banner
Picciano & Scahill, P.C. Newsletter
iNews
In this Issue
Tips for Jury Selection
Appellate Decisions
Decisions of Note
Legislative Update
Medicare Advantage
Results that Matter


Congratulations to Howard Greenwald   for obtaining a defense verdict on liability in Nassau County before Judge Antonio Brandveen on the matter of Brenda Aguilar v. Vito Fausto on October 26, 2012 Index No. 5086/10.  

Like us on Facebook

Please join Facebook and Like our Page to stay current with all the iNews from Picciano & Scahill. 
 
Search for "psnylaw" on Facebook to find our page. 
 
Join Our List
Join Our Mailing List
Forward to a Friend
Know someone who would like a copy of iNews? 

Use the Forward Feature below to send it and they will receive all future copies.
What do you think?
iNews Issue: 44               November 2012    
An Expression of Gratitude from P&S

As this, our 44th issue of iNews goes out, New York, New Jersey and the entire East
Coast is rebounding from Hurricane Sandy, arguably the worst storm in history.

While it is devastating to see the destruction and experience the loss of power and all that goes with it, at P&S we are reminded of just how brave and skilled
our First Responders are. We wish to express our gratitude to the brave men and
women of our fire departments, EMS and police departments who repeatedly run toward
disaster to help. At P&S we thank you all.

Trial Tips from Frank Scahill

 

Frank Scahill
Frank Scahill

The cross examination of the plaintiff's expert should be defense counsel's finest hour in the courtroom. 

 

On a surgery case, the plaintiff's expert usually shines bright on direct examination. A jury of lay persons most likely has never met a surgeon, and they are keenly impressed with the skills, education and capabilities of the Doctor who can operate and either save the plaintiff's life, or attempt to improve the plaintiff's medical condition. How can you cross swords with this healer and savior?  

 

The defense attorney will likely be no match for the surgeon going head to head with him or her on the medical issues. An effective cross examination must be subtle, like a skilled surgeon, having the doctor agree with your points in the case. Will he or she admit his patient had a good result? Will the surgeon admit the plaintiff had pre-existing arthritic changes that were not caused by trauma? 

 

You should know the plaintiff's chart better than the busy surgeon. The surgeon will only have the patient's medical chart from his or her office, not the voluminous records you have accumulated. 

 

The goal is to have the doctor admit he or she has seen many cases with the exact same symptoms that are not caused by trauma. On a Laminectomy case,  the surgeon will admit 90% of disc pathology is at the L4/L5 or L5/S1 level. Seize on that and discuss the reasons for the prevalence of disc herniations in the general population. Obviously body habitus plays a role, as does work environment. Have the surgeon agree with your expert's view of the case. A full frontal attack will most likely fail, however, as in battle, if you can flank the expert with your knowledge of all of the plaintiff's medical records, you have a greater chance of success. See the cross examination of a spinal surgeon attached and this exchange below from a recent trial.

 

Q.  Now, Doctor, I'd like you to assume for the moment that  there is no lawsuit, that there is no personal injury case,  we are not in a courtroom, we are in a doctor's office and  we are discussing a case and you have all these MRIs, you  have all these operative reports, you have everything in  front of you. Would you agree that the findings on both  the '04, '05 MRIs and '07, May of '07, December of '07 MRIs  could all be part of a degenerative process? Would you  agree with that?  

A. They could, yes.

 

Q. In fact, you've treated thousands of spinal  patients in the 26 years that you've been practicing as a  surgeon; correct?   

A. Yes.  

 

Q.  And you've seen hundreds, if not thousands, of people that have these exact same findings  that are not involved in lawsuits, they're not involved in personal injury claims, they just have these findings because of advanced arthritis or some other abnormality that has nothing to do with trauma; is that also true?   

A. Yes.

 

Read the full cross examination here.
Appellate Decisions of Note - October 2012

 

gavel

The New York State Court of Appeals issued two decisions last week with ramifications for the defense bar. 

