September 11, 2012

Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51757(U))

Headnote

The court considered the fact that the defendant insurer timely and properly mailed its initial and follow-up verification demands to the plaintiff medical provider at the listed street address. The plaintiff's third-party biller, Spendan Service Corp., claimed that it did not receive the verification demands, but did not meaningfully challenge the procedures followed by the defendant in mailing the demands or deny its receipt of the demands. The main issues decided were whether the plaintiff's claim for assigned first-party no-fault benefits should be dismissed, and whether the verification demands were effectively mailed to the plaintiff's authorized representative. The holding was that summary judgment dismissal of the plaintiff's claim for assigned first-party no-fault benefits was warranted, as the plaintiff failed to make any showing that the verification demands were not received by the billing entity due to the absence of its suite number or otherwise. The court reversed the order, granted the defendant's motion for summary judgment, and dismissed the complaint.

Reported in New York Official Reports at Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51757(U))

Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co. (2012 NY Slip Op 51757(U)) [*1]

Darlington Med. Diagnostic, P.C. v Praetorian Ins. Co.

2012 NY Slip Op 51757(U) [36 Misc 3d 155(A)]

Decided on September 11, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 September 11, 2012

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT

PRESENT: Lowe, III, P.J., Shulman, Torres, JJ
570175/11.

Darlington Medical Diagnostic, P.C. a/a/o Christopher Rodriguez, Plaintiff-Respondent, – –
against
Praetorian Insurance Company, Defendant-Appellant.

Defendant appeals from an order of the Civil Court of the City of New York, Bronx County (Mitchell J. Danzinger, J.), entered January 4, 2011, which denied its motion for summary judgment dismissing the complaint.

Per Curiam.

Order (Mitchell J. Danzinger, J.), entered January 4, 2011, reversed, with $10 costs, motion granted and complaint dismissed. The Clerk is directed to enter judgment accordingly.

Summary judgment dismissal of plaintiff’s claim for assigned first-party no-fault benefits is warranted on the full record now before us, which shows that the defendant insurer timely and properly mailed its initial and follow-up verification demands to the plaintiff medical provider at the street address listed in its claim form. Indeed, plaintiff, in opposing summary judgment, did not meaningfully challenge the procedures followed by defendant in mailing the verification demands or deny its receipt of defendant’s demands; instead, plaintiff maintained that defendant’s verification demands were not received by its third-party biller, an entity known as Spendan Service Corp., which apparently conducts its business from a designated suite at the same street address from which plaintiff operates its medical facility. However, the conclusory denial of receipt of the verification demands advanced by plaintiff’s third-party biller was insufficient to raise a triable issue as to the efficacy of defendant’s mailings. Even assuming, arguendo, that the medical biller can properly be viewed, on this record, as plaintiff’s authorized representative for the purposes of receiving and responding to further verification requests (see 11 NYCRR 65-3.5[a],[c]; see and compare St. Vincent’s Hosp. v American Tr. Ins. Co., 299 AD2d 338, 339-340 [2002]), plaintiff failed to make any showing that the verification demands were not received by the billing entity due to the absence from the mailings of its (the biller’s) suite number or otherwise (see Pardo v Central Coop. Ins. Co., 223 AD2d 832, 833 [1996]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concurI concurI concur [*2]
Decision Date: September 11, 2012