August 11, 2022

Stand-Up MRI of the Bronx, P.C. v MVAIC Ins. Co. (2022 NY Slip Op 50789(U))

https://www.beynensonlaw.com/case-law/stand-up-mri-of-the-bronx-p-c-v-mvaic-ins-co-2022-ny-slip-op50789u/

Court: Appellate Term, Second Department
Decided: August 11, 2022
Citation: 2022 NY Slip Op 50789(U)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Timeliness and preclusion MVAIC

Cite as

Stand-Up MRI of the Bronx, P.C. v MVAIC Ins. Co., 2022 NY Slip Op 50789(U) (App Term, 2d Dept, 9th & 10th Jud Dists 2022)

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Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The provider failed to establish that it gave MVAIC reasonable justification for submitting its claims after the 45-day deadline. The Appellate Term, Second Department, reversed the order, granted MVAIC summary judgment dismissing the complaint, and denied the provider's cross motion. Under 11 NYCRR 65-1.1, the claims were due within 45 days after services were rendered. MVAIC timely denied them and advised that reasonable justification could excuse the delay under 11 NYCRR 65-3.3 (e). The provider initially billed an insurance company and submitted the claims to MVAIC after learning that company would not cover them. It did not establish that it had explained to MVAIC why it initially submitted the claims to that insurer.

Reported in New York Official Reports at Stand-Up MRI of the Bronx, P.C. v MVAIC Ins. Co. (2022 NY Slip Op 50789(U))

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS

Stand-Up MRI of the Bronx, P.C., as Assignee of Norma Richardson, Respondent,
against
MVAIC Insurance Company, Appellant.

Marshall & Marshall, PLLC (David A. Gierasch of counsel), for appellant. Dash Law Firm, P.C. (James Errera of counsel), for respondent.

Appeal from an order of the District Court of Suffolk County, Third District (C. Stephen Hackeling, J.), entered July 19, 2021. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.

ORDERED that the order is reversed, without costs, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.

In this action by a provider to recover assigned first-party no-fault benefits, defendant Motor Vehicle Accident Indemnification Corporation (MVAIC) (sued herein as MVAIC Insurance Company) appeals from an order of the District Court denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment.

It is undisputed that plaintiff was required to submit its claim forms to MVAIC within 45 days after the services at issue had been rendered (see 11 NYCRR 65-1.1; Synergy First Med., PLLC v MVAIC, 44 Misc 3d 127[A], 2014 NY Slip Op 50964[U] [App Term, 2d Dept, 2d, 11th [*2]& 13th Jud Dists 2014]) and that plaintiff did not do so. In support of its motion for summary judgment, MVAIC established that it had timely denied plaintiff’s claims, based upon plaintiff’s untimely submissions, and that it had informed plaintiff that MVAIC could excuse the delay if plaintiff provided “reasonable justification” for the delay (see 11 NYCRR 65-3.3 [e]; see also Matter of Medical Socy. of State of NY v Serio, 100 NY2d 854, 862-863 [2003]; Mount Sinai Hosp. of Queens v Country Wide Ins. Co., 43 Misc 3d 139[A], 2014 NY Slip Op 50780[U] [App Term, 2d Dept, 9th & 10th Jud Dists 2014]). In opposition to MVAIC’s motion, plaintiff demonstrated that it had initially sent the claims at issue to an insurance company, but after plaintiff learned that the insurance company would not cover the claims, plaintiff sent the claims to MVAIC. However, plaintiff did not establish that it had provided MVAIC with a reasonable justification as to why it had initially submitted the claims to the insurance company. As a result, plaintiff did not establish that it had provided MVAIC with a reasonable justification for its untimely submission to MVAIC of the claim forms (see Norman Y. Schoenberg, M.D., P.C. v N.Y.C. Tr. Auth., 39 Misc 3d 128[A], 2013 NY Slip Op 50421[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2013]; Prestige Med. & Surgical Supply, Inc. v Chubb Indem. Ins. Co., 26 Misc 3d 145[A], 2010 NY Slip Op 50449[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2010]).

Accordingly, the order is reversed, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.

EMERSON, J.P., GARGUILO and DRISCOLL, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 11, 2022

Cited in this decision

A label shows how this decision treated the case it cites.

Synergy First Med., PLLC v MVAIC (2014 NY Slip Op 50964(U))The provider failed to justify its late claim to MVAIC by merely stating that it had timely submitted the claim to an insurer.
Mount Sinai Hosp. of Queens v Country Wide Ins. Co. (2014 NY Slip Op 50780(U))The provider's claim was submitted more than 45 days after the services, and the provider offered no justification for the delay.
Norman Y. Schoenberg, M.D., P.C. v N.Y.C. Tr. Auth. (2013 NY Slip Op 50421(U)) FollowedThe transit authority established submission of the provider's claim beyond 45 days without a reasonable justification for the delay.
Prestige Med. & Surgical Supply, Inc. v Chubb Indem. Ins. Co. (2010 NY Slip Op 50449(U))The provider failed to justify its late claim submission because it did not explain why it first billed another insurer.

Cited by

Good Samaritan Hosp. v MVAIC Ins. Co. (2022 NY Slip Op 51100(U))MVAIC established that the provider's claim was submitted late, and the provider failed to justify the delay or prove an earlier mailing.

Similar decisions

Queens Diagnostic Radiology, P.C. v MVAIC (2025 NY Slip Op 51147(U))The provider failed to justify submitting its claims to MVAIC more than 45 days after the services were rendered.
Bronx Community Med., P.C. v MVAIC (2024 NY Slip Op 51538(U))MVAIC obtained dismissal without prejudice because it had not received the provider's claim forms and the action was premature.
Bajaj v MVAIC (2015 NY Slip Op 51661(U))The provider submitted its claims to MVAIC after the 45-day deadline and failed to provide written justification for the delay.
Schottenstein Pain & Neuro, PLLC v MVAIC (2021 NY Slip Op 50643(U))The provider failed to establish reasonable justification for submitting five claims to MVAIC beyond the 45-day deadline.
AAA Chiropractic, P.C. v MVAIC (2010 NY Slip Op 51896(U))The provider's late claims were dismissed because it showed no written justification, and its conclusory demand for discovery did not defeat judgment.