Global Liberty Insurance Co. v. W. Joseph Gorum, M.D., P.C.
143 A.D.3d 768
| N.Y. App. Div. | 2016Background
- Global Liberty (insurer) sued under Insurance Law § 5106(c) for de novo review of two no-fault claim denials after master arbitration awards exceeding $5,000 to assignees of insured claimants.
- Two separate defendants: W. Joseph Gorum, M.D., P.C. (assignee of Maldotha Conyers) and Laxmidhar Diwan, M.D. (assignee of Jerry Souffront).
- Gorum failed to answer or appear; Global Liberty moved for leave to enter a default judgment against Gorum.
- Global Liberty also moved for summary judgment against Diwan, arguing the surgery Diwan performed on Souffront was not medically necessary and therefore not covered, and sought dismissal of Diwan’s breach-of-contract counterclaim.
- The Supreme Court denied both the default-judgment branch (based on the insurer’s expert affirmation lacking an original signature) and the summary-judgment branch as to Diwan (finding insurer failed to make out prima facie entitlement).
- The Appellate Division modified to grant leave to enter default against Gorum but affirmed denial of summary judgment as to Diwan.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Leave to enter default judgment vs. Gorum | Service proved; expert peer-review affirmation supported claim; default judgment warranted | Gorum did not appear or answer (no opposition) | Granted: service and facts shown; bare lack of original signature on expert affirmation was not a proper basis to deny default relief |
| Prima facie entitlement to summary judgment that insurer has no coverage for Diwan’s surgery | Peer review and records show surgery was not medically necessary, so no coverage | Surgery was medically necessary; evidence disputed | Denied: insurer failed to meet prima facie burden that surgery was not medically necessary |
| Dismissal of Diwan’s breach-of-contract counterclaim | Contract/breach claim lacked merit because services not covered | Counterclaim raises fact issues about necessity/coverage | Denied: unresolved factual issues preclude dismissal |
| Sufficiency of opponent papers once prima facie burden unmet | If prima facie proof is lacking, opposing papers need not be considered | N/A | Court declined to reach sufficiency of opposing papers because plaintiff failed prima facie showing |
Key Cases Cited
- Woodson v. Mendon Leasing Corp., 100 N.Y.2d 62 (establishes proof needed to show the "facts constituting the claim" for default relief)
- Rokina Optical Co. v. Camera King, 63 N.Y.2d 728 (default admits traversable allegations)
- Winegrad v. New York Univ. Med. Ctr., 64 N.Y.2d 851 (standard that if movant fails prima facie, court need not consider opposing papers)
- Rechler Equity B-1, LLC v. AKR Corp., 98 A.D.3d 496 (procedural requirement regarding affidavits and signatures)
- Liberty County Mutual v. Avenue I Med., P.C., 129 A.D.3d 783 (requirements for CPLR 3215 default-motion submissions)