LIBERTY MUTUAL INSURANCE COMPANY v. PC (2025)

Order, Supreme Court, New York County (Debra A. James, J.), entered on or about November 24, 2023, which granted plaintiffs’ motion for summary judgment and adjudged and declared that plaintiffs are not obligated to honor or pay claims for reimbursement to defendants Bronx Medical Health Provider and Burke Physical Therapy PC, as assignees of defendants Dilia Mercado, Jose Mercado, and Miguel Angel Santiago (the individual defendants), with respect to no-fault benefits for an alleged motor vehicle collision that occurred on April 15, 2019, unanimously affirmed, with costs.

The individual defendants were allegedly involved in a vehicle collision with another vehicle.  According to plaintiffs, which are the no-fault insurance providers, no injuries were reported at the scene, and no citations were issued.  After the collision, the individual defendants sought medical treatment from defendant medical providers for their alleged injuries;  the medical providers then sought and were denied reimbursement as assignees of the individual defendants.

Plaintiffs established their entitlement to summary judgment by providing a specific objective justification for conducting examinations under oath (EUOs) of the individual defendants (11 NYCRR 65–3.5[e];  see Country–Wide Ins. Co. v. Delacruz, 205 A.D.3d 473, 473, 168 N.Y.S.3d 63 [1st Dept. 2022]).  Although the explanation that plaintiffs provided was not particularly extensive, it was sufficient to establish the justification and to establish that defendants had not requested these EUOs arbitrarily or as a matter of routine.  We note that plaintiffs moved for summary judgment after the close of discovery, during which they had disclosed to defendants the basis for their requests (cf.  Delacruz, 205 A.D.3d at 473, 168 N.Y.S.3d 63).

Furthermore, Supreme Court correctly concluded that, with respect to these defendants, plaintiffs established that they sent timely requests for the EUOs. Thus, the individual defendants’ failure to appear for EUOs constitutes a breach of a condition precedent to coverage and voids the policy ab initio (see Unitrin Advantage Ins. Co. v. Dowd, 194 A.D.3d 507, 508, 143 N.Y.S.3d 543 [1st Dept. 2021]).

We have considered defendants’ remaining arguments and find them unavailing.