Horizon P.T. Care, P.C. v. Kemper Ins. Co.
2025 NY Slip Op 50823(U)
N.Y. App. Term.2025Background
- Horizon P.T. Care, P.C. (Horizon) sought to recover no-fault benefits from Kemper Insurance Company for services provided to Anthony Ghee after a car accident in 2014.
- Before this action, Unitrin (allegedly the same as or related to Kemper) obtained a default declaratory judgment in Supreme Court against Horizon and Ghee, due to their failure to attend scheduled examinations under oath (EUOs).
- In the Civil Court action, Horizon moved for summary judgment or, alternatively, for factual findings in its favor; Kemper cross-moved for summary judgment, arguing res judicata based on the prior Supreme Court default judgment.
- The Civil Court denied both motions but found that Horizon had established a prima facie case by timely submitting bills and limited the trial issue to whether the prior judgment precluded the present claim.
- Kemper appealed, disputing both the finding that Horizon had proved its prima facie case and the limitation on trial issues.
- The Appellate Term modified the lower court's order to strike the findings in Horizon's favor and limitation of trial issues but affirmed the denial of summary judgment for Kemper.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether res judicata barred this no-fault claim | Horizon argued res judicata did not apply or was unproven | Kemper argued claim was barred by Supreme Court default declaratory judgment | Denied for lack of evidence Unitrin/Kemper are same party, so res judicata not established |
| Whether Horizon had established prima facie case as to bills' timeliness/propriety | Horizon claimed it timely and properly submitted bills | Kemper contested that this was proven or should be deemed established | Lower court's finding in Horizon's favor on this struck, as record did not support it |
| Whether trial should be limited to the preclusion effect of the prior declaratory judgment order | Horizon sought such limitation | Kemper objected, saying it was improper | Lower court's limitation on issues for trial struck |
| Whether collateral estoppel bars this action (raised on appeal) | Not raised below | Raised for first time on appeal | Not considered |
Key Cases Cited
- Matter of Hunter, 4 NY3d 260 (NY Ct App 2005) (restating res judicata doctrine—matters decided or that could have been decided in prior case between same parties are barred)
- Schuylkill Fuel Corp. v. Nieberg Realty Corp., 250 NY 304 (NY Ct App 1929) (res judicata precludes relitigation of same transactions between same parties)
- Watts v. Swiss Bank Corp., 27 NY2d 270 (NY Ct App 1970) (explaining standards for claim preclusion)
- Kaufman v. Eli Lilly & Co., 65 NY2d 449 (NY Ct App 1985) (explaining that issues not actually litigated in default cannot be given collateral estoppel effect)
- Ciraldo v. JP Morgan Chase Bank, N.A., 140 AD3d 912 (NY App Div 2016) (clarifying res judicata requirements—claims must be between same parties or those in privity)