June 12, 2009
Focus Radiology, P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 51218(U))
https://www.beynensonlaw.com/case-law/focus-radiology-p-c-v-new-york-cent-mut-ins-co-2009-ny-slip-op51218u/
- Decided
- June 12, 2009
- Citation
- 2009 NY Slip Op 51218(U) · 24 Misc 3d 126(A)
- Posture
- Motion to dismiss (CPLR 3211)
- Outcome
- Provider prevailed
- Legal questions
- Proof of mailing · Service and jurisdiction over the insurer (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 Focus Radiology, P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 51218(U))
| Focus Radiology, P.C. v New York Cent. Mut. Ins. Co. |
| 2009 NY Slip Op 51218(U) [24 Misc 3d 126(A)] |
| Decided on June 12, 2009 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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: : WESTON, J.P., GOLIA and STEINHARDT, JJ
2008-350 RI C.
against
New York Central Mutual Insurance Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Richmond County (Johnny Lee Baynes, J.), entered November 29, 2007. The order denied defendant’s motion to dismiss the complaint pursuant to CPLR 3211 or, in the alternative, for summary judgment determining that defendant’s denial of claim form was timely mailed.
Order modified by adding thereto the provision that the acknowledgment of service annexed to defendant’s moving papers is deemed timely filed; as so modified, affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved pursuant to CPLR 3211 to dismiss the action without prejudice because plaintiff failed to file the summons with proof of service as required by former section 409 of the New York City Civil Court Act or, in the alternative, for summary judgment determining that defendant’s denial of claim form was timely mailed. In opposition, plaintiff asked for nunc pro tunc relief pursuant to CCA former 411. The Civil Court denied defendant’s motion. This appeal by defendant ensued.
Dismissal of the action without prejudice due to a violation of CCA former 409, which required that a copy of the summons with proof of service be filed within 14 days after service of the summons, is not warranted where, as here, plaintiff requested nunc pro tunc relief (see CCA former 411). Under the circumstances presented, such nunc pro tunc relief should have been granted.
The affidavit submitted by defendant’s claims examiner failed to establish that defendant timely mailed its verification requests and its denial of claim form based upon its standard office practice or procedure designed to ensure that items are properly addressed and mailed (see New [*2]York & Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 547 [2006]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Top Choice Med., P.C. v New York Cent. Mut. Fire Ins. Co., 22 Misc 3d 133[A], 2009 NY Slip Op 50230[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Align for Health Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co., 20 Misc 3d 144[A], 2008 NY Slip Op 51862[U] [App Term, 2d & 11th Jud Dists 2008]; Horton Med., P.C. v New York Cent. Mut. Fire Ins. Co., 20 Misc 3d 142[A], 2008 NY Slip Op 51682[U] [App Term, 2d & 11th Jud Dists 2008]). As a result, defendant did not establish that its denial of claim form was timely. Accordingly, defendant’s motion was properly denied and the order is modified to provide for nunc pro tunc relief.
Weston, J.P., and Steinhardt, J., concur.
Golia, J., dissents in a separate memorandum.
Golia, J., dissents and votes to reverse the order and grant defendant’s motion to dismiss
the complaint.
This appeal turns on plaintiff’s failure to comply with the requirements of the New York City Civil Court Act that were in effect at the time the underlying action was commenced.
The Civil Court action was commenced on or about November 10, 2003, and defendant served an answer upon plaintiff dated December 22, 2003.
Despite the fact that former section 409 of the Civil Court Act, which was in effect at the time, required that a copy of the summons with proof of service be filed within 14 days of service, to wit, November 24, 2003, this plaintiff did not file those documents until March 12, 2007, nearly 3¼ years later. This is a rather extensive oversight.
Furthermore, I disagree with the representation presented by the majority that, “In opposition, plaintiff asked for nunc pro tunc relief pursuant to CCA former 411”. In fact, what plaintiff stated in its opposition papers was, “If this court deems it necessary, I would request the filing of the summons and complaint be accepted nunc pro tunc”. This inchoate statement was not even a precatory “request” but, rather, a conditional offer to make such request only “if this court deems it necessary”. This failure to file an application for relief is important because if plaintiff had made an affirmative request for nunc pro tunc relief, then it would have been required to demonstrate why it was entitled to such relief. That would have necessitated an explanation of why it took more than 1,200 days to comply with a simple requirement that should have been done in 14 days.
I do not deem it necessary or even advisable to grant plaintiff’s or its counsel’s unsupported
request for nunc pro tunc relief for counsel’s failure to comply with well- established rules, which
were disregarded for approximately 3¼ years. I would simply dismiss the complaint
without prejudice.
Decision Date: June 12, 2009
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 a party’s evidence establish that it mailed a no-fault claim, denial, verification request or examination notice?
This decision: The insurer's proof did not establish mailing of its denial, verification request or IME/EUO notice
Held the claims examiner's affidavit failed to show the verification requests and denial were timely mailed under a standard office practice designed to ensure proper addressing and mailing, so timely denial was not established.
Of the 1,400 decisions on this question in the Second Department courts and the Court of Appeals, 260 (this one included) are in the same category.
Was the insurer validly served with process, and does the court have personal jurisdiction over it?
This decision: Insurer validly served and subject to the court's jurisdiction, or service defect cured/excused
Held dismissal for failure to file the summons with proof of service within 14 days under former CCA 409 unwarranted because plaintiff requested nunc pro tunc relief, which should have been granted under former CCA 411.
Of the 129 decisions on this question in the Second Department courts and the Court of Appeals, 31 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- New York & Presbyt. Hosp. v Allstate Ins. Co. (2006 NY Slip Op 03558) FollowedThe providers failed to establish mailing and receipt of the hospital bill asserted in their second cause of action.
- Top Choice Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50230(U)) FollowedThe insurer failed to establish timely mailing of its denial, leaving it unable to show that its medical-necessity defense was not precluded.
- Align for Health Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51862(U)) FollowedThe insurer failed to prove timely verification requests, and the provider failed to lay a business-records foundation.
- Horton Med., P.C. v New York Cent. Mut. Fire Ins. Co. (2008 NY Slip Op 51682(U)) FollowedThe provider failed to establish a business-record foundation for its claim forms, and the insurer failed to prove timely verification mailings.
Cited by
- Downtown Acupuncture PC v State Wide Ins. Co. (2015 NY Slip Op25371)The insurer's collateral estoppel request could not be entertained until it formally sought to plead fraudulent incorporation.
Similar decisions
- J.R. Dugo, D.C., P.C. v New York Cent. Mut. Ins. Co. (2009 NY Slip Op 29261)The provider's request for nunc pro tunc relief warranted accepting its late filing of the summons and proof of service.
- Radiology Today P.C. v Allstate Ins. Co. (2006 NY Slip Op 50472(U))An insurer's untimely denial precludes a defense that the provider failed to submit its bill within the applicable 180-day period.
- Atlantic Radiology Imaging, P.C. v Travelers Home (2014 NY Slip Op 51002(U))The insurer's dismissal motion was improperly converted to summary judgment without adequate notice under CPLR 3211 (c).
- Prestige Med. & Surgical Supply, Inc. v Clarendon Natl. Ins. Co. (2006 NY Slip Op 51672(U))The insurer's adjuster affidavits failed to establish timely mailing of denials, precluding its defenses.
- Roman Chiropractic, P.C. v Lumbermens Mut. Cas. Co. (2011 NY Slip Op 52090(U))A dismissal for want of prosecution does not bar a new action on res judicata grounds unless it specifies dismissal on the merits.