September 27, 2016

Treka Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51411(U))

https://www.beynensonlaw.com/case-law/treka-med-p-c-v-travelers-ins-co-2016-ny-slip-op-51411u/

Court: Appellate Term, Second Department
Decided: September 27, 2016
Citation: 2016 NY Slip Op 51411(U) · 53 Misc 3d 133(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Later treatment: Followed in 1 later decision (see Cited by)
Issues: Verification requests Provider's prima facie case Timeliness and preclusion
Legal questions: Proof of mailing · Outstanding verification and premature actions (see the maps)

Cite as

Treka Med., P.C. v Travelers Ins. Co., 53 Misc 3d 133(A), 2016 NY Slip Op 51411(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 established nonreceipt of one claim and outstanding verification for five others. For the first cause of action, the insurer described its mail-receipt procedures and demonstrated nonreceipt. The provider owner's affidavit asserted mailing almost a month before the claimed services were provided, and no attached claim matched the amount sought, leaving no triable mailing issue. For the third through seventh causes of action, the insurer established presumptive mailing of initial and follow-up verification requests and nonreceipt of the requested verification, making those claims premature. The Appellate Term, Second Department, affirmed the order granting the insurer summary judgment dismissing the first and third through seventh causes of action.

Reported in New York Official Reports at Treka Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51411(U))

[*1]

Treka Med., P.C. v Travelers Ins. Co.

2016 NY Slip Op 51411(U) [53 Misc 3d 133(A)]

Decided on September 27, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 September 27, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2014-413 Q C

Treka Medical, P.C., as Assignee of GOLAM SARWAR, Appellant,
against
Travelers Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Ulysses Bernard Leverett, J.), entered January 30, 2014. The order granted defendant’s motion for summary judgment dismissing plaintiff’s first, and third through seventh, causes of action.

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 plaintiff’s first, and third through seventh, causes of action.

Contrary to plaintiff’s argument with respect to the claim underlying the first cause of action, defendant sufficiently described its practices and procedures for receipt of mail and demonstrated, prima facie, that it had not received this claim. Contrary to plaintiff’s further argument, plaintiff failed to raise a triable issue of fact as to whether it had mailed this claim to defendant. While plaintiff submitted an affidavit by its owner, that affidavit alleges that this claim was mailed almost a month before the services set forth in that claim were provided. Moreover, while plaintiff attached to its opposition papers the claims allegedly sent to defendant, there was no claim attached matching the amount sought in the first cause of action.

Contrary to plaintiff’s arguments with respect to the third through seventh causes of action, the proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that initial and follow-up verification requests had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), and to demonstrate that defendant had not received the requested verification and, thus, that those causes of action are premature (see Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]).

Accordingly, the order is affirmed.

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

Decision Date: September 27, 2016

Legal questions (2)

Questions 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: Different mailing results for different documents or claims in one decision

Held the insurer's proof raised a presumption that its initial and follow-up verification requests were properly mailed, but that the provider's affidavit, dating mailing of one claim before the services were rendered, failed to show that claim was mailed.

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, 55 (this one included) are in the same category.

Outstanding verification and premature actions

Open the full map

Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?

This decision: Timely requests went unanswered; the claim is not overdue and the action is premature

Held five causes of action premature because the insurer proved it mailed initial and follow-up verification requests and never received the requested verification.

Premature: verification outstandingNonresponse denial upheldTriable issueInsurer's showing failsProvider compliedThis decision

Of the 374 decisions on this question in the Second Department courts and the Court of Appeals, 151 (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.

Cited by

A label shows how the later decision treated this one.

Elite Psychological Servs., P.C. v Country-Wide Ins. Co. (2026 NY Slip Op 50687(U)) FollowedA settling insurer's 21-day payment obligation begins upon actual receipt of a duly executed release and stipulation of discontinuance mailed to it.

Similar decisions

T & S Med. Supply Corp. v Travelers Ins. Co. (2018 NY Slip Op 51597(U))The provider's owner's affidavit raised a factual issue about receipt of verification and whether the action was premature.
Compas Med., P.C. v Travelers Ins. Co. (2016 NY Slip Op 51441(U))An insurer need not pay or deny a claim upon receiving only a partial response to its verification requests.
Flatlands Med., P.C. v Travelers Ins. Co. (2014 NY Slip Op 51856(U))The insurer failed to establish timely denials for seven claims but proved timely mailing of EUO notices and denials for two others.
Compas Med., P.C. v American Tr. Ins. Co. (2016 NY Slip Op 51433(U))The provider's mailing affidavit raised a triable issue whether requested verification had been received for two claims.
Gentlecare Ambulatory Anesthesia Servs. v Travelers Ins. Co. (2017 NY Slip Op 51802(U))The provider's affidavit raised a triable issue whether requested verification had been received and the action was premature.