November 28, 2012

Danielson v Country-Wide Ins. Co. (2012 NY Slip Op 52189(U))

Headnote

The court considered the defendant insurer's motion for summary judgment to dismiss the complaint and the plaintiff's cross motion for summary judgment. The main issue decided was whether the defendant insurer's verification requests were valid and if the plaintiff failed to respond to those requests. The court held that the defendant established its entitlement to summary judgment because the plaintiff failed to respond to the verification requests, and therefore, the underlying first-party no-fault claims were premature. The court also found that the defendant's requests for verification, made after the 15-day period but before the 30-day claim denial window expired, did not render the requests invalid, but only reduced the 30-day time period for payment or denial of the claim. Therefore, the court reversed the order, denied the plaintiff's cross motion, and granted the defendant's motion for summary judgment.

Reported in New York Official Reports at Danielson v Country-Wide Ins. Co. (2012 NY Slip Op 52189(U))

Danielson v Country-Wide Ins. Co. (2012 NY Slip Op 52189(U)) [*1]

Danielson v Country-Wide Ins. Co.

2012 NY Slip Op 52189(U) [37 Misc 3d 137(A)]

Decided on November 28, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 28, 2012

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT

PRESENT: Lowe, III, P.J., Shulman, Hunter, Jr., JJ
570608/12.

Carla Danielson, D.C., a/a/o Liu Chun Lau, Ng Yuk Keung, Plaintiff-Respondent,
against
Country-Wide Insurance Company, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, New York County (Ann E. O’Shea, J.), dated September 8, 2011, which denied its motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.

Per Curiam.

Order (Ann E. O’Shea, J.), dated September 8, 2011, reversed, without costs, plaintiff’s cross motion denied and defendant’s motion for summary judgment dismissing the complaint granted. The Clerk is directed to enter judgment accordingly.

It being undisputed on this record that plaintiff failed to respond to the defendant insurer’s verification requests, defendant established its prima facie entitlement to summary judgment dismissing the underlying first-party no-fault claims as premature (see St. Vincent Med. Care, P.C. v. Country Wide Ins. Co., 80 AD3d 599, 600 [2011]). That defendant requested verification after the 15-day period (11 NYCRR 65-3.5[b]), but before the 30-day claim denial window expired, did not render its requests invalid, but merely reduced the 30-day time period for payment or denial of the claim (see 11 NYCRR 65-3.8[j]; Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 318 [2007]; Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294, 300 [2007]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
Decision Date: November 28, 2012