June 17, 2022

New Millennium Med. Imaging, P.C. v 21st Century Ins. Co. (2022 NY Slip Op 50605(U))

https://www.beynensonlaw.com/case-law/new-millennium-med-imaging-p-c-v-21st-century-ins-co-2022-ny-slip-op50605u/

Court: Appellate Term, Second Department
Decided: June 17, 2022
Citation: 2022 NY Slip Op 50605(U)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Timeliness and preclusion

Cite as

New Millennium Med. Imaging, P.C. v 21st Century Ins. Co., 2022 NY Slip Op 50605(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2022)

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Summary

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

The provider failed to justify its late claim submission because the form sent to the wrong insurer bore the defendant insurer's name and address. The Appellate Term, Second Department, reversed the order, granted the insurer summary judgment dismissing the complaint and denied the provider's cross motion. Submission within 45 days after services was required under 11 NYCRR 65-1.1. The insurer timely denied the late claim and offered to excuse the delay upon reasonable justification under 11 NYCRR 65-3.3 (e). The provider initially sent the form to another insurer and submitted it to the defendant approximately a year later after discovering incorrect coverage information. It did not reasonably justify the initial misdirection despite the form's correct insurer information.

Reported in New York Official Reports at New Millennium Med. Imaging, P.C. v 21st Century Ins. Co. (2022 NY Slip Op 50605(U))

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

New Millennium Medical Imaging, P.C., as Assignee of Li Zhu Bian, Respondent,
against
21st Century Insurance Company, Appellant.

Law Offices of Buratti, Rothenberg & Burns (Bianca Maynard Francois of counsel), for appellant. Law Office of Damin J. Toell, P.C. (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Consuelo Mallafre Melendez, J.), entered January 8, 2020. 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, with $30 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 appeals from an order of the Civil Court entered January 8, 2020 denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment.

Plaintiff was required to submit its claim form to defendant within 45 days after the services were 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 & 13th Jud Dists 2014]) and it is undisputed that plaintiff failed to do so. Defendant timely denied plaintiff’s claim seeking to recover for those services, based upon plaintiff’s untimely submission, and informed plaintiff that defendant would excuse the delay if plaintiff provided a “reasonable justification” therefor (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]; Synergy First Med., PLLC, 2014 NY Slip Op 50964[U]). In opposition to defendant’s motion, plaintiff demonstrated that it had initially sent the claim form at issue to a different insurance company, and that, after plaintiff learned, approximately one year later, that [*2]the information it had regarding the insurance company covering the accident was incorrect, it sent the claim form to defendant. However, plaintiff did not establish a reasonable justification for initially submitting the claim form to the wrong insurance company, given that the claim form which plaintiff alleged it submitted to the wrong insurance company bore defendant’s name and address. As a result, plaintiff did not establish that it had provided defendant with a reasonable justification for its untimely submission of the claim form to defendant.

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.

ALIOTTA, P.J., GOLIA and BUGGS, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 17, 2022

Cited in this decision

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.

Similar decisions

New Millennium Med. Imaging, P.C. v American Tr. Ins. Co. (2017 NY Slip Op 51088(U))The insurer's late opposition papers were properly considered and raised a factual issue as to whether the claims had been timely denied.
New Millennium Med. Imaging, P.C. v Charter Oak Fire Ins. Co. (2019 NY Slip Op 51163(U))The insurer obtained summary judgment because its proof showed that it had issued no policy covering the loss.
Metropolitan Surgical Servs., P.C. v 21st Century Ins. Co. (2022 NY Slip Op 50606(U))An insurer need not comply with 11 NYCRR 65-3.6 (b) for IMEs scheduled before it receives the claim at issue.
New Millennium Med. Imaging, P.C. v Farmers Ins. Co. (2023 NY Slip Op 50091(U))The insurer's motion for summary judgment dismissing the provider's no-fault action as time-barred was denied.
Dynasty Med. Care, P.C. v 21st Century Sec. Ins. Co. (2018 NY Slip Op 51550(U))The insurer established late accident notice through an NF-2 received more than 30 days after the accident and timely denials on that ground.