Sharp View Diagnostic Imaging, P.C. v. GEICO Gen. Ins. Co.
2017 NYSlipOp 50855(U)
| N.Y. App. Term. | Jun 23, 2017Background
- Sharp View Diagnostic Imaging, as assignee of insured Falaise Walker, sued GEICO to recover assigned first‑party no‑fault medical payments arising from an accident in South Carolina.
- Civil Court (Kings County) denied plaintiff’s motion for summary judgment and granted GEICO’s cross‑motion, finding the policy limits were exhausted; plaintiff appealed.
- The GEICO policy contains a choice‑of‑law clause requiring interpretation under Georgia law; New York procedural law applies to the action.
- GEICO submitted an underwriter affidavit and policy/declaration pages showing a $10,000 medical payment limit but also relied on policy language increasing coverage to meet out‑of‑state minimums.
- GEICO’s affidavits failed to lay foundation for certain annexed printouts and did not provide South Carolina’s required minimum financial responsibility information.
- Plaintiff’s affidavit showed timely mailing of the claim but contained conclusory statements and did not establish that GEICO’s denial was untimely or legally insufficient.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether GEICO established exhaustion of policy limits and entitlement to dismissal | GEICO did not prove limits exhausted; plaintiff timely presented claim | GEICO showed policy limit of $10,000 and relied on evidence that limits were exhausted | Denied — GEICO’s proofs were insufficient (no foundation for printouts; no info on SC minimums) |
| Whether choice‑of‑law affects substantive interpretation | Plaintiff argued NY law or that Georgia law applied but facts controlling outcome not met | GEICO relied on policy’s Georgia choice‑of‑law clause | Court applied Georgia substantive law but New York procedure; choice clause noted but did not resolve summary judgment gaps |
| Whether plaintiff established prima facie entitlement to summary judgment | Plaintiff established claim was mailed timely and properly | GEICO contended plaintiff failed to show denial was untimely or conclusory | Denied — plaintiff’s affidavit was conclusory and did not meet standards to win on summary judgment |
| Whether affidavits sufficiently authenticated annexed electronic/printout materials | Plaintiff challenged the foundation for GEICO’s printouts | GEICO asserted affidavits supported the annexed materials and policy extracts | Denied — affidavits did not specifically authenticate the printouts or link them to South Carolina requirements |
Key Cases Cited
- Viviane Etienne Med. Care, P.C. v. Country‑Wide Ins. Co., 25 NY3d 498 (2015) (standards for provider summary judgment against insurer re: timeliness and sufficiency of claim denial)
- Westchester Med. Ctr. v. Nationwide Mut. Ins. Co., 78 A.D.3d 1168 (2d Dep’t 2010) (insurer denial must be shown to be conclusory, vague or without merit to defeat provider’s entitlement)
- St. Chiropractic, P.C. v. Geico Gen. Ins. Co., 53 Misc. 3d 59 (App. Term) (choice‑of‑law clause enforcing application of Georgia substantive law while New York procedure governs)