Reported in New York Official Reports at St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co. (2010 NY Slip Op 00668)
| St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co. |
| 2010 NY Slip Op 00668 [69 AD3d 923] |
| January 26, 2010 |
| Appellate Division, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| St. Vincent’s Hospital & Medical Center, as Assignee of Jane Fritz,
Respondent, v Allstate Insurance Company, Appellant. |
—[*1] McDonnell & Adels, PLLC, Garden City, N.Y. (Martha S. Henley of counsel), for appellant.
Joseph Henig, P.C., Bellmore, N.Y., for respondent.
In an action to recover no-fault medical benefits under an insurance contract, the defendant appeals from an order and judgment (one paper) of the Supreme Court, Nassau County (Feinman, J.), entered January 14, 2009, which, upon a decision of the same court dated December 3, 2008, granted the plaintiff’s motion for summary judgment on the complaint, in effect, denied the defendant’s cross motion for summary judgment dismissing the complaint, and is in favor of the plaintiff and against it in the principal sum of $32,086.70.
Ordered that the order and judgment is reversed, on the law, with costs, the motion is denied, the cross motion is granted, and the complaint is dismissed.
In support of its cross motion, the defendant made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that the accident in which the plaintiff’s assignor was injured was not an insured incident (see Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, 199 [1997]; see generally Alvarez v Prospect Hosp., 68 NY2d 320 [1986]). In opposition to the defendant’s prima facie showing, the plaintiff failed to raise a triable issue of fact. Contrary to the plaintiff’s contention, the defense of lack of coverage is not precluded by the defendant’s failure to pay or deny the subject no-fault claim within the requisite 30-day period (see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 318 [2007]; Central Gen. Hosp. v Chubb Group of Ins. Co., 90 NY2d at 199).
Accordingly, the Supreme Court should have denied the plaintiff’s motion for summary judgment on the complaint, and granted the defendant’s cross motion for summary judgment dismissing the complaint.
The plaintiff’s remaining contentions are without merit. Rivera, J.P., Dillon, Miller and Roman, JJ., concur.
Reported in New York Official Reports at AJS Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. (2010 NY Slip Op 50610(U))
| AJS Chiropractic, P.C. v New York Cent. Mut. Fire Ins. Co. |
| 2010 NY Slip Op 50610(U) [27 Misc 3d 129(A)] |
| Decided on January 22, 2010 |
| 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: : RIOS, J.P., PESCE and GOLIA, JJ
2008-1907 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 (George J. Silver, J.), entered September 11, 2008. The order granted plaintiff’s motion for summary judgment and denied defendant’s cross motion for summary judgment.
ORDERED that the appeal is stricken from the general calendar.
In this action to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment. While said motions were pending in the Civil Court, the Supreme Court, Queens County (James J. Golia, J.), in a declaratory judgment action brought by the instant defendant against, among others, the instant plaintiff and plaintiff’s assignor, issued a preliminary injunction staying “all pending and future actions” in “New York Civil and District Courts” involving, inter alia, said plaintiff and assignor. Thereafter, the Civil Court granted plaintiff’s motion for summary judgment and denied defendant’s cross motion for summary judgment dismissing the complaint. This appeal by defendant ensued. In light of the preliminary injunction issued by the Supreme Court, the parties herein were foreclosed from proceeding any further in this action. Accordingly, the appeal could not properly be perfected and must be stricken from the general calendar.
Rios, J.P., and Pesce J., concur.
Golia, J., taking no part.
[*2]
Decision Date: January 22, 2010
Reported in New York Official Reports at Style Acupuncture, P.C. v State-Wide Ins. Co. (2010 NY Slip Op 50089(U))
| Style Acupuncture, P.C. v State-Wide Ins. Co. |
| 2010 NY Slip Op 50089(U) [26 Misc 3d 1213(A)] |
| Decided on January 22, 2010 |
| Civil Court Of The City Of New York, Kings County |
| Baynes, J. |
| 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. |
Civil Court of the City of New York, Kings County
Style Acupuncture,
P.C. a/a/o CHANNIE COTTLE, Plaintiffs,
against State-Wide Ins. Co., Defendant. |
034843/08
Sylvain Jakobavics, Esq.
