July 2, 2007
Devonshire Surgical Facility v GEICO (2007 NY Slip Op 51308(U))
https://www.beynensonlaw.com/case-law/devonshire-surgical-facility-v-geico-2007-ny-slip-op-51308u/
- Court
- Appellate Term, First Department
- Decided
- July 2, 2007
- Citation
- 2007 NY Slip Op 51308(U) · 16 Misc 3d 130(A)
- Posture
- Summary judgment
- Outcome
- Split result
- Later treatment
- Followed in 4 later decisions (see Cited by)
- Legal questions
- Fraudulent incorporation (Mallela) · Claimant's prima facie case on motions (see the maps)
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.
Reported in New York Official Reports at Devonshire Surgical Facility v GEICO (2007 NY Slip Op 51308(U))
[*1]| Devonshire Surgical Facility v GEICO |
| 2007 NY Slip Op 51308(U) [16 Misc 3d 130(A)] |
| Decided on July 2, 2007 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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: McCOOE, J.P., SCHOENFELD, HEITLER, JJ
.
against
GEICO, Defendant-Appellant.
Defendant, as limited by the briefs, appeals from an order of the Civil Court of the City of New York, New York County (Anil C. Singh, J.), dated November 30, 2005, which (1) denied its cross motion for summary judgment dismissing the complaint, and (2) granted plaintiff Carnegie Hill Orthopedic Services summary judgment in the principal sum of $16,166.05, and plaintiff Devonshire Surgical Facility partial summary judgment in the principal sum of $3,000.
Per Curiam.
Order (Anil C. Singh, J.), dated November 30, 2005, modified to deny plaintiff Devonshire Surgical Facility’s motion for partial summary judgment, and as modified, affirmed without costs.
In this action to recover first-party no-fault benefits, defendant’s documentary submissions suffice to raise issues of fact as to whether plaintiff Devonshire Surgical Facility (Devonshire) was in compliance with the applicable state licensing requirements (see 11 NYCRR 65-3.16 (a)(12); State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]). Accordingly, Devonshire’s motion for partial summary judgment should have been denied.
Civil Court properly granted summary judgment in favor of plaintiff Carnegie Hill Orthopedic Services, P.C. (Carnegie). Defendant is precluded from asserting the defense of provider fraud based on fraudulent billing practices since it failed to timely deny Carnegie’s claims within the 30-day prescribed statutory period (see 11 NYCRR 65-3.8[c]; Valley Psychological, P.C. v Liberty Mut. Ins. Co., 30 AD3d 718 [2006]). Defendant’s challenge to the sufficiency of Carnegie’s prima facie case is unavailing inasmuch as defendant’s documentary submissions established its receipt of Carnegie’s claims.
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concurI concurI concur
Decision Date: July 2, 2007
Legal questions (2)
Questions of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.
On the merits, when may a no-fault insurer withhold payment because unlicensed persons own or control the provider (Mallela)?
This decision: Evidence of unlicensed ownership/control enough to proceed, but not resolved
Held the insurer's documentary submissions raised issues of fact whether the surgical facility complied with state licensing requirements under 65-3.16 (a) (12), so its partial summary judgment should have been denied.
Of the 16 decisions on this question in the First Department courts and the Court of Appeals, 3 (this one included) are in the same category.
On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?
This decision: Claimant's proof held to make out its prima facie case (rules on the question, but another ground decided the case)
Rejected the insurer's challenge to the orthopedic provider's prima facie case because the insurer's own documentary submissions established receipt of the claims.
Of the 47 decisions on this question in the First Department courts and the Court of Appeals, 41 (this one included) are in the same category. One decision in other departments that cites or is cited by this one is on the full map.
Cited in this decision
A label shows how this decision treated the case it cites.
- State Farm Mut. Auto. Ins. Co. v Mallela (2005 NY Slip Op 02416) FollowedFraudulently incorporated medical providers are ineligible for no-fault reimbursement under 11 NYCRR 65-3.16 (a) (12).
- Valley Psychological, P.C. v Liberty Mut. Ins. Co. (2006 NY Slip Op 04480) FollowedAn insurer's untimely denial precludes a fraud defense based on a psychologist's alleged failure to supervise treatment.
Cited by
A label shows how the later decision treated this one.
- P.L.P. Acupuncture, P.C. v Travelers Indem. Co. (2008 NY Slip Op 50484(U)) FollowedThe insurers' admission of receipt defeated their challenge to the provider's proof that its no-fault claims were mailed and received.
- Devonshire Surgical Facility v American Tr. Ins. Co. (2010 NY Slip Op 50867(U)) FollowedThe providers established overdue claims, and the insurer's late denials and discovery preclusion left no triable issue.
- Lenox Hill Radiology MIA, P.C. v American Tr. Ins. Co. (2008 NY Slip Op 28053) FollowedThe insurer failed to establish timely verification requests because its affidavits omitted when it received the provider's bill.
- Life Equip., Inc v Mid-Century Ins Co (2022 NY Slip Op 50877(U)) FollowedThe insurer's timely denials defeated the provider's request for judgment despite insufficient proof of the IME no-show defense.
Similar decisions
- Devonshire Surgical Facility v American Tr. Ins. Co. (2011 NY Slip Op 50513(U))The insurer's conclusory peer review report failed to raise a triable issue concerning medical necessity.
- Devonshire Surgical Facility v Nationwide Mut. Ins. Co. (2008 NY Slip Op 52015(U))The insurer's appeal was untimely because its notice of appeal was not filed within 30 days after service of the order with notice of entry.
- Devonshire Surgical Facility, LLC v Allstate Ins. Co. (2012 NY Slip Op 52351(U))The provider's cross motion failed because factual issues remained over billing rates applicable to its apparent surgical facility status.
- A.B. Med., PLLC v GEICO (2013 NY Slip Op 50203(U))The provider failed to establish that the insurer's denials were untimely or without merit as a matter of law.
- Orthotic Surgical & Med. Supply, Inc. v GEICO Ins. Co. (2008 NY Slip Op 50869(U))The provider's supporting affidavit failed to establish a business-record foundation for its summary judgment documents.