November 16, 2018

Parisien v 21st Century Ins. Co. (2018 NY Slip Op 51652(U))

https://www.beynensonlaw.com/case-law/parisien-v-21st-century-ins-co-2018-ny-slip-op-51652u/

Court: Appellate Term, Second Department
Decided: November 16, 2018
Citation: 2018 NY Slip Op 51652(U) · 61 Misc 3d 143(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Timeliness and preclusion
Legal questions: Proof of mailing (see the maps)

Cite as

Parisien v 21st Century Ins. Co., 61 Misc 3d 143(A), 2018 NY Slip Op 51652(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018)

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 established timely mailing of the denial forms asserting lack of medical necessity, defeating the provider's appellate challenge. The provider sought assigned first-party no-fault benefits and appealed an order denying its summary judgment motion and granting the insurer's cross motion dismissing the complaint on medical necessity grounds. The Appellate Term, Second Department, rejected the provider's mailing argument and affirmed the Civil Court, Kings County, order in the insurer's favor.

Reported in New York Official Reports at Parisien v 21st Century Ins. Co. (2018 NY Slip Op 51652(U))

[*1]

Parisien v 21st Century Ins. Co.

2018 NY Slip Op 51652(U) [61 Misc 3d 143(A)]

Decided on November 16, 2018

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This opinion is uncorrected and will not be published in the printed Official Reports.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 16, 2018

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

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2016-1528 K C

Jules Francois Parisien, M.D., as Assignee of Torres, Erika, Appellant,
against
21st Century Insurance Company, Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Law Offices of Bryan M. Rothenberg (Sharon A. Brennan of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (John J. Kelley, J.), entered May 6, 2016. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

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 denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint on the ground of a lack of medical necessity.

Contrary to plaintiff’s argument on appeal, defendant established that the denial of claim forms, which had denied the claims on the ground of a lack of medical necessity, had been timely 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 ELLIOT, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 16, 2018

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 established that its medical-necessity denial of claim forms had been timely mailed, rejecting the provider's appellate 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 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 Tri State Consumers Ins. Co. (2021 NY Slip Op 50728(U))The insurer's unrebutted IME report established a lack of medical necessity for the provider's subsequent services.
Parisien v Nationwide Ins. (2019 NY Slip Op 51980(U))The insurer's proof raised a presumption that its denial-of-claim forms had been properly mailed.
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 51602(U))No payment is due for medical service fees exceeding permissible fee-schedule charges under 11 NYCRR 65-3.8 (g) (1) (ii).