Lack of Proof that Intoxication Was Proximate Cause of Accident and Injuries Requires Denial of Summary Judgment to Insurer

NO-FAULT – INTOXICATION EXCLUSION – PROOF THAT INTOXICATION WAS CAUSE OF ACCIDENT AND INJURIES
Westchester Med. Ctr. a/a/o Esther Beaton v. Progressive Cas. Ins. Co.
(2nd Dept., decided 5/27/2008)

Same case name as the one below, but a different injured party.

Esther Beaton was injured after the vehicle she was driving crashed into a tree. Beaton was transported from the accident scene to the plaintiff hospital for care of her injuries.

Plaintiff WMC sent Progressive a hospital facility form (NF-5) seeking payment of its bill for Ms. Beaton's hospitalization. Progressive sent the plaintiff original and follow-up verification requests, specifically seeking information pertaining to Beaton's blood alcohol level at the time of the accident. Although Progressive received no response from WMC to its requests, it eventually received blood alcohol tests from a police laboratory indicating that Beaton was intoxicated at the time of her accident, and soon afterwards denied payment of WMC's bill on that basis.

WMC sued and both parties unsuccessfully moved for summary judgment. In AFFIRMING the lower court's order denying the plaintiff's motion for summary judgment based on its argument that Progressive's denial was untimely, the Second Department first noted that "if an insurer has reason to believe that the applicant was operating a motor vehicle while intoxicated or impaired by the use of a drug, and such intoxication or impairment was a contributing cause of the automobile accident, the insurer shall be entitled to all available information relating to the applicant's condition at the time of the accident", and "[p]roof of a claim shall not be complete until the information which has been requested, pursuant [thereto], has been furnished to the [insurer]" (11 NYCRR 65-3.8[g]). "

The appellate court agreed with the lower court's denial of Progressive's renewed cross motion to for summary judgment, however, because although Progressive submitted Beaton's certificate of disposition on her charge of driving while intoxicated pertaining to the accident, it "failed to establish, as a matter of law, that Beaton's intoxication was the cause of her accident and her resultant injuries."

Admissible proof of (intoxication + proximate cause) = sustainable denial.