November 18, 2022

Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51232(U))

https://www.beynensonlaw.com/case-law/veraso-med-supply-corp-v-state-farm-mut-auto-ins-co-2022-ny-slip-op51232u/

Court: Appellate Term, Second Department
Decided: November 18, 2022
Citation: 2022 NY Slip Op 51232(U) · 77 Misc 3d 131(A)
Posture: Trial
Outcome: Insurer prevailed
Issues: Verification requests Trial and evidence
Legal questions: Outstanding verification and premature actions (see the maps)

Cite as

Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co., 77 Misc 3d 131(A), 2022 NY Slip Op 51232(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022)

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 trial record supported findings that the provider had not fully supplied requested verification and that the insurer timely denied the claim. The Appellate Term, Second Department, affirmed the Civil Court, Kings County, judgment dismissing the complaint after a nonjury trial limited to verification responses and whether verification remained outstanding before denial. Although appellate review of a nonjury determination is as broad as the trial court's authority, credibility findings receive substantial deference because the trial court observes the witnesses. The proof supported the finding of incomplete responses and timely denial on that ground under 11 NYCRR 65-3.5 (o). The appellate court found no basis to disturb the determination.

Reported in New York Official Reports at Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2022 NY Slip Op 51232(U))

[*1]

Veraso Med. Supply Corp. v State Farm Mut. Auto. Ins. Co.

2022 NY Slip Op 51232(U) [77 Misc 3d 131(A)]

Decided on November 18, 2022

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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 18, 2022

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2020-349 K C

Veraso Medical Supply Corp., as Assignee of Fernandez, Mariel, Appellant,
against
State Farm Mutual Automobile Ins. Co., Respondent.

The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. James F. Butler & Associates (Mohammad Q. Rubbani of counsel), for respondent.

Appeal from a judgment of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered April 19, 2018. The judgment, after a nonjury trial, dismissed the complaint.

ORDERED that the judgment is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, a nonjury trial was held, limited to the issues of whether plaintiff had fully responded to defendant’s verification requests and whether verification was outstanding prior to the issuance of the denial. Following the trial, the Civil Court dismissed the complaint, finding that defendant sustained its burden of establishing that plaintiff had not fully responded to defendant’s verification requests and that verification was outstanding prior to the issuance of the denial.

In reviewing a determination made after a nonjury trial, the power of this court is as broad as that of the trial court, and this court may render the judgment it finds warranted by the facts, bearing in mind that the determination of a trier of fact as to issues of credibility is given substantial deference, as a trial court’s opportunity to observe and evaluate the testimony and demeanor of the witnesses affords it a better perspective from which to assess their credibility [*2](see Northern Westchester Professional Park Assoc. v Town of Bedford, 60 NY2d 492, 499 [1983]; Hamilton v Blackwood, 85 AD3d 1116 [2011]; Zeltser v Sacerdote, 52 AD3d 824, 826 [2008]). In the present case, the record supports the finding of the Civil Court, based upon its assessment of the proof adduced at trial, that plaintiff did not fully respond to defendant’s verification requests (see CPM Med Supply, Inc. v State Farm Fire & Cas. Ins. Co., 63 Misc 3d 140[A], 2019 NY Slip Op 50576[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019]; City Care Acupuncture, P.C. v Allstate Prop. & Cas. Ins. Co., 58 Misc 3d 138[A], 2017 NY Slip Op 51839[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2017]) and that defendant had timely denied plaintiff’s claim on that ground (see 11 NYCRR 65-3.5 [o]). Consequently, we find no basis to disturb the Civil Court’s determination.

Accordingly, the judgment is affirmed.

ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 18, 2022

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.

Outstanding verification and premature actions

Open the full map

Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?

This decision: Insurer properly denied the claim because verification was not provided (120-day rule)

Upheld, after a nonjury trial, the finding that the provider had not fully responded to the verification requests and that the insurer timely denied the claim on that ground under 11 NYCRR 65-3.5 (o).

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decisionCites it or cited by itCited or followed

Of the 374 decisions on this question in the Second Department courts and the Court of Appeals, 22 (this one included) are in the same category.

Cited in this decision

CPM Med Supply, Inc. v State Farm Fire & Cas. Ins. Co. (2019 NY Slip Op 50576(U))A provider's opinion that requested invoices are unnecessary does not reasonably justify failing to supply verification.
City Care Acupuncture, P.C. v Allstate Prop. & Cas. Ins. Co. (2017 NY Slip Op 51839(U))The providers' own purported verification responses showed that requested material remained outstanding and their no-fault action was premature.

Similar decisions

Veraso Med. Supply Corp. v Nationwide Ins. (2021 NY Slip Op 51167(U))The provider's failure to meet local licensing requirements was established at trial, rendering it ineligible for no-fault reimbursement.
Veraso Med. Supply Corp. v 21st Century Ins. Co. (2018 NY Slip Op 51696(U))The insurer failed to establish a timely denial after the assignor's alleged EUO nonappearances, defeating its summary judgment cross motion.
Right Aid Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51409(U))The provider's complaint dismissal was reversed for a new trial on whether requested verification remained outstanding.
Veraso Med. Supply Corp. v Victoria Fire & Cas. Co. (2019 NY Slip Op 50690(U))The insurer's summary judgment dismissing the claims for failure to give accident notice within 30 days was affirmed.
Sovera Med. Supply Corp. v State Farm Mut. Auto. Ins. Co. (2020 NY Slip Op 51363(U))Striking a pleading for discovery noncompliance requires a clear showing that the failure was willful, contumacious, or in bad faith.