March 11, 2016

BAB Nuclear Radiology, P.C. v Mercury Cas. Co. (2016 NY Slip Op 50318(U))

Headnote

The insurer moved for summary judgment dismissing a provider's no-fault action on the ground that it timely denied the claim because the provider did not submit it within 45 days of the services. The provider submitted an affidavit of its billing supervisor, and the Civil Court denied the motion. The Appellate Term held that the affidavit was sufficient to raise a triable issue of fact as to whether the claim was timely submitted. The insurer therefore did not prove as a matter of law noncompliance with 11 NYCRR 65-1.1, and the order was affirmed.

Reported in New York Official Reports at BAB Nuclear Radiology, P.C. v Mercury Cas. Co. (2016 NY Slip Op 50318(U))

[*1]
BAB Nuclear Radiology, P.C. v Mercury Cas. Co.
2016 NY Slip Op 50318(U) [50 Misc 3d 147(A)]
Decided on March 11, 2016
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This opinion is uncorrected and will not be published in the printed Official Reports.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 11, 2016
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and ELLIOT, JJ.
2013-1899 Q C

BAB Nuclear Radiology, P.C. as Assignee of Madeline Herth, Respondent,

against

Mercury Casualty Company, Appellant.


Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered August 8, 2013. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that it had timely denied the claim at issue based on plaintiff’s failure to submit it to defendant within 45 days of the date the services had been rendered. Plaintiff cross-moved for summary judgment. Defendant appeals from so much of an order of the Civil Court as denied defendant’s motion for summary judgment, finding that the affidavit of plaintiff’s billing supervisor was sufficient to demonstrate the existence of a triable issue of fact with respect to whether the claim had been timely submitted to defendant.

Contrary to defendant’s sole contention on appeal, the affidavit of plaintiff’s billing supervisor was sufficient to demonstrate the existence of a triable issue of fact with respect to whether the claim had been timely submitted to defendant. Consequently, defendant did not prove, as a matter of law, that plaintiff had failed to comply with the regulation requiring submission of claims within 45 days of the services rendered (see 11 NYCRR 65-1.1).

Accordingly, the order, insofar as appealed from, is affirmed.

Pesce, P.J., Aliotta and Elliot, JJ., concur.


Decision Date: March 11, 2016