Attorney for Plaintiff
2630 Ocean Avenue
Suite A-3
Brooklyn, NY 11229
718.332.0577
James Hiebler & Assoc.
Attorney for Defendant
20 Main Street
Hempstead, NY 11550
516.564.8000
Johnny L. Baynes, J.
Plaintiff in this application for first party no-fault benefits pursuant to Insurance Law § 5106[a], See also, Mary Immaculate Hospital. v. Allstate Ins. Co., 5 AD3d 742 [2004], moves for summary judgment in the amount of $729.71 for medical services rendered.
A party moving for summary judgment must show, by evidence in admissible form, that there are no material issues of fact in controversy and that they are entitled to judgment as a [*2]matter of law. Once that showing is made, the burden shifts to the opponent of the motion for summary judgment to come forward with proof in admissible form that there are material issues of fact in controversy which require a trial. Alvarez v. Prospect Hospital, 68 NY2d320 (1986); Winegrad v. New York University Medical Center, 64 NY2d 851(1985).
In the instant matter, plaintiff has shown, by admissible evidence, that it was assigned the instant claim and submitted same to defendant and that said claim was not paid within thirty days of its receipt by defendant. The Affidavit of Alla Noginsky, the owner of plaintiff facility, is detailed, clear and sets forth with specificity the basis for her knowledge of the procedures with respect to the instant claim, the manner of gathering and recording the billing information and the specifics as to the mailing of the bill and NF-3 claim form to the defendant.
Moreover, the Affidavit of Donna King, defendant’s employee, a no fault examiner, acknowledges that the NF-10 submitted with the defendant’s motion papers is correct. That NF-10 denial of claim form states clearly that the denial was not issued with respect to the bills, received “11/26/06-2/16/07”, until April 10, 2007, in clear violation of the requirement of Insurance Law § 5106[a] that the denial be issued within thirty (30) days of their receipt by defendant.
The NF-10 describes the basis for the denial as follows:
AS PER CARRIER’S INVESTIGATION A PORTION OF
YOUR BILL WILL NOT BE HONORED ACCORDING TO
THE CLAIMANT’S RECORDED STATEMENT THE
ACUPUNCTURE SESSIONS LASTED15 MINUTES.
CARRIER WAS BILLED AN ADDITIONAL 15 MINUTES
WITH NEEDLE REINSURCION [sic] WHICH WAS NOT
RENDERED. AS PER DENIAL OF 12/11/06 NO FURTHER
TREATMENT WILL BE HONORED. CONSULTANT
REPORT PREVIOUSLY SENT.
Defendant’s excuse for the delay in denying the claim is that there was a “pending fraud investigation”. There is no indication that any verification request was ever sent to plaintiff after defendant received the bills. Such a request would have served to toll the time to deny the claim. Moreover, the report of Special Investigations Unit [hereinafter “SIU”] Investigator, Charles Rorke, is unsworn and not in admissible form as required by CPLR § 3212. However, even if it were admissible, Mr. Rorke concluded that “there is no evidence that [the accident forming the basis of the claim] was caused or staged”.
Defendant correctly states that “a no fault insurer is not precluded from asserting a defense of fraud, despite the insurer’s untimely denial of the claim”. Central Gen. Hosp v. Chubb Group of Ins. Cos., 90 NY2d 195 [1997]; Matter of Progressive Northwestern Ins Co. V Van Dina, 282 Ad2d 269 [2d Dept 2001]. However, no such tolling provision applies with respect to provider fraud, which seemingly forms the basis for defendant’s denial. Fair Price Medical Supply Corp v. Travelers Indemnity Co., 10 NY3d 556, 860 NYS2d 471 [2008]. [*3]
Defendant urges that the Court find there is an issue of fact as to fraud and set the matter down for trial on that issue. The Court declines to do so. Even if there were admissible evidence of provider fraud, as set forth above, such evidence would not excuse defendant’s untimely denial of the within claims.
The Court finds that plaintiff has met its prima facie burden of proving mailing. Defendant is, however, unable to prove timely denial.
Wherefore, the Clerk of Court is directed to enter judgment in favor of plaintiff in the sum of $729.71, together with statutory costs, interest and attorneys fees.
The foregoing Constitutes the Decision and Order of the Court.
