o Damis, Magalie v. Lancer Insurance Co

Lower Court Index #s.
5725/14
5727/14
5723/14

Appellate Term of the Supreme Court – Second Judicial Department

Appellate Term Docket #s

2018-2503 KC
2018-2506 KC
2018-2507 KC

In a line of cases involving the same issues, the Appellate Term, Second Department, reversed each lower court decision and ordered that judgement be entered for the insurer, dismissing each complaint.  After non-jury trials, the Civil Court, Kings County, awarded Plaintiffs judgment for the amounts sought in each complaint.  The sole issues for trial were: (i) whether the insurer established that it timely mailed its letters requesting Plaintiff to appear for an EUO and (ii) whether the insurer timely mailed its denial of claim forms.  The lower court ruled that the because the insurer failed to send the EUO notices via certified mail, return receipt requested, the insurer failed to establish timely mailing of the notices.  On appeal, the Appellate Term held that the failure to send the EUO notices via certified mail, return receipt requested, was inconsequential since the letters were also sent via first-class mail and since the testimony at trial sufficiently established the procedures related thereto.  The Appellate Term also deemed sufficient, the claims examiner’s testimony as to the mailing of the denial of claim forms (notwithstanding the fact that the examiner did not have direct supervisory authority over the insurer’s mail personnel) and ordered the lower court to dismiss the complaints – each which were filed in 2014 (and accruing significant interest since then).   

»View Decisions

ADO 2018-02503 KC
ADO 2018-02506 KC
ADO 2018-02507 KC