If Named Insured Dies, Coverage is Limited to Spouse and Estate Representative: Sunrise Acupuncture, P.C. a/a/o Sharise Davis v Kemper Independence Ins. Co.

AuthorRogak, Lawrence

* Upon the testimony and evidence proffered at trial, the Court hereby finds in favor of defendant and dismisses the complaint.

The instant action is for the payment of no-fault insurance benefits for medical treatment. The complaint alleges, in relevant part, the following: On May 16, 2008, assignor SHARISE DAVIS (Davis) was involved in an automobile accident. At the time of the instant accident, Davis was covered under an automobile insurance policy issued by defendant, which provided benefits under the New York State No-Fault Law. Davis sought treatment from plaintiff SUNRISE ACUPUNCTURE, PC. the assignee of Davis' no-fault benefits under defendant's policy. Plaintiff submitted claims for medical treatment provided to Davis and defendant denied them. Based on the foregoing, pursuant to the New York State No-Fault Law and the policy, plaintiff seeks judgment in the amount of $425 plus interest.

On July 28, 2013 this Court (Taylor, J.) denied defendant's motion for summary judgment and dismissal of the complaint. The Court held that defendant failed to submit admissible evidence in support of its claim that Davis was not an insured under the policy issued to the Albanos. Defendant appealed and the Appellate Term affirmed (Sunrise Acupuncture P.C. v Kemper Indep. Ins. Co., 50 Misc 3d 133(A) [App Term 2016] ["We sustain the denial of defendant-insurer's motion for summary judgment. Although defendant asserted that the underlying no-fault claim is precluded by a provision of the subject insurance policy limiting coverage, upon the death of the insured, to the 'legal representative of the deceased,' defendant failed to tender evidentiary proof in admissible form establishing that the policy contained such a provision."]).

At trial, the parties stipulated to the admission of several documents in evidence, some of which will be discussed hereinafter. More importantly, the parties limited the Court's inquiry to one issue, namely, whether under the instant facts defendant's insurance policy afforded coverage to Davis.

The parties submitted the insurance policy at issue (Exhibit B). Said policy was issued to Ronald and America Albano (the Albanos). According to the policy, the term began on July 24, 2007 and ended a year later. Per the declarations, the policy covered a 1998 Mercury and a 1980 Plymouth automobile. Section III of the policy governed coverage with respect to the foregoing vehicles. Specifically, the policy defined a "your covered...

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