September 5, 2012

AIM Acupuncture, P.C. v Travelers Ins. Co. (2012 NY Slip Op 51773(U))

Headnote

The court considered the fact that the defendant had timely mailed requests and follow-up requests for verification for the first-party no-fault benefits. The main issue decided was whether the defendant had received the requested verification, and if the 30-day period within which the defendant was required to pay or deny the claims had begun to run. The holding of the case was that the defendant demonstrated it had not received the requested verification, and the plaintiff did not show that such verification had been provided to the defendant prior to the commencement of the action. Consequently, the court held that the plaintiff's action was premature, and the defendant's motion for summary judgment dismissing the complaint was granted.

Reported in New York Official Reports at AIM Acupuncture, P.C. v Travelers Ins. Co. (2012 NY Slip Op 51773(U))

AIM Acupuncture, P.C. v Travelers Ins. Co. (2012 NY Slip Op 51773(U)) [*1]

AIM Acupuncture, P.C. v Travelers Ins. Co.

2012 NY Slip Op 51773(U) [36 Misc 3d 157(A)]

Decided on September 5, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on September 5, 2012

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
2011-1063 Q C.

AIM Acupuncture, P.C. as Assignee of ALBERT DINKINS, Respondent, —
against
Travelers Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Queens County (Carmen R. Velasquez, J.), entered March 4, 2011. 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 of the Civil Court as denied defendant’s motion for summary judgment dismissing the complaint.

The affidavits submitted by defendant in support of its 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 Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). Defendant demonstrated that it had not received the requested verification, and plaintiff did not show that such verification had been provided to defendant prior to the commencement of the action. Consequently, the 30-day period within which defendant was required to pay or deny the claims [*2]did not begin to run (see Insurance Department Regulations [11 NYCRR] § 65-3.8 [a]; 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]; D & R Med. Supply v American Tr. Ins. Co., 32 Misc 3d 144[A], 2011 NY Slip Op 51727[U] [App Term, 2d, 11th & 13th Jud Dists 2011]), and, thus, plaintiff’s action is premature.

Accordingly, the order, insofar as appealed from, is reversed, and defendant’s motion for summary judgment dismissing the complaint is granted.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: September 05, 2012