Quality Psychological Services v. Hartford Ins.

Insurance Law

New York Law Journal

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Judge Harriet Thompson

Quality Psychological Services (QPS) sued to recover no-fault benefits resulting from injuries allegedly sustained in a motor vehicle accident. Insurer Hartford moved for summary judgment, arguing QPS failed to submit to two properly scheduled examinations under oath (EUOs), noting it was a condition precedent to coverage, thus precluding recovery of the medical claim. QPS argued Hartford failed to establish the EUOs were properly mailed or rebut QPS' prima facie case. The court noted the common law doctrine of presumption of regularity "is still alive" in New York state, and presumption of receipt may be created by proof of actual mailing or proof of a standard office practice designed to ensure items were properly addressed and mailed. It ruled Hartford met its burden of showing its routine and reasonable office procedures demonstrating the notices were mailed and received by QPS. The court found Hartford issued a timely denial of payment on the ground QPS failed to appear at two scheduled EUOs, nor offered a reasonable excuse for non-compliance with the policy's condition precedent. Thus, Hartford was granted summary judgment dismissal of the complaint.

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