EDUARDO DEL ROSARIO v. State Farm Insurance Company, Defendant(s) (2026)

Recitation, as required by CPLR 2219(a), of the papers considered in the review of this motion:

Motion, Affidavits and Exhibits NYSCEF 4-15

Opposition, Cross-Motion, Affidavits,

and Exhibits NYSCEF 17-18

Reply/Opposition to Cross-Motion NYSCEF 19

Upon the foregoing cited papers and due deliberation, it is determined as follows:

This is an action by a health services provider to recover assigned first-party no-fault benefits from the insurer defendant. Plaintiff-Assignee, CuraHealth, commenced this action by filing a summons and complaint on January 10, 2025, seeking payment pursuant to 11 NYCRR § 65.15 in the amount of $496.80 for health services rendered to assignor, Eduardo del Rosario, in connection with personal injuries sustained in an automobile accident occurring on December 27, 2023. Defendant insurance company, State Farm, joined issue by filing an answer on February 27, 2025. Now before this Court is defendant's motion for summary judgment on the grounds that the alleged December 27, 2023, loss was fraudulent, as well as plaintiff's cross-motion for summary judgment arguing defendant's claim of fraud is speculative and that, instead, plaintiff met its prima facie burden of demonstrating payments of the no-fault benefits are overdue.

In support of its motion, defendant details its thorough investigation into Mr. Rosario's claims, and submits numerous exhibits, including the affirmation of defendant's claim specialist employee Griffin Ballard, a copy of the NF-10 denial of claim form, an uncertified police report, an engineering report on data recovered from the vehicle's Event Data Recorder (EDR), as well as the certified Examination Under Oath (EUO) transcripts of Mr. Rosario, the driver of the insured vehicle, and passengers Cedeno and Hilarion.

The proponent of a summary judgment motion has the initial burden of making a prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to eliminate any material issues of fact from the case. Alvarez v Prospect Hosp., 68 NY2d 320, 324, 501 N.E.2d 572, 508 N.Y.S.2d 923 (1986); Winegrad v New York Univ. Med. Ctr., 64 NY2d 851, 852, 476 N.E.2d 642, 487 N.Y.S.2d 316 (1985); Sillman v Twentieth Century-Fox Film Corp., 3 NY2d 395, 403, 144 N.E.2d 387, 165 N.Y.S.2d 498 (1957). Failure to make such a showing requires denial of the motion, regardless of the sufficiency of the opposing papers. Winegrad, 64 NY2d 851. Once such proof has been offered, the burden then shifts to the opposing party to submit evidence in admissible form and "show facts sufficient to require a trial of any issue of fact." CPLR 3212 [b]; Alvarez, 68 NY2d at 324.

An intentionally caused or staged vehicular collision is not a covered accident under an insurance policy. Adirondack Ins. Exch. v Rodriguez, 215 AD3d 904, 905, 187 N.Y.S.3d 331 (2d Dept 2023); National Gen. Ins. Online, Inc. v Blasco, 210 AD3d 786, 787, 177 N.Y.S.3d 350 (2d Dept 2022); see Progressive Advanced Ins. Co. v McAdam, 139 AD3d 691, 692, 32 N.Y.S.3d 191 (2d Dept 2016). When a collision is intentionally caused, the insurer is not obligated to provide coverage, even to innocent third parties. Adirondack Ins. Exch., 215 AD3d at 905; Nationwide Gen. Ins. Co. v Pontoon, 123 AD3d 1040, 1041, 999 N.Y.S.2d 482 (2d Dept 2014).

In meeting its burden, an insurer need not "establish that the subject collision was the product of fraud, which would require proof of all elements of fraud, including scienter, by clear and convincing evidence." V.S. Med. Services, P.C. v. Allstate Ins. Co., 25 Misc 3d 39, 39 (NY App. Term, 2d Dep't 2009). The insurer need only establish by a preponderance of the evidence that the collision was not an accident. Id. The insurer must demonstrate the facts elicited during an investigation that make up the founded belief. Am. Alternative Ins. Corp. v Washington, 60 Misc 3d 1222[A], 110 N.Y.S.3d 496, 2018 NY Slip Op 51210[U] (Sup Ct, New York County 2018).

Here, defendant insurer established its prima facie entitlement to judgment as a matter of law by demonstrating that it's belief that the collision was intentionally caused is founded upon a thorough investigation resulting in proof that, inter alia, the policy originated less than a month prior to the alleged loss, the loss was not reported until a couple of months after the alleged accident, the policy claimants offered conflicting versions of events at their EUOs, and the claimants all received identical boilerplate treatment from the same medical providers despite testifying they did not appear to know each other.

In opposition, plaintiff failed to raise a triable issue of fact as to whether the collision was intentionally caused or staged, and plaintiff's cross-motion is insufficient to make a prima facie case for entitlement to summary judgment because, among other reasons stated above, plaintiff submitted only an affirmation by its counsel, who did not establish that he possessed personal knowledge of the facts. See Rockland Family Med. Care, P.C. v. State Farm Mut. Auto. Ins. Co., 76 Misc 3d 1126[A], 2022 NY Slip Op 50766[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022]; GBI Acupuncture, P.C. v. 21st Century Ins. Co., 48 Misc 3d 140[A], 2015 NY Slip Op. 51235[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]). "[A] plaintiff demonstrates prima facie entitlement to summary judgment by submitting evidence that payment of no-fault benefits are overdue, and proof of its claim, using the statutory billing form, was mailed to and received by the defendant insurer." Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498, 501 [2015]). Here, plaintiff's submissions fall short as an attorney affirmation alone is insufficient to raise an issue of fact to oppose a summary judgment motion. Sheepshead Bay Med. Supply, Inc. v Erie Ins. Co. of NY, 2021 NY Slip Op 50491(U) [71 Misc 3d 140(A)] (App. Term 2d Dep't 2021).

Accordingly, it is hereby,

ORDERED that defendant's motion for summary judgment is GRANTED in its entirety and plaintiff's complaint is hereby dismissed; and it is further

ORDERED that plaintiff's cross-motion is denied.

This constitutes the decision and order of the court.

Dated: June 1, 2026

Queens, New York

HON. FANIA JEAN, JCC

Fania Jean, J.