March 26, 2004

Amaze Med. Supply v Allstate Ins. Co. (2004 NY Slip Op 50211(U))

https://www.beynensonlaw.com/case-law/amaze-med-supply-v-allstate-ins-co-2004-ny-slip-op-50211u/

Court: Appellate Term, Second Department
Decided: March 26, 2004
Citation: 2004 NY Slip Op 50211(U)
Posture: Summary judgment
Outcome: Provider prevailed
Later treatment: Followed in 2 later decisions (see Cited by)
Issues: Timeliness and preclusion Provider's prima facie case
Legal questions: Claimant's prima facie case on motions (see the maps)

Cite as

Amaze Med. Supply v Allstate Ins. Co., 2004 NY Slip Op 50211(U) (App Term, 2d Dept, 2d & 11th Jud Dists 2004)

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.

The provider established entitlement to summary judgment by proving submission of complete claims that were not paid or denied within 30 days. In this action for assigned no-fault benefits for medical supplies, the Appellate Term, Second Department, reversed the order denying the provider's motion and granted summary judgment. Under former 11 NYCRR 65.15 (g) and Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co., the insurer was precluded from raising defenses such as lack of medical necessity. The matter was remanded for calculation of statutory interest and attorney fees under Insurance Law § 5106 (a) and former 11 NYCRR 65.15 (h) and 65.17 (b) (6).

Reported in New York Official Reports at Amaze Med. Supply v Allstate Ins. Co. (2004 NY Slip Op 50211(U))

[*1]

Amaze Med. Supply v Allstate Ins. Co.

2004 NY Slip Op 50211(U)

Decided on March 26, 2004

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on March 26, 2004

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM : 2nd and 11th JUDICIAL DISTRICTS

PRESENT: PESCE, P.J., GOLIA and RIOS, JJ.
NO. 2003-815 K C

AMAZE MEDICAL SUPPLY INC. a/a/o Derrick Darlington, Appellant,
against
ALLSTATE INSURANCE COMPANY, Respondent.

Appeal by plaintiff from an order of the Civil Court, Kings County (L. Baily-Schiffman, J), entered on April 9, 2003, which denied its motion for summary judgment.

Order unanimously reversed without costs, plaintiff’s motion for summary judgment granted in the principal sum of $1,685.31 and matter remanded to the court below for a calculation of statutory interest and an assessment of attorney’s fees.

Plaintiff instituted suit to recover first-party no-fault benefits for medical supplies it provided to the injured assignor. In our opinion, plaintiff established its prima facie entitlement to summary judgment by showing that it submitted complete proofs of claims to defendant which defendant did not pay or deny within 30 days (11 NYCRR 65.15 [g]; Amaze Med. Supply Inc. v Eagle Ins. Co., NYLJ, Dec. 29, 2003 [App Term,
2d & 11th Jud Dists]). Thus, pursuant to Presbyterian Hosp. in City of N.Y. v Maryland Cas. Co. (90 NY2d 274, 285 [1997]), the insurer is precluded from raising defenses such as lack of medical necessity (see Mingmen Acupuncture v Liberty Mutual, NYLJ, Apr. 10, 2002 [App Term, 2d & 11th Jud Dists]). Accordingly, plaintiff was entitled to summary judgment (Amaze Med. Supply Inc. v Eagle Ins. Co., NYLJ, Dec. 29, 2003 [App Term, 2d & 11th Jud Dists]).

The matter is accordingly remanded to the court below for a calculation of the statutory interest and an assessment of attorney’s fees (see Insurance Law § 5106 [a];
11 NYCRR 65.15 [h]; 65.17 [b] [6]; St.Clare’s Hosp. v Allstate Ins. Co., 215 AD2d 641 [1995]). [*2]
Decision Date: March 26, 2004

Legal questions

A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Claimant's prima facie case on motions

Open the full map

On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?

This decision: Claimant's proof held to make out its prima facie case

Held the supplier established prima facie entitlement by showing it submitted complete proofs of claim that the insurer neither paid nor denied within 30 days, so summary judgment was granted.

Proof sufficientMailing/receipt not shownOverdue not shownBusiness-record foundation lackingOther element missingThis decisionCites it or cited by itCited or followed

Of the 1,063 decisions on this question in the Second Department courts and the Court of Appeals, 511 (this one included) are in the same category. One decision in other departments that cites or is cited by this one is on the full map.

Cited by

A label shows how the later decision treated this one.

Capio Med., P.C. v Progressive Cas. Ins. Co. (2005 NYSlipOp 50526(U)) FollowedThe insurer's EUO requests did not toll the denial period because it failed to prove an authorizing endorsement or timely requests.
Rigid Med. of Flatbush, P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50582(U)) FollowedThe insurer failed to establish an EUO-authorizing policy endorsement or proper EUO notices, leaving its denial untimely.
Inwood Hill Med. v Allstate Ins. Co. (2004 NY Slip Op 50565(U))The insurer's EUO evidence failed to raise a triable issue that the injuries did not arise from an insured incident.

Similar decisions

Amaze Medical Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 51636(U))The insurer's denials issued more than 30 days after submission precluded its medical-necessity defense.
Amaze Med. Supply Inc. v Allstate Ins. Co. (2004 NY Slip Op 50833(U))The insurer failed to defeat partial summary judgment with an inadmissible chiropractor's peer review and late medical-necessity denials.
Amaze Med. Supply Inc. v General Assur. Co. (2005 NY Slip Op 50960(U))The insurer failed to raise a factual issue on IME nonappearance because it offered no competent proof that the requests were mailed.
Amaze Med. Supply, Inc. v Allstate Ins. Co. (2008 NY Slip Op 51866(U))The provider failed to establish its prima facie case because its affidavit did not lay a business-records foundation.
Amaze Med. Supply Inc. v GEICO Ins. (2005 NYSlipOp 51053(U))The insurer's unsworn peer review report was inadmissible and failed to rebut the provider's prima facie entitlement to payment.