December 12, 2013
Westchester Med. Ctr. v New S. Ins. Co. (2013 NY Slip Op 52085(U))
https://www.beynensonlaw.com/case-law/westchester-med-ctr-v-new-s-ins-co-2013-ny-slip-op52085u/
- Decided
- December 12, 2013
- Citation
- 2013 NY Slip Op 52085(U) · 41 Misc 3d 145(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Issues
- Verification requests
- Legal questions
- Outstanding verification and premature actions (see the maps)
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.
Reported in New York Official Reports at Westchester Med. Ctr. v New S. Ins. Co. (2013 NY Slip Op 52085(U))
| Westchester Med. Ctr. v New S. Ins. Co. |
| 2013 NY Slip Op 52085(U) [41 Misc 3d 145(A)] |
| Decided on December 12, 2013 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS
PRESENT: : NICOLAI, P.J., LaSALLE and MARANO, JJ
.
against
New South Insurance Company, Respondent.
Appeal from an order of the District Court of Nassau County, First District (Michael A. Ciaffa, J.), dated September 26, 2011. The order, insofar as appealed from as limited by the brief, denied plaintiff’s motion for summary judgment.
ORDERED that the order, insofar as appealed from, is affirmed, without 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 District Court as denied its motion for summary judgment.
The record shows that the District Court considered both defendant’s proof that defendant had not received requested verification from plaintiff and an affidavit from plaintiff which asserts that material responsive to the verification request had been sent to defendant. Thus, plaintiff failed to establish the absence of a material issue of fact. As a result, the District Court properly determined that plaintiff was not entitled to summary judgment. We decline defendant’s request to search the record and award it summary judgment dismissing the complaint.
Accordingly, the order, insofar as appealed from, is affirmed.Nicolai, P.J., LaSalle
and Marano, JJ., concur.
Decision Date: December 12, 2013
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.
Did unanswered verification requests make the provider’s claim premature, or justify denying it for nonresponse?
This decision: Fact issues remain on whether the verification defense applies
Held the provider not entitled to summary judgment because the insurer's proof of nonreceipt and the provider's affidavit that responsive material was sent raised an issue of fact.
Of the 385 decisions on this question in the Second Department courts and the Court of Appeals, 114 (this one included) are in the same category.
Similar decisions
- Westchester Med. Ctr. v A Cent. Ins. Co. (2014 NY Slip Op 01319)The insurer raised a factual issue as to whether it mailed a proper denial 22 days after receiving requested verification.
- Westchester Med. Ctr. v Travelers Prop. Cas. Ins. Co. (2012 NY Slip Op 50589(U))The provider's summary judgment motion was denied because it failed to demonstrate prima facie entitlement to judgment.
- Westchester Med. Ctr. v Country Wide Ins. Co. (2011 NY Slip Op 03838)The insurer raised a triable issue as to whether the hospital fully complied with its verification demand.
- Westchester Med. Ctr. v Lancer Ins. Co. (2012 NY Slip Op 02867)The insurer defeated the provider's summary judgment motion by proving timely verification requests and denial after verification was received.
- Westchester Med. Ctr. v Allstate Ins. Co. (2013 NY Slip Op 08616)The insurer failed to establish a verification toll because it offered no evidence of mailing a required follow-up request.