March 30, 2007
Fair Price Med. Supply Corp. v Clarendon Natl. Ins. Co. (2007 NY Slip Op 50639(U))
https://www.beynensonlaw.com/case-law/fair-price-med-supply-corp-v-clarendon-natl-ins-co-2007-ny-slip-op-50639u/
- Decided
- March 30, 2007
- Citation
- 2007 NY Slip Op 50639(U) · 15 Misc 3d 130(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Legal questions
- 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 Fair Price Med. Supply Corp. v Clarendon Natl. Ins. Co. (2007 NY Slip Op 50639(U))
| Fair Price Med. Supply Corp. v Clarendon Natl. Ins. Co. |
| 2007 NY Slip Op 50639(U) [15 Misc 3d 130(A)] |
| Decided on March 30, 2007 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 and 11th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON PATTERSON and GOLIA, JJ
2005-1796 K C.
against
Clarendon National Insurance Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Kings County (Eileen Nadelson, J.), entered September 29, 2005. The order denied plaintiff’s motion for summary judgment.
Order affirmed without costs.
In this action to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. In opposition, defendant asserted that it timely denied the claim on the ground of medical necessity based upon a peer review performed once the requested verification was received. The court denied plaintiff’s motion for summary judgment and this appeal by plaintiff ensued. On appeal, plaintiff contends, inter alia, that it was entitled to summary judgment because defendant failed to establish timely mailing of the verification requests and the denial of claim form.
Contrary to plaintiff’s contention, the affidavits submitted by defendant sufficiently established the timely mailing of the initial and follow-up verification requests as well as the denial of claim form since they described in detail the standard office practice and procedure used to ensure that the verification requests and denial of claim form were properly addressed and mailed (see New York & Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 547 [2006]; Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]).
Plaintiff further contends that the denial of claim form was defective since it was issued by Media Referral, Inc. which, plaintiff alleged, was acting as an independent insurance adjuster without a license (see Insurance Law § 2101 [g] [1]; § 2102 [a] [1]). However, plaintiff failed to establish the foregoing. Indeed, the affidavit by the representative of Media Referral, Inc. merely set forth that Media Referral, Inc. mailed verification requests, scheduled a peer review [*2]and mailed a denial of claim form at the specific request and on behalf of defendant.
In light of the foregoing, the order is affirmed.
Pesce, P.J., Weston Patterson and Golia, JJ., concur.
Decision Date: March 30, 2007
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 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's affidavits established timely mailing of the initial and follow-up verification requests and the denial because they described in detail the standard office practice ensuring proper addressing and mailing.
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.
- 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.
Cited by
- Tuncel v Progressive Cas. Ins. Co. (2008 NY Slip Op 52455(U))The insurer's chiropractor established that the assignor missed an IME at the office address stated in the scheduling letters.
Similar decisions
- Fair Price Med. Supply Corp. v General Assur. Co. (2005 NY Slip Op 50256(U))The insurer's conclusory proof of IME requests and nonappearance failed to raise a triable issue against the provider's claim.
- Fair Price Med. Supply Corp. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 50357(U))The provider and insurer failed to establish entitlement to summary judgment because their affidavits lacked the necessary personal knowledge.
- Fair Price Med. Supply Corp. v Allstate Ins. Co. (2007 NY Slip Op 50608(U))The provider's officer affidavit failed to establish a business-records foundation, defeating its prima facie summary judgment showing.
- Fair Price Med. Supply Corp. v Tri-State Consumer Ins. Co. (2007 NY Slip Op 50152(U))The provider's corporate officer affidavit failed to establish a business-records foundation for the documents supporting summary judgment.
- Fair Price Med. Supply Corp. v Liberty Mut. Ins. Co. (2006 NY Slip Op 51438(U))The insurer failed to prove timely mailing of its denial and was precluded from asserting its excessive-charge defense.