Dated: January 22, 2010
____________________________________
JOHNNY L. BAYNES, JCC
Reported in New York Official Reports at Eastern Star Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2010 NY Slip Op 50043(U))
| Eastern Star Acupuncture, P.C. v Clarendon Natl. Ins. Co. |
| 2010 NY Slip Op 50043(U) [26 Misc 3d 131(A)] |
| Decided on January 14, 2010 |
| Appellate Term, First 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. |
APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT
PRESENT: Schoenfeld, J.P., Shulman, Hunter, JJ
570686/09.
against
Clarendon National Insurance Company, Defendant-Appellant.
Defendant appeals from an order of the Civil Court of the City of New York, Bronx County (Raul Cruz, J.), entered October 16, 2008, which denied its motion for summary judgment dismissing the complaint.
Per Curiam.
Order (Raul Cruz, J.), entered October 16, 2008, reversed, without costs, motion granted and complaint dismissed on the condition that defendant, within 60 days of service upon it of a copy of this order with notice of entry, files with the Clerk of the Civil Court and serves upon plaintiffs an affidavit of Steven Esteves that is accompanied by a certificate demonstrating that the notary administered the oath as prescribed by the laws of the State of New Jersey. In the event defendant fails to duly file and serve such an affidavit, the order is affirmed, without costs.
The affidavit submitted by defendant of its employee (Esteves) established defendant’s
entitlement to summary judgment dismissing this action to recover first-party no-fault benefits.
Plaintiffs, however, raised a timely objection to the form of this affidavit, asserting that it did not
comply with CPLR 2309(c). Specifically, plaintiffs correctly note that the affidavit failed to
include a certificate demonstrating that the notary administered the oath as prescribed by the
laws of the State of New Jersey, the state in which the oath was administered (see CPLR
2309[c]; Real Property Law § 299-a[1]; PRA III, LLC v Gonzalez, 54 AD3d 917
[2008]). Inasmuch as the document can be given nunc pro tunc effect once the appropriate
certificate is obtained (Nandy v Albany Med. Ctr. Hosp., 155 AD2d 833, 834 [1989];
see Moccia v. Carrier Car Rental, Inc., 40 AD3d 504, 505 [2008]; see also Matapos
Tech. Ltd. v Compania Andina de Comercio Ltda, ___AD3d___, 2009 NY Slip Op. 09713
[Dec. 29, 2009]), we reverse the order and grant defendant’s motion for summary judgment
dismissing the complaint on the conditions stated above (cf. Sandoro v Andzel, 307
AD2d 706, 708-708 [2003]).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concurI concurI concur
[*2]
Decision Date: January 14, 2010
Reported in New York Official Reports at Synergy First Med. PLLC v ELRAC Inc. (2010 NY Slip Op 50048(U))
[*1]| Synergy First Med. PLLC v ELRAC Inc. |
| 2010 NY Slip Op 50048(U) [26 Misc 3d 131(A)] |
| Decided on January 14, 2010 |
| Appellate Term, First 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. |
PRESENT: Schoenfeld, J.P., Shulman, Hunter, JJ
570630/09.
against
ELRAC Inc. d/b/a Enterprise Rent A Car, Defendant-Appellant.
Defendant appeals from an order of the Civil Court of the City of New York, Bronx County
(Lizbeth Gonzalez, J.), entered June 30, 2009, which denied its motion for summary judgment
dismissing the complaint.
Per Curiam.
Order (Lizbeth Gonzalez, J.), entered June 30, 2009, reversed, without costs, and defendant’s
motion for summary judgment dismissing the complaint is granted. The Clerk is directed to enter
judgment accordingly.
In opposition to defendant’s prima facie showing of entitlement to judgment as a matter of
law on the ground that plaintiff did not submit timely proof of its claim for first-party no-fault
benefits (see 11 NYCRR 65-1.1; 65-2.4), plaintiff failed to raise a triable issue with
respect to whether it had a “reasonable justification” for its delay in submitting such proof
(see 11 NYCRR 65-3.3[e]). Plaintiff’s bald and unelaborated assertion that the delay was
attributable to a staffing issue, i.e., the absence of an (unidentified) employee responsible for
preparing claims because of “a family emergency,” is, under the circumstances presented,
insufficient to raise a triable issue (see
generally Bronx Expert Radiology, P.C. v Motor Vehicle Acc. Indem. Corp., 20 Misc 3d
140[A] [2008]; NY Arthroscopy &
Sports Medicine PLLC v Motor Veh. Acc. Indem. Corp., 15 Misc 3d 89 [2007]).
