April 20, 2009

Bronx Expert Radiology v Clarendon Natl. Ins. Co (2009 NY Slip Op 50747(U))

https://www.beynensonlaw.com/case-law/bronx-expert-radiology-v-clarendon-natl-ins-co-2009-ny-slip-op50747u/

Court: Appellate Term, First Department
Decided: April 20, 2009
Citation: 2009 NY Slip Op 50747(U) · 23 Misc 3d 133(A)
Posture: Summary judgment
Outcome: Provider prevailed
Later treatment: Followed in 3 later decisions (see Cited by)
Issues: Timeliness and preclusion

Cite as

Bronx Expert Radiology v Clarendon Natl. Ins. Co, 23 Misc 3d 133(A), 2009 NY Slip Op 50747(U) (App Term, 1st Dept 2009)

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.

The insurer failed to show that it considered the provider's explanation for submitting its claim beyond the 45-day period. The Appellate Term, First Department, affirmed the denial of the insurer's motion for summary judgment dismissing the complaint. Although the claim was concededly late under 11 NYCRR 65-1.1, its submission included correspondence explaining the delay. Under 11 NYCRR 65-3.3 (a) and Matter of Medical Socy. of the State of New York v Serio, insurers must allow reasonable justification for late notice and give due consideration to late-filing explanations, including difficulty identifying the insurer or submission to the wrong insurer. The record did not show that the insurer considered the explanation.

Reported in New York Official Reports at Bronx Expert Radiology v Clarendon Natl. Ins. Co (2009 NY Slip Op 50747(U))

[*1]

Bronx Expert Radiology v Clarendon Natl. Ins. Co

2009 NY Slip Op 50747(U) [23 Misc 3d 133(A)]

Decided on April 20, 2009

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This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on April 20, 2009

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: McKeon, P.J., Schoenfeld, J.
570085/08

Bronx Expert Radiology a/a/o Manuel Castillo, Plaintiff-Respondent,
against
Clarendon National Insurance Co, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, Bronx County (Fernando Tapia, J.), entered September 4, 2007, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Fernando Tapia, J.), entered September 4,
2007, affirmed, with $10 costs.

Although plaintiff’s claim for no-fault benefits was concededly submitted to defendant beyond the 45-day statutory period (see 11 NYCRR 65-1.1), the record shows that plaintiff’s claim submission included correspondence attempting to explain its delay in filing. Under the regulations, an insurer must not only provide a claimant the opportunity to submit a reasonable justification for any late notice (see 11 NYCRR 65-3.3[a]), but must also establish procedures to “ensure due consideration of denial of claims based upon late filings” and must give “appropriate consideration for situations where the claimant has difficulty ascertaining the insurer’s identity or inadvertently submits a claim to the incorrect insurer” (Matter of Medical Socy. of the State of New York v Serio, 100 NY2d 854, 863 [2003]). Inasmuch as the record does not indicate whether defendant gave any consideration to plaintiff’s explanation for its tardy submission as required by the regulations, we sustain the denial of defendant’s motion for summary judgment.

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: April 20, 2009

Cited by

A label shows how the later decision treated this one.

Van Loon DME USA, Inc v Maya Assur. Co. (2025 NY Slip Op 50102(U)) FollowedThe insurer failed to show proper consideration of the provider's explanation that late bills had first been sent to the wrong insurer.
Bronx Expert Radiology, P.C. v NYC Tr. Auth. (2011 NY Slip Op 51571(U)) FollowedThe provider failed to establish a reasonable justification for late claims, and the transit authority failed to show due consideration of its explanation.
Medalliance Med. Health Servs. v Travelers Prop. Cas. Ins. Co. (2021 NY Slip Op 50737(U)) FollowedThe insurer's misaddressed verification requests failed to toll the 30-day period to pay or deny the provider's claims.

Similar decisions

Bronx Expert Radiology, P.C. v Great N. Ins. Co. (2009 NY Slip Op 51474(U))The provider failed to justify its delayed claim submission after mistakenly billing the wrong insurer.
Bronx Expert Radiology, P.C. v Motor Veh. Acc. Indem. Corp. (2009 NY Slip Op 50621(U))The provider failed to justify its six-month delay in submitting claims to MVAIC after learning that another insurer had denied benefits.
Bronx Park Med., P.C. v Clarendon Natl. Ins. Co. (2014 NY Slip Op 51832(U))The insurer's unrebutted peer review established a factual basis and medical rationale for denying the services as medically unnecessary.
Bronx Expert Radiology, P.C. v Allstate Ins. Co. (2007 NY Slip Op 50682(U))The insurer's investigator affidavit failed to show a founded belief that the claimed injuries did not arise from an insured incident.
Lenox Hill Radiology & Mia, P.C. v American Mfrs. Mut. Ins. Co. (2013 NY Slip Op 51750(U))The provider submitted its claims more than 45 days after the services and offered no explanation for the delay.