November 1, 2016

Adelaida M. Laga, Pt v 21st Century Ins. Co. (2016 NY Slip Op 51623(U))

https://www.beynensonlaw.com/case-law/adelaida-m-laga-pt-v-21st-century-ins-co-2016-ny-slip-op51623u/

Court: Appellate Term, Second Department
Decided: November 1, 2016
Citation: 2016 NY Slip Op 51623(U) · 53 Misc 3d 148(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Later treatment: Followed in 1 later decision (see Cited by)
Issues: Timeliness and preclusion
Legal questions: Proof of mailing (see the maps)

Cite as

Adelaida M. Laga, Pt v 21st Century Ins. Co., 53 Misc 3d 148(A), 2016 NY Slip Op 51623(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016)

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 summary judgment motion dismissing the first four causes of action was granted based on timely mailed denials. The Appellate Term, Second Department, affirmed the order, insofar as appealed from, because the insurer established timely mailing, rejecting the provider's sole contention to the contrary.

Reported in New York Official Reports at Adelaida M. Laga, Pt v 21st Century Ins. Co. (2016 NY Slip Op 51623(U))

[*1]

Adelaida M. Laga, PT v 21st Century Ins. Co.

2016 NY Slip Op 51623(U) [53 Misc 3d 148(A)]

Decided on November 1, 2016

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This opinion is uncorrected and will not be published in the printed Official Reports.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 1, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-503 Q C

Adelaida M. Laga, PT, as Assignee of JARRET JACOBS, Appellant,
against
21st Century Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Larry Love, J.), entered February 24, 2014. The order, insofar as appealed from, granted the branches of defendant’s motion seeking summary judgment dismissing the first through fourth causes of action.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from so much of an order of the Civil Court as granted the branches of defendant’s motion seeking summary judgment dismissing the first through fourth causes of action.

Contrary to plaintiff’s sole contention, defendant established that the denial of claim forms at issue had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; see also Acupuncture Healthcare Plaza I, P.C. v Truck Ins. Exch., 50 Misc 3d 146[A], 2016 NY Slip Op 50309[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]). Accordingly, the order, insofar as appealed from, is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: November 01, 2016

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 denials were timely mailed, rejecting the provider's sole contention on appeal and upholding dismissal of the causes of action.

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 1,384 decisions on this question in the Second Department courts and the Court of Appeals, 806 (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.
Acupuncture Healthcare Plaza I, P.C. v Truck Ins. Exch. (2016 NY Slip Op 50309(U))The insurer established timely mailing of its denial and full payment under the fee schedule for acupuncture performed by chiropractors.

Cited by

A label shows how the later decision treated this one.

TAM Med. Supply Corp. v 21st Century Ins. Co. (2017 NY Slip Op 51510(U)) FollowedThe insurer established EUO nonappearance and timely mailing of its denial forms, supporting dismissal of the provider's claims.

Similar decisions

Adelaida M. Laga, PT v Hereford Ins. Co. (2017 NY Slip Op 51462(U))The provider's affidavit raised a factual issue about receipt of requested verification, defeating the insurer's prematurity motion.
Laga v Allstate Ins. Co. (2018 NY Slip Op 50416(U))The insurer failed to establish timely mailing of its denials and therefore did not show that its defenses escaped preclusion.
Laga v American Commerce Ins. Co. (2017 NY Slip Op 51250(U))The insurer failed to establish a timely denial of the sixth claim on its EUO nonappearance defense.
Laga v Country Wide Ins. Co. (2017 NY Slip Op 51155(U))The insurer's proof supported a presumption of proper denial mailing, and the provider's remaining challenge was first raised on appeal.
Adelaida M. Laga, Pt v GEICO Ins. Co. (2017 NY Slip Op 51713(U))The insurer failed to establish the correct fee schedule conversion factor or proper application of Ground Rule 11.