 

 

Dean v Tower Ins. Co. of N.Y. (2012 NY Slip Op 07142) and Bentoria Holdings, Inc. v Travelers Indemnity Co. (2012 NY Slip Op 07141) were both decided on October 25, 2012. 

 

In Dean v. Tower Insurance Company, Judge Ciparick issued the majority opinion on the question of "residence premises" found in a homeowner's insurance policy. Here the plaintiffs purchased a homeowners policy prior to the closing date from Tower Insurance Company. Post closing the insured discovered extensive termite damage to the home which took over a year to repair. The purchaser never moved into the home, although they renewed the policy one year after the closing date. Fifteen months post closing, with the house still vacant, a fire destroyed the house. Tower disclaimed coverage stating, "Our investigation revealed the dwelling was unoccupied at the time of the loss. Accordingly, this dwelling does not qualify as a 'residence premises' there is no coverage for this claim under your policy." In the definitions section of the policy, "residence premises" was defined as: "The one family dwelling . . . where you reside." Judge Ciparick found the term ambiguous noting, "The standard for determining residency for purposes of insurance coverage requires something more than temporary or physical presence and requires at least some degree of permanence and intention to remain" (Government Empls. Ins. Co. v Paolicelli, 303 AD2d 633, 633 [2d Dept 2003] see also Matter of Aetna Cas. & Sur. Co. v Gutstein, 80 NY2d 773, 775 [1992]; Matter of Allstate Ins. Co. [Rapp], 7 AD3d 302, 303 [1st Dept 2004]).... Further, because the term "reside" is not defined in the contract making the term "residence premises" ambiguous, it is arguable that the reasonable expectations of an average insured (see Cragg, 17 NY3d at 122) is that occupancy of the premises would satisfy the policy's requirements.... Courts have held that "[a] householder need not necessarily have conventional, or, indeed, any furniture in a house to occupy it. His presence in it for sleeping and eating and working purposes can literally constitute occupancy. He can, if he will, sleep and eat on the floor or on improvised devices."

 

Bentoria Holdings, Inc. v Travelers Indemnity Co.  involved an "earth movement" exclusion in a property damage policy for a building in Brooklyn. 

 

The building suffered cracks as a result of an excavation being conducted on the lot next door to it. Plaintiff submitted a claim, which Travelers rejected, relying on the earth movement exclusion. The Court of Appeals previously addressed this issue in Pioneer Tower Owners Assn. v State Farm Fire & Cas. Co. (12 NY3d 302 [2009]), with a finding that earth movement exclusions using identical language are not applicable to losses caused by excavation. 

 

In Bentoria Holdings, Travelers prevailed as their policy was amended to add the term. "man-made" to the definition of movement of earth. "By expressly excluding earth movement due to man-made or artificial causes," the policy contradicts the idea that "the intentional removal of earth by humans" is not an excluded event. This policy cannot reasonably be read to cover the damage on which plaintiff's claim is based."

 

Read Dean v. Tower Insurance  here.

 

Read Bentoria Holdings, Inc. v. Travelers here.  

 

Decisions of Note - October 2012
 

Typically an expert's affidavit is needed for a plaintiff to defeat a motion for summary judgment, creating a question of fact, sufficient for the trial court to deny the motion. 

 

What happens when the plaintiff files a Note of Issue and Certificate of Readiness without exchanging an expert's report pursuant to CPLR 3101(d)? Defense counsel routinely cited Construction by Singletree, Inc. v Lowe (55 AD3d 861, 866 N.Y.S.2d 702), as standing for the proposition that a party's failure to disclose its experts pursuant to CPLR 3101(d)(1)(i) prior to the filing of a Note of Issue and Certificate of Readiness, by itself, requires preclusion of an expert's affirmation or affidavit submitted in support of a motion for summary judgment.

 

Rivers v. Birnbaum (2012 NY Slip Op 6935 decided by the Appellate Division, Second Department on October 17, 2012, with Judge Belen writing the majority opinion, reversed that assumption. The Second Department rule now allows a party to offer a late exchange, in opposition to the summary judgment motion.  Citing the absence of time limits by the legislature who enacted CPLR 3101(d), the court found the expert affidavit can be considered in opposition to the motion, post note of issue, where there had been no previous exchange.

