December 6, 2019

Parisien v Nationwide Ins. (2019 NY Slip Op 51980(U))

https://www.beynensonlaw.com/case-law/parisien-v-nationwide-ins-2019-ny-slip-op-51980u/

Court: Appellate Term, Second Department
Decided: December 6, 2019
Citation: 2019 NY Slip Op 51980(U) · 65 Misc 3d 158(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Timeliness and preclusion
Legal questions: Proof of mailing (see the maps)

Cite as

Parisien v Nationwide Ins., 65 Misc 3d 158(A), 2019 NY Slip Op 51980(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2019)

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 insurer's proof raised a presumption that its denial-of-claim forms had been properly mailed. The provider's sole appellate challenge to the insurer's summary judgment motion concerned the sufficiency of that mailing proof. Applying St. Vincent's Hosp. of Richmond v Government Empls. Ins. Co., the Appellate Term, Second Department, rejected the challenge and affirmed the order granting the insurer summary judgment dismissing the assigned no-fault benefits complaint and denying the provider's cross motion for summary judgment.

Reported in New York Official Reports at Parisien v Nationwide Ins. (2019 NY Slip Op 51980(U))

[*1]

Parisien v Nationwide Ins.

2019 NY Slip Op 51980(U) [65 Misc 3d 158(A)]

Decided on December 6, 2019

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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 6, 2019

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

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, BERNICE D. SIEGAL, JJ
2018-1579 K C

Jules Francois Parisien, M.D., as Assignee of Gaddy, Matthew L., Appellant,
against
Nationwide Ins., Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Law Office of Kevin J. Philbin (Kevon Lewis of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Joy F. Campanelli, J.), entered March 28, 2018. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.

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

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.

Contrary to plaintiff’s sole appellate argument with respect to defendant’s motion for summary judgment, the proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim forms had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]).

Accordingly, the order is affirmed.

PESCE, P.J., ALIOTTA and SIEGAL, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 6, 2019

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.

Proof of mailing

Open the full map

Did a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?

This decision: The insurer's (or its agent's) proof established mailing of its denial, verification request or IME/EUO notice

Held the insurer's proof sufficient to give rise to a presumption that the denial of claim forms were properly mailed, rejecting the provider's sole argument.

Insurer proved mailingInsurer failed to proveProvider proved mailingProvider failed to proveTriable issue on mailingMixed rulingsThis decisionCites it or cited by itCited or followed

Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 809 (this one included) are in the same category.

Cited in this decision

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

St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co. (2008 NY Slip Op 04072) FollowedThe insurer raised factual issues concerning a proper timely denial and its entitlement to deny the hospital's claim.

Similar decisions

Parisien v 21st Century Ins. Co. (2018 NY Slip Op 51652(U))The insurer established timely mailing of the denial forms asserting lack of medical necessity, defeating the provider's appellate challenge.
Parisien v Allstate Ins. Co. (2019 NY Slip Op 51154(U))The insurer failed to establish timely mailing of its denials, but the provider also failed to establish entitlement to summary judgment.
Parisien v NY City Tr. Auth. (2018 NY Slip Op 51699(U))The self-insurer proved timely mailing of its denials, and the provider's remaining argument was unpreserved.
Parisien v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51770(U))The insurer's summary judgment motion dismissing the provider's claims for the assignor's EUO nonappearance was granted.
Parisien v Travelers Ins. Co. (2022 NY Slip Op 50553(U))The insurer established the provider's failure to attend two duly scheduled EUOs and timely denials on that ground.