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concurI concurI concur
Decision Date: January 14, 2010Canarsie Family Med. Practice, PLLC v American Tr. Ins. Co. (2010 NY Slip Op
50070(U))
Reported in New York Official Reports at Canarsie Family Med. Practice, PLLC v American Tr. Ins. Co. (2010 NY Slip Op 50070(U))
| Canarsie Family Med. Practice, PLLC v American Tr. Ins. Co. |
| 2010 NY Slip Op 50070(U) [26 Misc 3d 132(A)] |
| Decided on January 12, 2010 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| As corrected in part through November 4, 2011; it 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: : GOLIA, J.P., PESCE and WESTON, JJ
2009-112 K C.
against
American Transit Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Robin S. Garson, J.), entered August 8, 2008, deemed in part from a judgment of said court entered November 13, 2008 (see CPLR 5501 [c]). The judgment, entered pursuant to so much of the August 8, 2008 order as granted plaintiff’s motion for summary judgment to the extent of awarding plaintiff summary judgment upon its fourth through tenth causes of action and denied so much of defendant’s cross motion as sought summary judgment dismissing said causes of action, awarded plaintiff the principal sum of $1,113.03. The order, insofar as appealed from, denied so much of defendant’s cross motion as sought summary judgment dismissing plaintiff’s first, second and third causes of action.
ORDERED that the judgment is affirmed without costs; and it is further,
ORDERED that the order, insofar as appealed from, is modified by providing that so much of defendant’s cross motion as sought summary judgment dismissing plaintiff’s second and third causes of action is granted; as so modified, the order, insofar as appealed from, is affirmed without costs.
In this action by a provider to recover assigned first-party no-fault benefits, the Civil Court granted plaintiff’s motion for summary judgment to the extent of awarding plaintiff summary judgment upon its fourth through tenth causes of action, and denied defendant’s cross motion for summary judgment dismissing the complaint. The instant appeal by defendant ensued. A judgment was subsequently entered awarding plaintiff the principal sum of $1,113.03 on its fourth through tenth causes of action.
Contrary to defendant’s contention, the affidavit of plaintiff’s billing manager established [*2]the mailing of the claims in question since he stated that he had personally mailed the claims (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; cf. New York & Presbyt. Hosp. v Allstate Ins. Co., 29 AD3d 547 [2006]). In addition, a review of the record indicates that plaintiff’s affidavit sufficed to establish that the annexed claim forms constituted evidence in admissible form (see CPLR 4518; Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Thus, insofar as is relevant to this appeal by defendant, plaintiff made out its prima facie entitlement to summary judgment.
While defendant argues that plaintiff was not entitled to summary judgment upon its fourth through tenth causes of action and that defendant was entitled to summary judgment dismissing said causes of action because defendant had timely denied the underlying claims based on the assignor’s failure to appear for independent medical examinations, defendant’s motion papers failed to establish that the assignor failed to appear for such examinations (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 [2006]). Consequently, defendant failed to demonstrate its entitlement to judgment upon said causes of action or even to raise a triable issue of fact with respect thereto. Accordingly, plaintiff was entitled to summary judgment upon these causes of action (id.).
In support of the branches of its cross motion seeking summary judgment dismissing plaintiff’s second and third causes of action, defendant established that the claims at issue in said causes of action were timely denied on the ground of lack of medical necessity based upon an affirmed peer review report which set forth a factual basis and medical rationale for the doctor’s opinion that there was a lack of medical necessity for such medical services (see A.B. Med. Servs., PLLC v American Tr. Ins. Co., 15 Misc 3d 132[A], 2007 NY Slip Op 50680[U] [App Term, 2d & 11th Jud Dists 2007]; Amaze Med. Supply Inc. v Allstate Ins. Co., 12 Misc 3d 142[A], 2006 NY Slip Op 51412[U] [App Term, 2d & 11th Jud Dists 2006]). In view of the foregoing, defendant made a prima facie showing of its entitlement to summary judgment dismissing said causes of action, and the burden shifted to plaintiff to demonstrate the existence of a triable issue of fact (see Zuckerman v City of New York, 49 NY2d 557 [1980]). Since plaintiff failed to do so, defendant was entitled to summary judgment dismissing plaintiff’s second and third causes of action (see A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d & 11th Jud Dists 2007]).