 

"We recognize that CPLR 3101(d)(1)(i) is part of CPLR article 31, which governs the discovery process. We further recognize that, generally, when a party files a note of issue and certificate of readiness, it must affirm that "[d]iscovery proceedings now known to be necessary [have been] completed" (22 NYCRR 202.21). However, as previously discussed, the Legislature omitted a specific deadline by which a party must respond to a CPLR 3101(d)(1)(i) request, and the statute itself specifically vests a trial court  [*15] with the discretion to allow the testimony of an expert who was disclosed near the commencement of trial. 

 

Thus, the statutory scheme provides that, even where one party requests trial expert disclosure during discovery pursuant to CPLR 3101(d)(1)(i), a recipient party who does not respond to the request until after the filing of the Note of Issue and Certificate of Readiness will not automatically be subject to preclusion of its expert's trial testimony. 

 

Accordingly, the failure of a party to exchange expert information pursuant to CPLR 3101(d)(1)(i) before the filing of a note of issue and certificate of readiness will not divest a trial court of the discretion to consider an affirmation or affidavit submitted by that party's experts in the context of a timely motion for summary judgment."

 

Read the decision here.

 

Legislative Update - Attorney Liens

 

On October 4, 2012, Governor Cuomo signed into law Senate Bill 1546 / Assembly Bill 5275 which comes into effect on January 1, 2013. This Bill amends the Judiciary Law to allow attorneys to attach a charging lien to the proceeds of any recovery obtained as the result of arbitration, mediation, or any pre-litigation negotiated settlement.     

 

An attorney who is discharged without cause has three remedies to recover the value of his or her legal services: the retaining lien, the charging lien, and the plenary action in quantum meruit (Butler, Fitzgerald & Potter v Gelmin, 235 A.D.2d 218, 218-19, 651 N.Y.S.2d 525). These remedies are not exclusive, but cumulative.

 

The "retaining lien" gives an attorney the right to keep, with certain exceptions, all of the papers, documents and other personal property of the client which have come into the lawyer's possession in his or her professional capacity as long as those items are related to the subject representation (Lerner v Seigel, 22 A.D.2d 816, 254 N.Y.S.2d 802). This type of lien is founded upon physical possession, and an attorney may forfeit its retaining lien by voluntarily giving away any of the items to which it may have attached.

 

(Annotation, Attorney's Retaining Lien: What Items of Client's Property or Funds Are Not Subject to Lien, 70 ALR 4th 827First Nat'l Bank & Trust Co. v Hyman   Novick Rlty Corp., 72 A.D.2d 858, 859, 421 N.Y.S.2d 733 [retaining lien cannot be satisfied by property not in the possession or control of the attorney]). Further, an attorney's retaining lien generally lasts "until [the attorney's] disbursements have been fully paid and, as a general rule, his fee has been determined." (Cosgrove v Tops Mkts, Inc., 39 Fed Appx 661, 664).  

 

The second remedy available to an attorney for recovery of his or her fee is the Judiciary Law § 475 "charging lien." This can be employed both while the action is pending, and in a separate lawsuit (Citizen's Bank, supra). 

 

Judiciary Law § 475, entitled, "Attorney's lien in action, special or other proceeding," provides:  The [charging] lien is predicated on the idea that the attorney has by his skill and effort obtained the judgment, and hence 'should have a lien thereon for his compensation, in analogy to the lien which a mechanic has upon any article which he manufactures.'  Williams v Ingersoll, 89 NY 508, 517 (1882)  (Butler, Fitzgerald & Potter v Sequa Corp., 250 F.3d 171, 177; see also LMWT Realty Corp v Davis Agency, 85 N.Y.2d 462, 467-468, 626 N.Y.S.2d 39, 649 N.E.2d 1183). 

