June 14, 2004
New York Hosp. Med. Ctr. of Queens v AIU Ins. Co. (2004 NY Slip Op 05217)
https://www.beynensonlaw.com/case-law/new-york-hosp-med-ctr-of-queens-v-aiu-ins-co-2004-ny-slip-op-05217/
- Decided
- June 14, 2004
- Citation
- 2004 NY Slip Op 05217 · 8 AD3d 456
- Posture
- Summary judgment
- Outcome
- Provider prevailed
- Later treatment
- Followed in 6 later decisions (see Cited by)
- Legal questions
- Claimant's prima facie case on motions (see the maps)
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.
Reported in New York Official Reports at New York Hosp. Med. Ctr. of Queens v AIU Ins. Co. (2004 NY Slip Op 05217)
| New York Hosp. Med. Ctr. of Queens v AIU Ins. Co. |
| 2004 NY Slip Op 05217 [8 AD3d 456] |
| June 14, 2004 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| New York Hospital Medical Center of Queens, as Assignee of Vincent Derenzo, et al., Appellants, v AIU Insurance Company, Respondent. |
—[*1]
In an action to recover no-fault benefits under an insurance contract, the plaintiffs appeal, as limited by their brief, from so much of an order of the Supreme Court, Nassau County (Joseph, J.), dated July 7, 2003, as denied that branch of their motion which was for summary judgment on the first and second causes of action to recover no-fault benefits for medical services rendered by the plaintiff New York Hospital Medical Center of Queens.
Ordered that the order is reversed insofar as appealed from, on the law, with costs, the motion is granted, and the matter remitted to the Supreme Court, Nassau County, for further proceedings consistent herewith.
The Supreme Court erred in denying the plaintiffs’ motion for summary judgment on the first and second causes of action on the ground that the hospital facility forms submitted by the plaintiffs lacked necessary signatures. The defendant’s failure to object to the completeness of the hospital facility forms within 10 days of receipt constituted a waiver of any defenses based thereon (see New York & Presbyt. Hosp. v American Tr. Ins. Co., 287 AD2d 699, 701 [2001]; Mount Sinai Hosp. v Triboro Coach, 263 AD2d 11, 17 [1999]; St. Clare’s Hosp. v Allcity Ins. Co., 201 AD2d 718, 720 [1994]). In opposition to the plaintiffs’ prima facie showing of entitlement to judgment as a matter of law (see Insurance Law § 5106 [a]; 11 NYCRR 65.15 [g] [3]), the defendant failed to raise a triable issue of fact (see New York & Presbyt. Hosp. v Allstate Ins. Co., 295 AD2d 412 [2002]; cf. Hospital for Joint Diseases v Nationwide Mut. Ins. Co., 284 AD2d 374, 375 [2001]). [*2]
As the plaintiffs established their entitlement to the no-fault benefits, as well as to statutory interest and attorney’s fees (see Insurance Law § 5106 [a]; 11 NYCRR 65-4.6), we remit the matter to the Supreme Court, Nassau County, to calculate the amount owed to the plaintiff for no-fault benefits, statutory interest, and attorney’s fees. S. Miller, J.P., Adams, Cozier and Rivera, JJ., concur.
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.
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 (rules on the question, but another ground decided the case)
Held the hospitals made their prima facie showing despite missing signatures on the facility forms, because the insurer waived that objection by not raising it within 10 days of receipt, and the insurer raised no triable issue.
Of the 1,065 decisions on this question in the Second Department courts and the Court of Appeals, 513 (this one included) are in the same category.
Cited by
A label shows how the later decision treated this one.
- New York Hosp. Med. Ctr. of Queens v Motor Veh. Acc. Indem. Corp. (2004 NY Slip Op 08087) FollowedMVAIC must comply with the 30-day deadline to pay or deny a no-fault claim before qualifying the injured claimant.
- Hospital for Joint Diseases v Allstate Ins. Co. (2005 NY Slip Op 06192) FollowedAn insurer waived assignment objections by failing to timely object to hospital forms or seek verification of the assignments.
- Rockaway Blvd. Med. P.C. v Progressive Ins. (2005 NY Slip Op 25278) FollowedA provider's omission of its relationship with the treating physician from claim forms does not defeat its prima facie case.
- Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co. (2006 NY Slip Op 08214) FollowedAn insurer waives claim-form and assignment defenses by failing to timely object to form adequacy or seek assignment verification.
- Delta Diagnostic Radiology, P.C. v Progressive Cas. Ins. Co (2006 NYSlipOp 50491(U)) FollowedAn insurer's bill-of-particulars demand is improper when it seeks evidentiary material rather than amplification of the pleadings.
- A.B. Med. Servs. PLLC v American Tr. Ins. Co. (2005 NY Slip Op 51893(U)) FollowedThe insurer waived defenses based on incomplete assignments by failing to object within 10 days of receipt.
- Nyack Hosp. v Metropolitan Prop. & Cas. Ins. Co. (2005 NY Slip Op 02235)The insurer failed to prove mailing of its denial, and the denial was incomplete even if timely.
- Siegel v Progressive Cas. Ins. Co. (2004 NY Slip Op 24532)An assignment is an essential element of a provider's no-fault claim, and an insurer cannot waive its complete absence.
- Westchester Med. Ctr. v Progressive Cas. Ins. Co. (2005 NY Slip Op 50348(U))The insurer failed to prove mailing of verification requests and waived its assignment and medical-necessity objections.
- Amaze Med. Supply Inc. v Travelers Prop. Cas. Corp. (2005 NY Slip Op 50201(U))A provider's cashing of partial-payment checks does not establish accord and satisfaction without clear notice that acceptance settles the claim.
Similar decisions
- New York Hosp. Med. Ctr. of Queens v New York Cent. Mut. Fire Ins. Co. (2004 NY Slip Op 05626)The insurer failed to establish mailing of assignment-verification requests and could not defeat the hospitals' summary judgment motion.
- New York Hosp. Med. Ctr. of Queens v Allstate Ins. Co. (2014 NY Slip Op 00640)The providers established receipt of their claim and nonpayment or improper denial within 30 days, warranting summary judgment.
- New York & Presbyt. Hosp. v AIU Ins. Co. (2005 NY Slip Op 06014)A resubmitted no-fault claim previously and timely denied is not subject to a new 30-day payment-or-denial period.
- New York Univ Hosp. Tisch Inst. v New York City Tr. Auth. (2004 NY Slip Op 01159)The defendant was precluded from disclaiming coverage because it failed to reject the provider's claim within 30 days.
- New York Univ. Hosp. Rusk Inst. v Hartford Acc. & Indem. Co. (2006 NY Slip Op 06223)The insurers were precluded from contesting a hospital claim because they failed to establish that their denial letter met regulatory requirements.