Defendant also contends that the Civil Court should have granted it summary judgment dismissing plaintiff’s first cause of action because defendant established that it had timely denied the claim on the ground that the fees charged were excessive and not in accordance with the workers’ compensation fee schedule. While defendant is not precluded from asserting said defense (cf. Westchester Med. Ctr. v American Tr. Ins. Co., 17 AD3d 581 [2005]), defendant failed to establish that the fees charged were in fact excessive. As a result, defendant is not entitled to summary judgment dismissing plaintiff’s first cause of action.
Accordingly, the judgment in favor of plaintiff is affirmed and the order, insofar as appealed
from, is modified by providing that defendant’s cross motion for summary
judgment dismissing the complaint is granted to the extent of dismissing plaintiff’s second
and third causes of action.
Golia, J.P., Pesce and Weston, JJ., concur.
Decision Date: January 12, 2010
Reported in New York Official Reports at Amercure Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 50068(U))
| Amercure Acupuncture, P.C. v GEICO Ins. Co. |
| 2010 NY Slip Op 50068(U) [26 Misc 3d 132(A)] |
| Decided on January 12, 2010 |
| 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
2008-2040 Q C.
against
GEICO Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered October 7, 2008, deemed from a judgment of the same court entered November 5, 2008 (see CPLR 5501 [c]). The judgment, entered pursuant to the October 7, 2008 order granting plaintiff’s motion for summary judgment, awarded plaintiff the principal sum of $656.91.
ORDERED that the judgment is reversed without costs, the order entered October 7, 2008 is vacated, plaintiff’s motion for summary judgment is denied and, upon searching the record, summary judgment is granted to defendant dismissing the complaint.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved
for summary judgment. Defendant opposed the motion on the ground
that it had properly reimbursed plaintiff for licensed acupuncture services at the rate
consistent with the amount paid for acupuncture services provided by licensed chiropractors. The
Civil Court granted plaintiff’s motion, holding that defendant had failed to demonstrate that it
had issued timely denials of the claims. This appeal by defendant ensued. A judgment was
subsequently entered, from which the appeal is deemed to be taken (see CPLR 5501 [c]).
On appeal, defendant’s sole contention with respect to plaintiff’s prima facie case is that the affidavit of plaintiff’s billing manager failed to establish that the documents annexed to plaintiff’s motion for summary judgment were admissible as business records. Upon our review of the record, we find that the affidavit was sufficient to establish that the documents annexed to plaintiff’s moving papers were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York [*2]Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]).
Defendant established through the affidavit of its claims division employee that it had timely mailed the denial of claim forms to plaintiff, by setting forth the office practices or procedures used to ensure that such items are properly addressed and mailed (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16, 18 [App Term, 2d & 11th Jud Dists 2007]).
For the reasons stated in Great Wall Acupuncture, P.C. v GEICO Ins. Co. (___ Misc 3d ___, 2009 NY Slip Op 29467 [App Term, 2d, 11th & 13th Jud Dists 2009]), it was proper for defendant to use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which plaintiff was entitled to receive for the acupuncture services rendered by its licensed acupuncturist. Furthermore, since it is undisputed that defendant has fully paid plaintiff the amount to which plaintiff is entitled under the workers’ compensation fee schedule for acupuncture services performed by chiropractors, it is appropriate for this court to search the record and grant summary judgment to defendant dismissing the action (see Merritt Hill Vineyards v Windy Hgts. Vineyard, 61 NY2d 106 [1984]; AVA Acupuncture, P.C. v GEICO Gen. Ins. Co., 17 Misc 3d 41, 43 [App Term, 2d & 11th Jud Dists 2007]).
Weston, J.P., Golia and Steinhardt, JJ., concur.
