Medical Imaging of Bronx, P.C., Inc. v MVAIC (2026 NY Slip Op 26160)

Reported in New York Official Reports at Medical Imaging of Bronx, P.C., Inc. v MVAIC (2026 NY Slip Op 26160)

Supreme Court, Appellate Term, First Department

Decided on October 1, 2026

570613/26

Present: James, P.J., Brigantti, Alpert, JJ.

Defendant appeals from a judgment of the Civil Court of the City of New York, Bronx County (Brenda Rivera, J.), entered on or about August 11, 2025, after a nonjury trial, in favor of plaintiff and awarding it damages in the principal amount of $967.70.

Per Curiam.

Judgment (Brenda Rivera, J.), entered on or about August 11, 2025, reversed, with $30 costs, and judgment directed in favor of defendant dismissing the complaint.

In this action by a provider to recover assigned first-party no-fault benefits, the parties stipulated that: (1) plaintiff provided medical services to its assignor in May and June of 2021; (2) the claims were timely submitted to American Transit Insurance Company [ATIT], but were denied in July and August of 2021 on the ground that the underlying policy expired; (3) plaintiff then submitted the claims to MVAIC, with a copy of the ATIT denial and cover letter; and (4) MVAIC received the claims on December 15, 2021 and timely denied the claim based upon the 45-day rule. The parties’ stipulation further limited the issues to be tried to whether plaintiff had a “reasonable justification” for the delay in submitting the claims to MVAIC (see 11 NYCRR 65-3.3 [e]).

At trial, plaintiff’s witness testified that upon receiving the ATIT denial, he reached out to the referring physician to determine if another carrier should be billed. However, the witness had no independent knowledge or records of when this contact was made. He only indicated that the physician responded on November 15, 2021, indicating that MVAIC was the new insurance.

Following the trial, the court determined that “plaintiff has proffered a reasonable excuse for the delay” in submitting the claim to MVAIC. This determination was not based upon the evidence, but upon what the court characterized as “strong policy considerations,” including the size of the population, the “overburdened” medical service providers, and the “reasonableness” of the time to submit claims.

We reverse. The court had no authority to disregard the strict time frames and criteria on the filing of no-fault claims, which were intended to combat an escalating fraud problem, were consistent with the policy underlying the No—Fault Law to provide prompt compensation to legitimate claimants (see Raffellini v State Farm Mut. Auto. Ins. Co., 9 NY3d 196, 201 [2007]). [*2]Indeed, no party requested that the court consider public policy considerations in making its determination.

Based upon our authority to render judgment warranted by the facts (see Northern Westchester Professional Park Assoc. v Town of Bedford, 60 NY2d 492, 499 [1983]), we direct judgment in favor of defendant dismissing the complaint. Plaintiff failed to establish a reasonable justification for the delay in submitting the claims to MVAIC. Even assuming that plaintiff’s submission of the claims to ATIT justified the initial delay, the evidence was insufficient to establish a “reasonable justification” for the additional four-month delay between the July/August denial of claims by ATIT and the submission of the claims to MVAIC in or about December 2021 (see Bronx Expert Radiology, P.C. v Motor Veh. Acc. Indem. Corp., 23 Misc 3d 129[A], 2009 NY Slip Op 50621[U] [App Term, 1st Dept 2009]; Bronx Expert Radiology, P.C. v Motor Veh. Acc. Indem. Corp., 20 Misc 3d 140[A], 2008 NY Slip Op 51612[U] [App Term, 1st Dept 2008]; NY Arthroscopy & Sports Medicine PLLC v Motor Veh. Acc. Indem. Corp., 15 Misc 3d 89 [App Term, 1st Dept 2007]). Plaintiff’s evidence, including the testimony of its witness, was insufficient. Although the witness testified that plaintiff reached out to the referring physician to determine whether plaintiff should bill another carrier, the witness was unable to recall or otherwise determine when plaintiff contacted the physician.

Furthermore, MVAIC’s denials informed plaintiff that the delay could be excused if plaintiff provided reasonable justification. However, plaintiff did not respond to the denials, and, instead chose to rely upon the cover letters submitted with its claims stating that the claims had previously been submitted to another carrier. However, this was insufficient because the cover letters did not explain the several months delay between ATIT’s denial and the submission to MVAIC (see Carniol v MVAIC, 62 Misc 3d 148[A], 2019 NY Slip Op 50232[U] [App Term, 1st Dept 2019]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.

I concur I concur I concur

Decision Date: October 1, 2026