December 12, 2005

Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484)

https://www.beynensonlaw.com/case-law/central-suffolk-hosp-v-new-york-cent-mut-fire-ins-co-2005-nyslipop-09484/

Court
Appellate Division, Second Department
Decided
December 12, 2005
Citation
2005 NY Slip Op 09484
Posture
Summary judgment
Outcome
Insurer prevailed
Later treatment
Contrasted (cf., but see) in 2 and followed in 86 later decisions (see Cited by)
Issues
Verification requests Interest and attorney fees
Legal questions
Outstanding verification and premature actions (see the maps)
Cite as
Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 2005 NY Slip Op 09484 (2d Dept 2005)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

An insurer need not pay or deny a no-fault claim until it receives all relevant verification requested. One hospital admitted receiving the initial verification request but did not state whether it responded, entitling the insurer to dismissal under 11 NYCRR 65-3.8 (a) (1) and (b) (3). Another hospital's principal claim had been paid, leaving interest and attorney fees. Although that hospital disputed receipt of the mailed requests, it supplied verification later, defeating its assertion of untimely payment under 11 NYCRR 65-3.8. The Appellate Division, Second Department, affirmed the denial of the hospitals' motion on the first cause of action, reversed the denial of the insurer's cross motion, and dismissed the complaint.

Reported in New York Official Reports at Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484)

Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co.
2005 NYSlipOp 09484
December 12, 2005
Appellate Division, Second Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, February 15, 2006
Central Suffolk Hospital, as Assignee of Renard Legette, et al., Appellants-Respondents,
v
New York Central Mutual Fire Insurance Company, Respondent-Appellant.

—[*1]

In an action to recover no-fault medical payments under insurance contracts, the plaintiffs appeal from so much of an order of the Supreme Court, Nassau County (Phelan, J.), dated January 20, 2004, as denied that branch of their motion which was for summary judgment on the first cause of action, and the defendant cross-appeals from so much of the same order as denied its cross motion for summary judgment dismissing the complaint.

Ordered that the order is affirmed insofar as appealed from; and it is further,

Ordered that the order is reversed insofar as cross-appealed from, on the law, the cross motion is granted, and the complaint is dismissed; and it is further,

Ordered that one bill of costs is awarded to the defendant.

The Supreme Court improperly denied that branch of the defendant’s cross motion which was for summary judgment dismissing the first cause of action to recover payments for medical services provided by Central Suffolk Hospital. “An insurer is not obligated to pay or deny a claim until it has received verification of all relevant information requested (see 11 NYCRR 65.15 [g] [1] [i]; [2] [iii])” (St. Vincent’s Hosp. of Richmond v American Tr. Ins. Co., 299 AD2d 338, [*2]340 [2002]). Here, in the proof offered in response to the defendant’s prima facie showing of entitlement to summary judgment, the plaintiff Central Suffolk Hospital, as assignee of Renard Legette, admitted receiving the defendant’s initial request for verification of the claim, yet failed to state what response, if any, was made. Pursuant to 11 NYCRR 65-3.8 (a) (1) and (b) (3), on the undisputed facts presented, the defendant was entitled to summary judgment dismissing the plaintiffs’ first cause of action (see Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 [2004]).

The Supreme Court also improperly denied the branch of the defendant’s cross motion which was for summary judgment dismissing the second cause of action to recover for medical services provided by White Plains Hospital Center (hereinafter White Plains). As noted by the Supreme Court, the principal amount of the claim, $733.91, has been paid, leaving only the portion of the second cause of action seeking interest and an award of an attorney’s fee. Although White Plains maintained before the Supreme Court that it did not receive either of the requests for verification which the defendant asserted were sent by mail on May 21, 2003, and June 23, 2003, White Plains provided the verification of claim to the defendant on July 14, 2003. In view of this circumstance, the assertion that the claim underlying the second cause of action was not paid in a timely way, which is the predicate for the plaintiffs’ claim for interest and an award of an attorney’s fee, is without basis under 11 NYCRR 65-3.8. Adams, J.P., Krausman, Rivera and Lifson, JJ., concur.

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