July 27, 2011
Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52452(U))
https://www.beynensonlaw.com/case-law/radiology-today-p-c-v-new-york-cent-mut-fire-ins-co-2011-ny-slip-op52452u/
- Decided
- July 27, 2011
- Citation
- 2011 NY Slip Op 52452(U) · 34 Misc 3d 139(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Later treatment
- Followed in 1 later decision (see Cited by)
- Legal questions
- Outstanding verification and premature actions · Proof of mailing (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 Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co. (2011 NY Slip Op 52452(U))
| Radiology Today, P.C. v New York Cent. Mut. Fire Ins. Co. |
| 2011 NY Slip Op 52452(U) [34 Misc 3d 139(A)] |
| Decided on July 27, 2011 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON and STEINHARDT, JJ
2010-978 K C.
against
New York Central Mutual Fire Insurance Company, Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered February 16, 2010. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint.
ORDERED that the order, insofar as appealed from, is reversed, without costs, and defendant’s motion for summary judgment dismissing the complaint is granted.In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from so much of an order as denied its motion for summary judgment dismissing the complaint based on a finding that defendant had failed to establish that plaintiff did not comply with defendant’s requests for verification.
Contrary to plaintiff’s contention, the affidavit of defendant’s litigation examiner, submitted in support of defendant’s motion, established that defendant had timely mailed its requests and follow-up requests for verification (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb [*2]Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]), and that plaintiff had failed to provide the MRI films which, among other things, defendant’s requests for verification had sought. As plaintiff’s opposing papers failed to address defendant’s requests for the assignor’s MRI films, plaintiff did not demonstrate that it had provided defendant, prior to commencement of the action, with the verification requested. Consequently, the 30-day period within which defendant was required to pay or deny the claims did not commence to run and plaintiff’s action is premature (see Insurance Department Regulations [11 NYCRR] § 65-3.8 [a]; Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co., 44 AD3d 903 [2007]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]). Accordingly, the order, insofar as appealed from, is reversed, and defendant’s motion for summary judgment dismissing the complaint is granted.
Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 27, 2011
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.
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 the action premature because the insurer showed timely requests for the MRI films and other items, and the provider's papers never addressed the films, so verification remained outstanding.
Of the 385 decisions on this question in the Second Department courts and the Court of Appeals, 153 (this one included) are in the same category.
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 (rules on the question, but another ground decided the case)
Rejecting the provider's contention, held the litigation examiner's affidavit established timely mailing of the verification requests and follow-up requests.
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.
- Delta Diagnostic Radiology, P.C. v Chubb Group of Ins. (2007 NY Slip Op 27345) FollowedAn insurer may prove mailing by describing its standard procedure for properly addressing and mailing items.
- Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 08038) FollowedThe hospital's claim was premature because unrebutted proof showed that it ignored timely verification and follow-up requests.
- Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 09484) FollowedAn insurer need not pay or deny a no-fault claim until it receives all relevant verification requested.
Cited by
A label shows how the later decision treated this one.
- American Tr. Ins. Co. v PDA NY Chiropractic, P.C. (2023 NY Slip Op 50938(U)) FollowedA provider's substantial compliance with reasonable additional verification requests does not make its claims payable.
Similar decisions
- Atlantic Radiology Imaging, P.C. v NY Cent. Mut. Fire Ins. Co. (2012 NY Slip Op 51725(U))The insurer proved timely mailing of IME notices and denials and the assignor's failure to attend the duly scheduled IMEs. An employee of the company retained to schedule the IMEs described standard office mailing practices establishing timely mailing of the scheduling letters.
- Radiology Today, P.C. v GEICO Ins. Co. (2009 NY Slip Op 51578(U))The insurer's premature verification follow-up left its denial untimely and precluded its medical-necessity defense.
- Radiology Imaging of Queens v Progressive Ins. (2011 NY Slip Op 51860(U))The insurer's unopposed peer review and timely denial established entitlement to dismissal for lack of medical necessity.
- Comprehensive MRI of N.Y., P.C. v New York Cent. Mut. Fire Ins. Co. (2014 NY Slip Op 50128(U))Conflicting medical expert opinions raised a triable issue of fact concerning the medical necessity of the provider's services.
- Radiology Today, P.C. v Mercury Ins. Co. (2012 NY Slip Op 50148(U))The provider's owner's affirmation was improper under CPLR 2106 and failed to rebut the insurer's medical-necessity peer review.