 

Further, enforcement of a charging lien is founded upon the equitable notion that the proceeds of a settlement are ultimately "under the control of the court, and the parties within its jurisdiction, [and the court] will see that no injustice is done to its own officers" (Rooney v  Second Ave R. Co., 18 NY 368, 369;   see also Fischer-Hansen v Brooklyn Heights R.R., 173 NY 492, 502, 66 N.E. 395, 33 Civ. Proc. R. 326Rosenman & Colin v Richard, 850 F.2d 57, 60)

 

However, an attorney's recovery under Judiciary Law § 475 is contingent upon his client reaching a favorable outcome, because the charging lien is a specific attachment to the funds which constitute the client's recovery (Butler v Sequa, supraat 177). Moreover,  "the plaintiff must show that he comes within the statute by establishing the facts alleged in his complaint, and the action is open to any defense tending to show that no lien ever existed, or that if it once existed it was discharged with the consent of the plaintiff, or was waived or forfeited by his misconduct or neglect" (Fischer-Hansen, supra at 502).

 

A third remedy is a plenary action in quantum meruit for the reasonable value of the services rendered (Butler v Sequa, supra at 179Smith v Boscov's Dept Store, 192 A.D.2d 949, 596 N.Y.S.2d 575Bruk v Albin, 270 A.D.2d 441, 442, 704 N.Y.S.2d 648Cushion v Nemes, 266 A.D.2d 126, 698 N.Y.S.2d 670, lv denied 94 NY2d 760, 727 N.E.2d 577, 706 N.Y.S.2d 80). 

 

This cause of action accrues immediately upon an attorney's discharge, and, unlike the "retaining lien" or the "charging lien," it can be exercised by the attorney against all of the former client's assets (Butler v    Gelmin, supra at 219). In determining the value of the attorney's services provided to the client prior to discharge, a number of variables are considered.

 

"While the terms of the percentage agreement is one factor that may be taken into account ..., it is not to be considered the dispositive factor .... Other factors, such as the nature of the litigation, the difficulty of the case, the time spent, the amount of money involved, the results achieved and amounts customarily charged for similar services in the same locality, for example, should also be considered" (Smith v Boscov's, supra 192 A.D.2d at 950-51[citations omitted]).

 

A defendant's payment of settlement proceeds, while on notice of a charging lien, is made at a defendant's peril. (see Schneider, Kleinick, Weitz, Damashek & Shoot v. City of New York, attached). 

 

A Court applied this principle to similar facts presented in Morgan v Drewry, (285 App Div 1, 135 N.Y.S.2d 171). In that case, the lien was held by an attorney who was not the attorney of record at the time of the settlement. 

 

Consistent with Fischer, we concluded that, "where a defendant settles a claim or cause of action, the lien of the plaintiff's attorney attaches to the amount agreed upon in settlement the instant the agreement is made and the law will not permit the defendant to say it has nothing in its hands to satisfy the lien. (Fischer-Hansen v Brooklyn Heights RR Co, 173 NY 492, 66 N.E. 395, 33 Civ. Proc. R. 326Sargent v McCleod, 209 N.Y. 360Matter of Levy, 249 N.Y. 168, 163 N.E. 244)." (Morgan, supra at 5).

 

 
Medicare Advantage

Medicare What should an Insurance Carrier do with a lien presented (usually by the Rawlings Company) on a Medicare Advantage plan, not a strict Government Medicare Lien?

 

This lien concerns Medicare Advantage organizations acting as "secondary payers" under the Medicare Act. The lien involves benefits received under the Medicare Advantage program, which is set forth in Part C of the Medicare Act. (See 42 U.S.C. §§1395w-21-1395w-29). 

 

Under this part, Medicare enrollees may elect to receive their benefits from private insurers, called MA organizations, rather than from the government. MA organizations enter into contracts with the Center for Medicare and Medicaid Services, the branch of the Department of Health and Human Services that administers the Medicare program.

 

The question is whether Section 5-335 of New York's General Obligation Law, prevents a lien on the settlement from the  private insurer administering the Medicare Advantage program.