Decision Date: January 12, 2010
Reported in New York Official Reports at Quality Rehab & P.T., P.C. v GEICO Ins. Co. (2010 NY Slip Op 50067(U))
| Quality Rehab & P.T., P.C. v GEICO Ins. Co. |
| 2010 NY Slip Op 50067(U) [26 Misc 3d 132(A)] |
| Decided on January 12, 2010 |
| 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
2008-2036 Q C.
against
GEICO Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered September 22, 2008, deemed from a judgment of the same court entered November 5, 2008 (see CPLR 5501 [c]). The judgment, entered pursuant to the September 22, 2008 order granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment dismissing the complaint, awarded plaintiff the principal sum of $292.94.
ORDERED that the judgment is reversed without costs, the order entered September
22, 2008 is vacated, plaintiff’s motion for summary judgment is denied and
defendant’s cross motion for summary judgment dismissing the complaint is granted,
without prejudice to plaintiff commencing a new action.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment. Defendant opposed the motion and cross-moved for summary judgment dismissing the complaint on the ground that the action was premature, because it had been commenced before defendant had received responses to its outstanding verification requests. By order entered September 22, 2008, the Civil Court granted plaintiff’s motion and denied defendant’s cross motion. Defendant’s appeal from said order is deemed to be from the judgment which was subsequently entered pursuant thereto (see CPLR 5501 [c]).
On appeal, defendant’s sole contention with respect to plaintiff’s prima facie case is that the affidavit of plaintiff’s billing manager failed to establish that the documents annexed to plaintiff’s motion for summary judgment were admissible as business records. Upon our review of the record, we find that the affidavit was sufficient to establish that the documents annexed to plaintiff’s moving papers were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Contrary to the finding of the Civil Court, the affidavit of defendant’s claim representative sufficiently established that defendant had timely mailed its request and follow-up request for verification to plaintiff (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16, 18 [App Term, 2d & 11th Jud Dists 2007]). Since plaintiff did not demonstrate that it had provided defendant, prior to the [*2]commencement of the action, with the verification, the 30-day period within which defendant was required to pay or deny the claims did not commence to run (see Insurance Department Regulations [11 NYCRR] § 65-3.8 [a] [1]; Central Suffolk Hosp. v New York Cent. Mut. Fire Ins. Co., 24 AD3d 492 [2005]; Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533 [2004]; Vista Surgical Supplies, Inc. v General Assur. Co., 12 Misc 3d 129[A], 2006 NY Slip Op 51034[U] [App Term, 2d & 11th Jud Dists 2006]). Thus, plaintiff’s action is premature (Hospital for Joint Diseases v New York Cent. Mut. Fire Ins. Co., 44 AD3d 903 [2007]).
Accordingly, the judgment is reversed, the order entered September 22, 2008 is vacated, plaintiff’s motion for summary judgment is denied and defendant’s cross motion for summary judgment dismissing the complaint is granted, without prejudice to plaintiff commencing a new action.
Weston, J.P., Golia and Steinhardt, JJ., concur.
Decision Date: January 12, 2010
Reported in New York Official Reports at Metropolitan Med. Supplies, LLC v GEICO Ins. Co. (2010 NY Slip Op 50066(U))
| Metropolitan Med. Supplies, LLC v GEICO Ins. Co. |
| 2010 NY Slip Op 50066(U) [26 Misc 3d 132(A)] |
| Decided on January 12, 2010 |
| 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
2008-2034 Q C.
against
GEICO Insurance Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County (Diane A. Lebedeff, J.), entered October 8, 2008. The order, insofar as appealed from as limited by the brief, granted the branches of plaintiff’s motion seeking summary judgment with respect to plaintiff’s second and third causes of action. The appeal is deemed to be from a judgment of the same court entered November 5, 2008 which awarded plaintiff the principal sum of $708.37 (see CPLR 5501 [c]).
ORDERED that the judgment is reversed without costs, so much of the order as
granted the branches of plaintiff’s motion seeking summary judgment upon plaintiff’s
second and third causes of action is vacated, the branches of plaintiff’s motion seeking
summary judgment upon said causes of action are denied and the matter is remitted to the Civil
Court for all further proceedings.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much of an order of the Civil Court as granted the branches of plaintiff’s motion seeking summary judgment on plaintiff’s second and third causes of action. The appeal is deemed to be from the judgment which was subsequently entered (see CPLR 5501 [c]).
On appeal, defendant’s sole contention with respect to plaintiff’s prima facie case is that the affidavit of plaintiff’s billing manager failed to establish that the documents annexed to plaintiff’s motion for summary judgment were admissible as business records. Upon our review of the record, we find that the affidavit was sufficient to establish that the documents annexed to plaintiff’s moving papers were admissible pursuant to CPLR 4518 (see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]).
Contrary to the finding of the Civil Court, the affidavit of defendant’s claims representative sufficiently established the timely mailing of the denial of claim forms, which denied plaintiff’s claims on the grounds that the supplies provided were medically unnecessary and that the fees charged by plaintiff were excessive (see Residential Holding Corp. v Scottsdale Ins. Co., 286 AD2d 679 [2001]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). In opposition to the branch of plaintiff’s [*2]motion for summary judgment upon plaintiff’s second cause of action, defendant raised a triable issue of fact by annexing an affirmed peer review report which set forth a factual basis and medical rationale for the doctor’s opinion that the medical supplies at issue in said cause of action were not medically necessary (see A.B. Med. Servs., PLLC v American Tr. Ins. Co., 15 Misc 3d 132[A], 2007 NY Slip Op 50680[U] [App Term, 2d & 11th Jud Dists 2007]; Amaze Med. Supply Inc. v Allstate Ins. Co., 12 Misc 3d 142[A], 2006 NY Slip Op 51412[U] [App Term, 2d & 11th Jud Dists 2006]). In addition, in opposition to the branch of plaintiff’s motion seeking summary judgment upon plaintiff’s third cause of action, defendant established that there was an issue of fact as to whether the fees charged by plaintiff were excessive.
Accordingly, the judgment is reversed, so much of the order as granted the branches of
plaintiff’s motion seeking summary judgment upon plaintiff’s second and third causes of action is
vacated, the branches of plaintiff’s motion seeking summary judgment upon said causes of action
are denied and the matter is remitted to the Civil Court for all further proceedings.
Weston, J.P., Golia and Steinhardt, JJ., concur.
Decision Date: January 12, 2010
Reported in New York Official Reports at Raz Acupuncture, P.C. v Travelers Prop. Cas. Ins. Co. (2010 NY Slip Op 50065(U))
| Raz Acupuncture, P.C. v Travelers Prop. Cas. Ins. Co. |
| 2010 NY Slip Op 50065(U) [26 Misc 3d 132(A)] |
| Decided on January 12, 2010 |
| 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
2008-1544 K C.
against
Travelers Property Casualty Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Kings County (Sylvia G. Ash, J.), entered April 23, 2007. The order, insofar as appealed from as limited by the brief, granted plaintiff’s cross motion for summary judgment. The appeal is deemed to be from a judgment of the same court entered August 30, 2007 which awarded plaintiff the principal sum of $791.92 (see CPLR 5501 [c]).
ORDERED that the judgment is reversed without costs, so much of the order entered April 23, 2007 as granted plaintiff’s cross motion for summary judgment is vacated, and plaintiff’s cross motion for summary judgment is denied.
In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much of an order of the Civil Court entered April 23, 2007 as granted plaintiff’s cross motion for summary judgment. The appeal is deemed to be from the judgment that was subsequently entered pursuant to said portion of the order (see CPLR 5501 [c]).
Plaintiff’s cross motion for summary judgment was supported by an affidavit of an employee of a third-party billing company who did not demonstrate that he possessed personal knowledge of plaintiff’s business practices and procedures to establish that the annexed documents were admissible pursuant to CPLR 4518. As a result, plaintiff failed to make a prima facie showing of its entitlement to summary judgment (see Psychology YM, P.C. v Nationwide Mut. Ins. Co., 24 Misc 3d 140[A], 2009 NY Slip Op 51634[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Andrew Carothers, M.D., P.C. v GEICO Indem. Co., 24 Misc 3d 19 [App Term, 2d, 11th & 13th Jud Dists 2009]; see also Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. Co., 15 Misc 3d 144[A], 2007 NY Slip Op 51161[U] [App Term, 2d & 11th Jud Dists 2007], affd 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006]). Accordingly, the judgment is reversed, so much of the April 23, 2007 order as granted plaintiff’s cross motion for summary judgment is vacated [*2]and plaintiff’s cross motion for summary judgment is denied.
In light of the foregoing, we reach no other issue.
Weston, J.P., Golia and Steinhardt, JJ., concur.
Decision Date: January 12, 2010