 

The New York statute reads as follows:

 

§5-335. Limitation of non-statutory reimbursement and subrogation claims in personal injury and wrongful death

(a) When a plaintiff settles with one or more defendants in an  action for personal injuries, medical, dental, or podiatric malpractice, or wrongful death, it shall be conclusively presumed that the settlement does not include any compensation for the cost of health care services, loss of earnings or other economic loss to the extent those losses or expenses have been or are obligated to be paid or reimbursed by a benefit provider, except for those payments as to which there is a statutory right of reimbursement. By entering into any such settlement, a plaintiff shall not be deemed to have taken an action in derogation of any non-statutory right of any benefit provider that paid or is obligated to pay those losses or expenses; nor shall a plaintiff's entry into such settlement constitute a violation of any contract between the plaintiff and such benefit provider.  Except where there is a statutory right of reimbursement, no party entering into such a settlement shall be subject to a subrogation claim or claim for reimbursement by a benefit provider and a benefit provider shall have no lien or right of subrogation or reimbursement against any such settling party, with respect to those losses or expenses that have been or are obligated to be paid or reimbursed by said benefit provider.

 

Two Judges from the Supreme Court of Kings County held that the Medicare Act does not preempt GOL §5-335. (See Trezza v. Trezza, 32 Misc. 3d 1209(A), 934 N.Y.S.2d 37, 2011 WL 2640794 (N.Y. Sup. Ct. June 23, 2011); Ferlazzo v. 18th Avenue Hardware, Inc., 33 Misc. 3d 421, 929 N.Y.S.2d 690 (N.Y. Sup. Ct. Aug. 22, 2011). 

 

In each of these decisions, a Medicare Advantage enrollee sought to extinguish a purported lien asserted by their respective MA organizations. The courts granted the motions. These decisions were based on the premise that, pursuant to the federal court decisions in Engstrom and Nott, there was no private right of action for MA organizations to seek reimbursement. In Trezza, the court concluded that "'[b]ecause 'the Medicare Act permits, but does not mandate, HMO insurers to contract for subrogation rights,' subrogation in this context remains a state contract law issue."

 

A Queens County Supreme Court decision held, in accordance with the Kings County cases, that the Medicare Act does not provide MA organizations with a federal private right of action. (See Spellman v. Arya, Index No. 18662/2007, slip op. (N.Y. Sup. Ct. June 14, 2011). Instead, the court held, such rights are contractual in nature. However, the Queens court did consider the express preemption provisions of the statute and regulations and held that these provisions are "clear and unambiguous.... To the degree that GOL §5-335 eliminates [the MA organization's] contract right to seek reimbursement from plaintiff out of the settlement proceeds, it is preempted by federal law." Id. at 7-8.

 

A Federal Court Case, Potts v. The Rawlings Co. (11 Civ. 9071), decided by Judge Paul Oetken, on September 25, 2012 now holds GOL §5-335 is preempted by the Medicare Act. (See attached). 

 

In State Court, however, I submit the State Court Judges will follow the precedents above and determine that the Medicare Advantage insurer will not have a lien.

 

Like Us on Facebook
Visit us on Facebook at "psnylaw" and Like Us in order to stay in touch between issues of iNews.  And, if you like our Facebook page, please invite your friends to like us too.  We want to reach as many people as possible with informative, current decisions of note regarding insurance defense law.
SEND US YOUR QUESTIONS OR COMMENTS
 
If you have someone to add to our email list, please contact Frank Scahill at fscahill@psnylaw.com.  

If you have any questions or comments about our newsletter "iNews" please contact Frank Scahill, Managing Partner, at fscahill@psnylaw.com.

Picciano & Scahill, PC

900 Merchants Concourse-Suite 310
Westbury, New York 11590
516.294.5200  

DISCLAIMER:
This newsletter is for education and information purposes only, and is not intended to provide legal advice. No attorney-client relationship exists or is created by the use of this newsletter or the information provided herein.  This newsletter should not be used as a substitute for competent legal advice from a professional attorney in your state.